Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis is also referred to as spinal meningitis.

Meningitis may develop in response to a number of causes, usually bacteria or viruses, but meningitis can also be caused by physical injury, cancer or certain drugs.

The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis. For example, bacterial meningitis is usually more severe than viral, fungal, or parasitic meningitis. Although it can be very serious, bacterial meningitis can be treated with antibiotics that can prevent severe illness and reduce the spread of infection from person to person.

See also Meningitis Questions and Answers

Risk Factors of Meningitis The most effective way to protect you and your child against certain types of meningitis is to complete the childhood vaccine schedule. The risk of meningitis increases by not following the recommended vaccine schedule. Other factors that can increase your risk of meningitis include: Age. Viral meningitis occurs mostly in children younger than age 5. Before the availability of effective vaccines, bacterial meningitis was most commonly diagnosed in young children. Now, as a result of the protection offered by current childhood vaccines, bacterial meningitis is more commonly diagnosed among pre-teens and young adults. Community setting. Infectious diseases tend to spread quickly wherever larger groups of people gather together. As a result, college students living in dormitories, military personnel and children in childcare facilities are at an increased risk. Pregnancy. Pregnant women are at an increased risk of catching listeriosis. The bacteria that cause listeriosis, listeria bacteria, can also cause meningitis. The unborn baby of a pregnant woman with listeriosis is also at risk. Working with animals. Dairy farmers, ranchers, and other people who work with domestic animals are at an increased risk of contracting listeriosis. The bacteria that cause listeriosis, listeria bacteria, can also cause meningitis. Weakened immune system. There are certain diseases, medications and surgical procedures that may weaken the immune system and increase risk of meningitis.

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Causes

Meningitis is mostly caused by microorganisms like bacteria, viruses, parasites, and fungi. These microorganisms infect blood and the cerebrospinal fluid (CSF). Meningitis can also develop from non-infectious causes, including certain diseases like AIDS, cancer, diabetes, physical injury, or certain drugs that weaken the body’s immune system.

Bacterial Meningitis

Bacterial meningitis is usually more severe than viral meningitis. Bacterial meningitis can have serious after-effects, such as brain damage, hearing loss, limb amputation, or learning disabilities.

One of the leading causes of bacterial meningitis in children and young adults in the United States is the bacterium Neisseria meningitidis. Meningitis caused by this bacterium is known as meningococcal disease. Causes of bacterial meningitis also vary by age group:

Age Group	Causes
Newborn	Group B Streptococci, Escherichia coli, Listeria monocytogenes
Infants	Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
Children	N. meningitidis, S. pneumoniae
Adult	S. pneumoniae, N. meningitidis, Mycobacteria

Viral Meningitis

Viral

meningitis is generally less severe and resolves without specific treatment. Most viral meningitis cases in the United States, especially during the summer months, are caused by enteroviruses; however, only a small number of people with enterovirus infections actually develop meningitis.

Other viral infections that can lead to meningitis include

• Mumps
• Herpesvirus, including Epstein-Barr virus, herpes simplex viruses, varicella-zoster virus (which also causes chicken pox and shingles), measles, and influenza
• Viruses spread through mosquitoes and other insects (arboviruses)
• In rare cases LCMV (lymphocytic choriomeningitis virus), which is spread by rodents, can cause viral meningitis

Fungal Meningitis

Fungal meningitis is rare, but can be life threatening. Although anyone can get fungal meningitis, people at higher risk include those who have AIDS, leukemia, or other forms of immunodeficiency (an immune system that does not respond adequately to infections) and immunosuppression (immune system malfunction as a result of medical treatment).

The most common cause of fungal meningitis for people with immune system deficiencies, like HIV, is Cryptococcus. This disease is one of the most common causes of meningitis in Africa.

The fungus that causes thrush, Candida, can lead to meningitis in rare cases, especially in pre-mature babies with very low birth weight.

Meningitis due to Histoplasma can happen in anybody, but people with immunodeficiencies are at a higher risk. Histoplasma is found primarily in soil or bird/bat droppings in the Midwestern United States, although it can be seen in other places.

Soil in Southwestern United States and northern Mexico contain the fungus Coccidioides which can cause fungal meningitis. Although anyone can get infected with coccidioidal meningitis, people at higher risk include African Americans, Filipinos, pregnant women in the third trimester, and immunocompromised persons.

Non-infectious Meningitis

Non–infectious meningitis causes include

• Cancers
• Systemic lupus erythematosus (lupus)
• Certain drugs
• Head injury
• Brain surgery

Signs & Symptoms

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Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as

• Nausea
• Vomiting
• Photophobia (sensitivity to light)
• Altered mental status

Bacterial Meningitis

The symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure.

Infants younger than one month old are at a higher risk for severe infection. In newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear to be slow or inactive, irritable, vomiting or feeding poorly. In young children, doctors may also look at the child’s reflexes, which can also be a sign of meningitis.

Although the early symptoms of viral meningitis and bacterial meningitis may be similar, later symptoms of bacterial meningitis can be very severe (e.g., seizures, coma). For this reason, if you think you or someone else may have meningitis, see a physician as soon as possible.

Meningococcemia

This is the more dangerous and deadly of illnesses caused by Neisseria meningitidis. When Neisseria meningitidis bacteria enter the bloodstream and multiply, they damage the walls of the blood vessels and cause bleeding into the skin and organs.

Symptoms may include:

• fever
• fatigue
• vomiting
• cold hands and feet
• cold chills
• severe aches or pain in the muscles, joints, chest or abdomen
• rapid breathing
• diarrhea
• and, in the later stages, a puerperal rash or a petechial rash

Meningococcemia is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours. In non-fatal cases, permanent disabilities can include amputations or severe scarring as a result of skin grafts.

Viral Meningitis

Viral meningitis is an infection of the meninges (the covering of the brain and spinal cord) that is caused by a virus. Enteroviruses, the most common cause of viral meningitis, appear most often during the summer and fall in temperate climates.

Viral meningitis can affect babies, children, and adults. It is usually less severe than bacterial meningitis and normally clears up without specific treatment. The symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a healthcare provider right away if you think you or your child might have meningitis.

Symptoms of viral meningitis in adults may differ from those in children:

Common symptoms in infants

• Fever
• Irritability
• Poor eating
• Hard to awaken

Common symptoms in adults

• High fever
• Severe headache
• Stiff neck
• Sensitivity to bright light
• Sleepiness or trouble waking up
• Nausea, vomiting
• Lack of appetite

The symptoms of viral meningitis usually last from 7 to 10 days, and people with normal immune systems usually recover completely.

Fungal Meningitis

Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience:

• Dislike of bright lights
• Changes in mental status, confusion
• Hallucinations
• Personality changes

Diagnosis

Early diagnosis and treatment are very important. Classic signs of meningitis include sudden onset of fever, headache and stiff neck. These signs are often accompanied by other symptoms, such as nausea, vomiting, sensitivity to light (photophobia), and altered mental status. Older children and adults may experience a skin rash. In young children, the signs may be more subtle and my include inactivity, irritability, vomiting, or poor feeding.

If meningitis is suspected, samples of blood or cerebrospinal fluid are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause. In the case of bacterial meningitis, for example, antibiotics can help prevent severe illness and reduce the spread of infection from person to person.

Bacterial Meningitis

If bacteria are present, they can be grown (cultured). Growing the bacteria in the laboratory is important for confirming the presence of bacteria and for identifying the specific type of bacteria that is causing the infection.

Viral Meningitis

The specific causes of meningitis may be determined by tests used to identify the virus in samples collected from the patient.

Fungal Meningitis

To confirm fungal meningitis, specific lab tests can be performed, depending on the type of fungus suspected.

Treatment

Bacterial Meningitis

Bacterial meningitis can be treated with a number of effective antibiotics. It is important that treatment be started early in the course of the disease. If bacterial meningitis is suspected, initial treatment with ceftriaxone and vancomycin is recommended. Appropriate antibiotic treatment of the most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.

Viral Meningitis

There is no specific treatment for viral meningitis. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Most patients completely recover on their own within 7 to 10 days. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

Fungal Meningitis

Fungal meningitis is treated with long courses of high dose antifungal medications. This is usually given using an IV line and is done in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, there is often a need for longer treatment.

Prevention

Bacterial Meningitis

Keeping up to date with recommended immunizations is the best defense. Maintaining healthy habits, like getting plenty of rest and not coming into close contact with people who are sick, can also help. If you are pregnant, you can reduce your risk of meningitis caused by Listeria bacteria (listeriosis) by cooking meats thoroughly and avoiding cheeses made from unpasteurized milk.

There are vaccines for three bacteria that can cause meningitis: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b (Hib):

Meningococcal vaccines

There are two kinds of vaccines against Neisseria meningitidis available in the US. Meningococcal polysaccharide vaccine (Menomune®) has been approved by the Food and Drug Administration (FDA) and available since 1981. Meningococcal conjugate vaccines, Menactra® and Menveo®, were licensed in 2005 and 2010, respectively. Each vaccine can prevent 2 of the 3 most commonly occurring strains in the US. Meningococcal vaccines cannot prevent all types of the disease, but they do protect many people who might become sick if they didn't get the vaccine. Meningococcal conjugate vaccine is routinely recommended for all 11 through 18 year olds and for certain high-risk children and adults. For information on meningococcal vaccines, visit the vaccine site.

Pneumococcal vaccines

There are two types of pneumococcal vaccine currently available: a polysaccharide vaccine and a conjugate vaccine. The pneumococcal conjugate vaccine, PCV7 (Prevnar®), which was licensed in late 2000, was the first pneumococcal vaccine for use in children under the age of 2 years. PCV13 (Prevnar 13®), which was licensed in early 2010, replaces PCV7. Pneumococcal vaccines for the prevention of disease among children who are 2 years and older and adults have been in use since 1977. Pneumovax® is a 23-valent polysaccharide vaccine (PPSV) that is currently recommended for use in adults who are 65 years of age and older, for persons who are 2 years and older and at high risk for pneumococcal disease (including those with sickle cell disease, HIV infection, or other immunocompromising condition), and for persons 19-64 years of age who smoke or have asthma. For information on pneumococcal vaccines, visit the vaccine site.

Hib vaccines

The Haemophilus influenzae type b (Hib) vaccine is highly effective against bacterial meningitis caused by a type of bacteria called Haemophilus influenzae type b. The Hib vaccine can prevent pneumonia (lung infection), epiglottitis (a severe throat infection), and other serious infections caused by Hib bacteria. It is recommended for all children under 5 years old in the US, and it is usually given to infants starting at age 2 months. Hib vaccine can be combined with other vaccines. For information on Hib vaccine, visit the vaccine site.

Viral Meningitis

People with certain viral infections can sometimes develop meningitis. There are no vaccines for the most common causes of viral meningitis. Thus, the best way to prevent it is to prevent viral infections. However, that can be difficult since sometimes people can be infected with a virus and spread the virus even though they do not appear sick. Following are some steps you can take to help lower your chances of becoming infected with viruses or of passing one on to someone else:

• Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose.
• Clean contaminated surfaces, such as doorknobs or the TV remote control, with soap and water and then disinfect them with a dilute solution of chlorine-containing bleach.
• Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
• Make sure you and your child are vaccinated. Vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (MMR vaccine) and chickenpox (varicella-zoster vaccine).
• Avoid bites from mosquitoes and other insects that carry diseases that can infect humans.
• Control mice and rats. If you have a rodent infestation in and/or around your home, follow the cleaning and control precautions listed on CDC’s website about LCMV (Lymphocytic choriomeningitis virus).

Fungal Meningitis

There is little evidence that specific activities can lead to developing fungal meningitis, although avoiding exposure to environments likely to contain fungal elements is prudent. People who are immunosuppressed (for example, those with HIV infection) should try to avoid bird droppings and avoid digging and dusty activities, particularly if they live in a geographic region where fungi like Histoplasma, Coccidioides, or Blastomyces species exist. HIV-infected people cannot completely avoid exposure. Some guidelines recommend that HIV-infected people receive antifungal prophylaxis if they live in a geographic area where the incidence of fungal infections is very high.

Meningococcal Vaccination

Meningococcal vaccines protect against most types of meningococcal disease, but they do not prevent all cases. There are two kinds of vaccines against Neisseria meningitidis available in the United States: meningococcal polysaccharide vaccine (Menomune®) and meningococcal conjugate vaccine (Menactra® and Menveo®).

For more information on meningococcal vaccines, visit the Meningococcal Vaccine site or Recommendations of the Advisory Committee on Immunization Practices.

For Those Getting Vaccinated, Who does CDC recommend get the vaccine?

• Children: Meningococcal conjugate vaccine is recommended for certain high-risk children from ages 2 through 10.
• Pre-teens/Adolescents: Meningococcal conjugate vaccine is routinely recommended for all 11 through 18 year olds. If your child did not get this vaccine at the 11- or 12-year-old check-up, make an appointment for him or her to get it now.
• Adults: Either meningococcal polysaccharide vaccine or meningococcal conjugate vaccine is recommended for adults if you
  • Are a college freshman living in a dormitory
  • Are a military recruit
  • Have a damaged spleen or your spleen has been removed
  • Have terminal complement deficiency
  • Are a microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen)
  • Are traveling to or residing in countries in which the disease is common

Who does CDC recommend get a booster dose of the vaccine?

* Children previously vaccinated with meningococcal conjugate vaccine or meningococcal polysaccharide vaccine at 2 through 6 years of age who remain at an increased risk for meningococcal disease should receive an additional dose of meningococcal conjugate vaccine three years after their previous meningococcal vaccine and every five years thereafter, if at continued risk. * Persons who were previously vaccinated with meningococcal conjugate vaccine or meningococcal polysaccharide vaccine at 7 through 55 years of age and who are at increased risk for meningococcal disease should receive an additional dose of meningococcal conjugate vaccine five years after their previous dose and every five years thereafter, if at continued risk.

Who should not get vaccinated?

People Most at Risk

Managing Meningococcal Disease - Meningitis & Septicemia (PAL)

Bacterial meningitis caused by Neisseria meningitidis bacteria (meningococcal disease) can be fatal and should always be viewed as a medical emergency. About 10% of infected people die from the disease. In non-fatal cases, those affected experience long-term disabilities, such as brain damage, loss of limb, or deafness. Preventing the disease through the use of meningococcal vaccine is important.

Although anyone can get meningitis, pre-teens and adolescents, college freshmen who live in dormitories and travelers to countries where meningitis is always present are at an increased risk for meningococcal disease. Before the availability of effective vaccines, bacterial meningitis was most commonly diagnosed in young children. Now, as a result of the protection offered by current childhood vaccines, bacterial meningitis is more commonly diagnosed among pre-teens and young adults.

• Pre–teens and Adolescents
• College Freshmen
• Travelers

Like bacterial meningitis, viral meningitis can affect anyone. But infants younger than 1 month old and people whose immune systems are weak are at higher risk for severe infection. People who are around someone with viral meningitis have a chance of becoming infected with the virus that made that person sick, but they are not likely to develop meningitis as a complication of the illness.