Meningitis

Condition Basics

What is meningitis?

Meningitis is inflammation of the lining around the brain and spinal cord. It's usually caused by an infection. The infection occurs most often in children, teens, and young adults. Also at risk are older adults and people who have long-term health problems, such as a weakened immune system.

There are two main kinds of meningitis. They are:

Viral meningitis.

This is fairly common. It usually doesn't cause serious illness. In severe cases, it can cause prolonged fever and seizures.

Bacterial meningitis.

This isn't as common, but it's very serious. It needs to be treated right away to prevent brain damage and death.

What causes it?

Viral meningitis is caused by viruses. Bacterial meningitis is caused by bacteria. Meningitis can also be caused by other organisms and some medicines, but this is rare. Most forms of meningitis are contagious. The germs that cause it can be passed from one person to another.

What are the symptoms?

The most common symptoms in teens and adults are:

• A stiff and painful neck, especially when you try to touch your chin to your chest.
• Fever.
• Headache.
• Vomiting.
• Trouble staying awake.
• Seizures.

Children, older adults, and people with other medical problems may have different symptoms:

• Babies may be cranky and refuse to eat. They may have a rash. They may cry when held.
• Young children may act like they have the flu. They may cough or have trouble breathing.
• Older adults and people with other medical problems may have only a slight headache and fever.

It is very important to see a doctor right away if you or your child has these symptoms. Only a doctor can tell whether they are caused by viral or bacterial meningitis. And bacterial meningitis can be deadly if it's not treated right away.

How is it diagnosed?

Your doctor will ask questions about your health and do an exam. A lumbar puncture, or spinal tap, is usually done to check for meningitis. A sample of fluid is removed from around the spine and tested. Your doctor may do other tests, such as blood tests, a CT scan, or an MRI.

How is meningitis treated?

With mild cases of viral meningitis, you may only need home treatment, like drinking extra fluids and taking medicine for pain and fever. Bacterial meningitis is treated with antibiotics in a hospital. You may also get steroid medicine. You'll be watched carefully to prevent serious problems such as hearing loss, seizures, or brain damage.

Can it be prevented?

The best way to protect your child from meningitis is to make sure that your child gets all the standard vaccines for children. These include shots for meningitis, measles, chickenpox, Haemophilus influenzae type B (Hib) disease, and pneumococcal infection. Talk to the doctor about whether your child needs the meningococcal vaccine.

How it Spreads

Germs that cause meningitis can be spread in many ways. This includes:

• During birth. A mother can pass germs that cause meningitis to her baby even if the mother doesn't have symptoms.
• Through stool. Stool could have enteroviruses or certain types of bacteria in it. Wash your hands often. This can help prevent infection in you and your children.
• Through coughing and sneezing. Infected people can pass certain bacteria that are normally found in saliva or mucus.
• Through kissing, sexual contact, or contact with infected blood. Viruses that cause meningitis can be passed from an infected person to another person.
• From eating certain foods. Eating food contaminated with Listeria monocytogenes bacteria can cause meningitis.
• From rodents and insects. But this is rare.

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What Increases Your Risk

Risk factors for meningitis include:

• Genetics. Some people may inherit the tendency to get meningitis.
• Crowded living conditions. People in camps, day care centers, schools, and college dormitories are more likely to get it.
• Having other infections. This includes upper respiratory infections, mumps, tuberculosis (TB), syphilis, Lyme disease, and illnesses caused by herpes viruses.
• Not getting childhood immunizations. People who didn't get shots for mumps, Hib disease, or pneumococcal infections before age 2 are more likely to get meningitis.
• Age. Older adults who haven't gotten a pneumococcal vaccine are more likely to get meningitis.
• Not having a working spleen. The spleen is part of the body's immune system.
• Travel to areas where the disease is common.

Certain medical problems can also increase your risk for meningitis.

Prevention

Childhood vaccinations are the best way to prevent meningitis. You also can take other steps to lower your risk of getting or spreading meningitis. Here are some things you can do.

• Get vaccinated.

  These shots prevent germs from causing some of the diseases that can lead to meningitis. They include shots for:

  • Measles, mumps, and rubella (MMR).
  • Chickenpox.
  • Hib disease.
  • Pneumococcal disease (PPSV23 or pneumococcal conjugate). Getting this shot usually protects people from the type of bacteria that is most likely to cause meningitis death.
  • Meningococcal disease (conjugate or MenB). These shots may be recommended for those with certain medical conditions or for people who travel to where the disease is common. They may be recommended for those who live in shared housing and are near an outbreak. Booster shots are sometimes needed.
• If you come in close contact with someone who has bacterial meningitis, call your doctor.

  Taking antibiotics may keep you from getting the illness. If your contact is only casual—for example, at school or at work—you may not need to take antibiotics.

• Stay away from people who have it.
• Keep people with meningitis separate from other people in the home.
• Wash your hands often if you have meningitis or are taking care of someone who does.

  Wash your hands after using the toilet or helping a sick child use the toilet, after changing a sick baby's diaper, and after handling used bedsheets, towels, clothes, or personal items of a sick person.

• Avoid contact with wild animals.

  And take steps to prevent bites from bugs, such as mosquitoes and ticks, that might carry disease-causing bacteria or viruses.

A link has been found between meningitis and cochlear implants for severe hearing loss. To help protect against meningitis, experts recommend that people with cochlear implants get a pneumococcal shot. Also, some people with implants have ear infections before they get meningitis, so it's important to treat ear infections right away with antibiotics.

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Symptoms

Symptoms of bacterial meningitis most often appear all of a sudden.

Symptoms of viral meningitis may appear all of a sudden or may develop slowly over a period of days.

The most common symptoms of either form of meningitis include:

• A fever.
• A severe headache that won't go away.
• A stiff and painful neck, especially when trying to touch the chin to the chest.
• Vomiting.
• Confusion and decreased level of consciousness.
• Seizures.

Less common symptoms include:

• Feeling sluggish.
• Having muscle aches and weakness.
• Having strange feelings (such as tingling) or weakness throughout the body.
• Eye sensitivity and eye pain from bright lights.
• Dark purple and blotchy skin rash.
• Dizzy spells.

It's very important to see a doctor right away if you or your child has these symptoms. Only a doctor can tell if they are caused by viral or bacterial meningitis. And the bacterial type can be deadly if it's not treated right away.

Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis.

• In babies, the signs of it may be a fever, crankiness that's hard to calm, decreased appetite, a rash, vomiting, and a shrill cry. Babies also may have a stiff body and bulging soft spots on the head that aren't caused by crying. Babies with meningitis may cry when handled.
• Young children with meningitis may act like they have the flu. Or they may cough or have trouble breathing.
• Older adults and people with other medical conditions may have only a slight headache and fever. They may not feel well and may have little energy.

What Happens

The course of meningitis often depends on your age, general health, and the organism causing the infection. The illness can range from mild to severe.

Viral meningitis is more common in the late summer and early fall. It usually doesn't cause serious illness. A visit to the doctor followed by home treatment may be all you need.

You may get better within 2 weeks. But some people may feel lightheaded and tired for several months after the illness.

Bacterial meningitis occurs most often from late winter to early spring. It usually causes serious illness and can cause death. The symptoms usually develop suddenly and last for 2 to 3 weeks. A person with bacterial meningitis is treated with antibiotics in a hospital.

When to Call a Doctor

Call 911 or other emergency services immediately if:

• You or your child has symptoms of severe meningitis, such as fever, seizures, and confusion.
• Your baby has signs of severe meningitis, such as trouble breathing or a fever with a bulging soft spot on the head not caused by crying.

Call your doctor now if:

• You or your child has symptoms of meningitis, such as severe and persistent headache, stiff neck, fever, rash, nausea, and vomiting.
• You or your child has viral meningitis and does not get better with home treatment after 3 days.
• You or your child is being treated for viral meningitis and has signs of complications, such as a fever that lasts longer than 3 full days and does not go down during home treatment.
• Your baby has a fever that comes and goes, diarrhea, vomiting, a swollen belly, and a shrill cry.

Call a doctor soon if you think you may have been exposed to meningitis. You can be treated with antibiotics. This may keep you from getting the illness.

Watchful waiting

Watchful waiting is a wait-and-see approach.

It's not a good choice if you think that you or your child has meningitis, because you can't tell what type of meningitis it may be. Call your doctor as soon as symptoms appear.

Exams and Tests

Your doctor will ask questions about your health, do an exam, and do one or more tests.

The doctor will almost always do a lumbar puncture. A long, thin needle is put into the spinal canal. The doctor uses the needle to collect samples of spinal fluid to check for bacteria and viruses.

Other tests that may be done include a:

• Complete blood count. This checks for signs of infection.
• Blood culture. This checks for infections.
• Urine test. It checks for infection in the urinary tract.
• Chest X-ray. It checks for lung infections.
• CT scan or MRI. These tests can look for swelling of brain tissue or for complications such as brain damage.

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Treatment Overview

With mild cases of viral meningitis, you may only need home treatment. This includes drinking extra fluids and taking medicine for pain and fever.

Bacterial or severe viral meningitis may require treatment in a hospital. This includes:

• Medicines such as antibiotics, steroid medicines, and medicines to reduce fever.
• Oxygen therapy. This is done if you have trouble breathing. If people are too sick to breathe on their own, they may need a machine called a ventilator.
• Treatments to remove mucus from the bronchial tubes.
• Supportive care. In the hospital, doctors watch you closely and provide care if needed.

Most healthy adults who have recovered from meningitis don't need follow-up care. But babies and children always need follow-up care after they get better. This is to check for long-term problems caused by the illness.

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Self-Care

Home treatment usually is all that is needed for most people who have viral meningitis.

• Get plenty of rest.

  Rest promotes healing and provides relief from symptoms such as a headache. Quiet activities, such as reading books, playing board games, watching videos, or listening to music, help pass the time.

• Take steps to lower your fever.

  Cool washcloths to the forehead, cool baths, and medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) can be used to reduce fever, if needed. Be safe with medicines. Read and follow all instructions on the label.

• Use medicine to relieve headaches and muscle aches.

  Minor pain usually can be relieved with medicines such as acetaminophen (Tylenol) or ibuprofen (Advil).

• Prevent dehydration.

  Drink plenty of fluids. Choose water and other clear liquids.

• Watch for signs of complications.

  While you are sick, the most common complications include fever lasting for longer than expected and seizures. After you recover, watch for signs of long-term complications, such as hearing loss.

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