Meningitis

Definition
Meningitis is an inflammation of the membranes (meninges) and cerebrospinal fluid
surrounding your brain and spinal cord, usually due to the spread of an infection. The
swelling associated with meningitis often triggers the "hallmark" symptoms of this
condition, including headache, fever and a stiff neck.

Most cases of meningitis are caused by a viral infection, but bacterial and fungal
infections also can lead to meningitis. Depending on the cause of the infection,
meningitis can resolve on its own in a couple of weeks — or it can be a life-
threatening emergency.

If you suspect that you or someone in your family has signs or symptoms of
meningitis, seek medical care right away. Early treatment can prevent serious
complications.

Symptoms
It's easy to mistake the early signs and symptoms of meningitis for the flu (influenza).
Meningitis symptoms may develop over a period of one or two days and typically
include:

 A high fever
 Severe headache
 Vomiting or nausea with headache
 Confusion, or difficulty concentrating — in the very young, this may appear as
inability to maintain eye contact
 Seizures
 Sleepiness or difficulty waking up
 Stiff neck
 Sensitivity to light
 Lack of interest in drinking and eating
 Skin rash in some cases, such as in viral or meningococcal meningitis

Earlier signs and symptoms that may suggest a serious infection, although not
necessarily meningitis, include:

 Leg pain
 Ice-cold hands and feet
 Abnormally pale skin tone

Signs in newborns
Newborns and young infants may not have the classic signs and symptoms of
headache and stiff neck. Instead, signs and symptoms of meningitis in this age group
may include:
  Constant crying
 Excessive sleepiness or irritability
 Poor feeding
 A bulge in the soft spot on top of a baby's head (fontanel)
 Stiffness in the baby's body and neck

Infants with meningitis may be difficult to comfort, and may even cry harder when
picked up.

If you or your child has bacterial meningitis, delaying treatment increases the risk of
permanent brain damage. In addition, bacterial meningitis can prove fatal in a matter
of days. Seek medical care right away if you or anyone in your family has any signs
or symptoms.

When to see a doctor

If you or someone in your family has signs or symptoms of meningitis — such as
fever, severe headache, confusion, vomiting and stiff neck — seek medical care right
away. There's no way to know what kind of meningitis you or your child has without
seeing your doctor and undergoing testing.

Viral meningitis may improve without treatment in a few days, but bacterial
meningitis is serious and can come on very quickly. If you or your child has bacterial
meningitis, the sooner the treatment begins, the better the chances of a recovery
without serious complications.

Also talk to your doctor if a family member or someone you work with has
meningitis. You may need to take medications to prevent getting sick.

Causes
Meningitis usually results from a viral infection, but the cause may also be a bacterial
infection. Less commonly, a fungal infection may cause meningitis. Because bacterial
infections are the most damaging, identifying the source of the infection is an
important part of developing a treatment plan.

Bacterial meningitis
Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and
migrate to the brain and spinal cord. But it can also occur when bacteria directly
invade the meninges, as a result of an ear or sinus infection or a skull fracture.

A number of strains of bacteria can cause acute bacterial meningitis. The most
common include:

 Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of

bacterial meningitis in infants and young children in the United States. It can also cause
pneumonia and ear and sinus infections. When pneumococcal meningitis is associated with
an ear infection, it's not always clear which came first — the meningitis or the ear infection
— because they usually occur together.
 Neisseria meningitidis (meningococcus). This bacterium is another leading cause of
bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an
upper respiratory infection enter your bloodstream. This infection is highly contagious and
may cause local epidemics in college dormitories and boarding schools and on military
bases.
 Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b
(Hib) bacterium was the leading cause of bacterial meningitis. But new Hib vaccines —
available as part of the routine childhood immunization schedule in the United States —
 have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends
to follow an upper respiratory infection, ear infection (otitis media) or sinusitis.
 Listeria monocytogenes (listeria). These bacteria can be found almost anywhere — in soil,
in dust and in foods that have become contaminated. Contaminated foods have included
soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also carry the
bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although
pregnant women, newborns and older adults tend to be more susceptible. Listeria can cross
the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or
die shortly after birth.

Viral meningitis
Viruses cause a greater number of cases of meningitis each year than do bacteria.
Viral meningitis is usually mild and often clears on its own within two weeks. A
group of common viruses known as enteroviruses are responsible for about 90 percent
of viral meningitis in the United States.

The most common signs and symptoms of enteroviral infections are rash, sore throat,
joint aches and headache. Many older children and adults with enteroviral meningitis
describe the "worst headache I've ever had." These viruses tend to circulate in late
summer and early fall. Viruses associated with mumps, herpes infection, West Nile
virus or other diseases also can cause viral meningitis.

Chronic meningitis
Ongoing (chronic) forms of meningitis occur when slow-growing organisms invade
the membranes and fluid surrounding your brain. Although acute meningitis strikes
suddenly, chronic meningitis develops over four weeks or more. Nevertheless, the
signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental
cloudiness — are similar to those of acute meningitis. This type of meningitis is rare.

Fungal meningitis
Fungal meningitis is relatively uncommon. Cryptococcal meningitis is a fungal form
of the disease that affects people with immune deficiencies, such as AIDS. It's life-
threatening if not treated with an antifungal medication.

Other meningitis causes

Meningitis can also result from noninfectious causes, such as drug allergies, some
types of cancer and inflammatory diseases such as lupus.

Risk factors
Not completing the childhood vaccine schedule increases your risk of meningitis. So
do a few other risk factors:

 Age. Most cases of viral meningitis occur in children younger than age 5. In
the past, bacterial meningitis also usually affected young children. But since
the mid-1980s, as a result of the protection offered by current childhood
vaccines, the median age at which bacterial meningitis is diagnosed has shifted
from 15 months to 25 years.
 Living in a community setting. College students living in dormitories,
personnel on military bases, and children in boarding schools and child care
facilities are at increased risk of meningococcal meningitis, probably because
 infectious diseases tend to spread quickly wherever large groups of people
congregate.
 Pregnancy. If you're pregnant, you're at increased of contracting listeriosis —
an infection caused by listeria bacteria, which may also cause meningitis. If
you have listeriosis, your unborn baby is at risk, too.
 Working with animals. People who work with domestic animals, including
dairy farmers and ranchers, have a higher risk of contracting listeria, which
can lead to meningitis.
 Compromised immune system. Factors that may compromise your immune
system — including AIDS, diabetes and use of immunosuppressant drugs —
also make you more susceptible to meningitis. Removal of your spleen, an
important part of your immune system, also may increase your risk.

Complications
The complications of meningitis can be severe. The longer you or your child has the
disease without treatment, the greater the risk of seizures and of permanent
neurological damage, including hearing loss, blindness, loss of speech, learning
disabilities, behavior problems and brain damage, even paralysis.

Non-neurological complications may include kidney failure and adrenal gland failure.
Your adrenal glands produce a number of important hormones including cortisol,
which helps your body deal with stress.

Bacterial infections of your central nervous system progress quickly. Within a matter
of days, the disease can lead to shock and death.

Preparing for your appointment

In some cases when you call to set up an appointment with your doctor, you may be
told to go to the emergency room or call 911.

Depending on the cause, meningitis can be life-threatening. If you know you've been
exposed to someone with meningitis and you have now developed symptoms, don't
wait to seek medical care. Go to an emergency room and let medical staff know
immediately that you may have meningitis.

If your doctor determines that he or she should see you first, it's critical to be well
prepared for your appointment. Here's some information to help you get ready, and
what to expect from your doctor.

What you can do

 Be aware of any pre- or post-appointment restrictions. At the time you

make the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet. Also ask if you may need to stay at your
doctor's office for observation following your tests.
 Write down any symptoms you're experiencing, including changes in your
mood, thinking or behavior. Make a note of when you first noticed each
 symptom on your list. Your doctor will want to know if you had cold or flu-
like symptoms leading up to the symptoms you're experiencing now.
 Write down key personal information, including any recent moves,
vacations or interactions with animals. If you're a college student, your doctor
likely will ask questions about any similar signs or symptoms in your
roommates and dorm-mates. Your doctor will also want to know your
vaccination history.
 Make a list of all medications, as well as any vitamins or supplements, that
you're taking.
 Take a family member or friend along. Meningitis can be a medical
emergency. Take someone who can soak up all the information your doctor
provides and who can stay with you if you need immediate treatment.
 Write down questions to ask your doctor.

Prepare a list of questions so that you can make the most of your time with your
doctor. For meningitis, some basic questions to ask your doctor include:

 What is likely causing my symptoms or condition?

 Other than the most likely cause, what are possible causes for my symptoms or
condition?
 What kinds of tests do I need?
 What treatment do you recommend?
 Am I at risk of long-term complications?
 If my condition is not treatable with antibiotics, what steps can I take to help
my body recover?
 Am I contagious? Do I need to be isolated?
 What is the risk to my family? Should they take preventive medication?
 Should I see a specialist? What will that cost, and will my insurance cover
seeing a specialist?
 Do I need to take prescription medicine? If so, is there a generic alternative?
 Are there any brochures or other printed material that I can take home with
me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to
ask questions during your appointment at any time that you don't understand
something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them
may reserve time to go over any points you want to spend more time on. Your doctor
may ask:

 When did you first begin experiencing symptoms?

 How severe are your symptoms? Do they seem to be getting worse?
 Does anything seem to improve your symptoms, or to make you even more
uncomfortable?
 Do you know if you've been exposed to anyone with meningitis?
 Is anyone else who you live with having similar symptoms?
 What is your vaccination history?
 Have you been taking any immune-suppressant medications?
  Do you have any pre-existing health problems, including allergies to any
medications?

What you can do in the meantime

When you call your doctor's office for an appointment, describe the type and severity
of your symptoms clearly. If your doctor determines that you don't need to come in
immediately, rest as much as possible while you're waiting for your appointment.
Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever
and body aches. Avoid nonsteroidal anti-inflammatory medications, including aspirin,
which may not be safe in people with untreated meningitis. Also avoid any
medications that may reduce your alertness.

Don't go to work or school. Work with your doctor to get a diagnosis and find out if
treatment is needed as soon as possible.

Tests and diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical
history, a physical exam and certain diagnostic tests. During the exam, your doctor
may check for signs of infection around the head, ears, throat and the skin along the
spine. You or your child may undergo the following diagnostic tests:

 Throat culture. A throat culture can find and identify the bacteria causing
throat pain, neck pain and headache, but can't determine what pathogens may
be in your spinal fluid.
 Imaging. X-rays and computerized tomography (CT) scans of the chest, skull
or sinuses may reveal swelling or inflammation. These tests can also help your
doctor look for infection in other areas of the body that may be associated with
meningitis.
 Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often
made by analyzing a sample of your cerebrospinal fluid (CSF), which is
collected during a procedure known as a spinal tap. In people with meningitis,
the CSF fluid often shows a low sugar (glucose) level along with an increased
white blood cell count and increased protein. CSF analysis may also help your
doctor identify the exact bacterium that's causing the illness. Traditionally, it
can take up to a week to get these test results. In March 2007, the Food and
Drug Administration approved the Xpert EV test, a test that takes only two
and one-half hours. This test identifies any genetic material in the CSF from a
class of viruses responsible for approximately 90 percent of viral meningitis
cases. A positive test tells your doctor you likely have viral meningitis, and a
negative test strongly suggests no viral meningitis, making the less common
bacterial form of meningitis more likely. This can help those with viral
meningitis avoid unnecessary treatment with antibiotics.
 Polymerase chain reaction analysis. If your doctor suspects meningitis, he or
she may order a DNA-based test known as a polymerase chain reaction (PCR)
amplification to check for the presence of certain causes of meningitis.

If you have chronic meningitis caused by cancer or an inflammatory illness, you may
need additional tests.
Treatments and drugs
Bacterial meningitis
Acute bacterial meningitis requires prompt treatment with intravenous antibiotics to
ensure recovery and reduce the risk of complications. The antibiotic or combination
of antibiotics that your doctor may choose depends on the type of bacteria causing the
infection. Often, analyzing a sample of cerebrospinal fluid can help identify the
bacteria. If you or your child has bacterial meningitis, your doctor may recommend a
broad-spectrum antibiotic until he or she can determine the exact cause of the
meningitis.

If you or your child has bacterial meningitis, your doctor may recommend treatments
for brain swelling, shock, convulsions or dehydration. Infected sinuses or mastoids —
the bones behind the outer ear that connect to the middle ear — may need to be
drained. Any fluid that has accumulated between the brain and the membranes that
surround it may also need to be drained or surgically removed.

Viral meningitis
Antibiotics can't cure viral meningitis, and most cases improve on their own in a week
or two without therapy. Treatment of mild cases of viral meningitis is usually with
bed rest, plenty of fluids and over-the-counter pain medications to help reduce fever
and relieve body aches. If the cause of your meningitis is the herpes virus, your doctor
may also recommend an antiviral medication aimed at this virus.

Prevention
Meningitis typically results from contagious infections. Common bacteria or viruses
that can cause meningitis can spread through coughing, sneezing, kissing or sharing
eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or
work with someone who has the disease.

These steps can help prevent meningitis:

 Wash your hands. Careful hand washing is important to avoiding exposure to

infectious agents. Teach your children to wash their hands often, especially
before they eat and after using the toilet, spending time in a crowded public
place or petting animals. Show them how to wash their hands vigorously,
covering both the front and back of each hand with soap and rinsing
thoroughly under running water.
 Stay healthy. Maintain your immune system by getting enough rest,
exercising regularly, and eating a healthy diet with plenty of fresh fruits,
vegetables and whole grains.
 Cover your mouth. When you need to cough or sneeze, be sure to cover your
mouth and nose.
 If you're pregnant, take care with food. Reduce your risk of listeriosis if
you're pregnant by cooking meat thoroughly and avoiding cheeses made from
unpasteurized milk.
Immunizations
Some forms of bacterial meningitis are preventable with the following vaccinations:

 Haemophilus influenzae type b (Hib) vaccine. Children in the United States

routinely receive this vaccine as part of the recommended schedule of
vaccines, starting at about 2 months of age. The vaccine is also recommended
for some adults, including those who have sickle cell disease or AIDS and
those who don't have a spleen.
 Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the
regular immunization schedule for children younger than 2 years in the United
States. In addition, it's recommended for children between the ages of 2 and 5
who are at high risk of pneumococcal disease, including children who have
chronic heart or lung disease or cancer.
 Pneumococcal polysaccharide vaccine (PPV). Older children and adults
who need protection from pneumococcal bacteria may receive this vaccine.
The Centers for Disease Control and Prevention recommends the PPV vaccine
for all adults older than 65 and younger adults and children who have weak
immune systems, chronic illnesses such as heart disease, diabetes or sickle cell
anemia, and those who don't have a spleen.
 Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control
and Prevention recommends that a single dose of MCV4 be given to children
ages 11 to 12 or to any children ages 11 to 18 who haven't yet been
vaccinated. However, this vaccine can be given to younger children who are at
high risk of bacterial meningitis or who have been exposed to someone with
the disease. It's approved for use in children as young as 2 years old.