Meningitis: Symptoms, Transmission & Treatment

Meningitis is a serious inflammation of the meninges, which are the membranes that cover the brain and the entire spinal cord. It can be caused by viruses, bacteria, parasites, or fungi.

Because the meninges become inflamed, neck stiffness is common and it may be hard to bend the neck forward and touch the chin to the chest. Fever, nausea, and a severe headache are also common.

It is important to identify meningitis as soon as the first symptoms appear. Early treatment can help prevent complications that may lead to permanent damage or even death.

Main types

The main types of meningitis are:

1. Viral meningitis

Viral meningitis is a type of meningitis caused by viruses and is usually more common in the summer and in people over 15 years old.

The main viruses associated with viral meningitis are enteroviruses, such as Coxsackievirus and poliovirus, Epstein-Barr virus, and herpes virus. Infection caused by herpes virus is called herpetic meningitis.

In cases of herpetic meningitis, the virus can also cause inflammation in several areas of the brain, which is a condition called meningoencephalitis.

2. Bacterial meningitis

Bacterial meningitis is more serious than viral meningitis and refers to inflammation of the meninges caused by bacteria such as Neisseria meningitidis, Streptococcus pneumoniae, Mycobacterium tuberculosis, and Haemophilus influenzae.

Meningitis caused by the bacteria Neisseria meningitidis is called meningococcal meningitis and, although rare, happens more often in children and older adults, especially when there are conditions that weaken the immune system.

3. Fungal meningitis

Fungal meningitis is more common in people with weakened immune systems due to age or chronic illness, and it is often associated with fungi such as Cryptococcus and Coccidioides species.

In some cases, it may also result from infection with Candida or Aspergillus.

4. Eosinophilic meningitis

Eosinophilic meningitis is a rare type of meningitis caused by infection with the parasite Angiostrongylus cantonensis, which infects slugs and snails.

People become infected by eating contaminated animals or foods contaminated with secretions from these animals, which can lead to symptoms such as severe headache, nausea, vomiting, and neck stiffness.

5. Aseptic meningitis

Although inflammation of the meninges is most often caused by infections, it can also have non-infectious causes. In these cases, it is called aseptic meningitis.

The main situations that increase the risk of aseptic meningitis include severe blows to the head, certain drugs, and some chronic diseases, such as lupus or cancer.

Main symptoms

In general, the main symptoms that may suggest meningitis are:

• Fever above 100.4°F (38°C)

• Very severe headache

• Neck stiffness, with difficulty touching the chin to the chest

• Red spots on the body

• Sensitivity to light

• Excessive sleepiness with difficulty waking up

• Confusion

• Seizures

According to the CDC, meningococcal meningitis commonly presents with the sudden onset of fever, headache, and stiff neck, and may also include nausea, vomiting, photophobia, or altered mental status.

In babies and children, other symptoms may also appear that can make parents suspect meningitis, such as high-pitched crying, irritability, difficulty moving the head, and even a firmer soft spot that looks slightly swollen.

Online symptom test

To determine your risk for meningitis, enter your symptoms below:

Please note that this is a guidance tool and does not replace a consultation with a doctor. You are encouraged to speak to your doctor about your symptoms.

Confirming a diagnosis

Meningitis is diagnosed by a neurologist, infectious disease specialist, or primary care provider by evaluating the signs and symptoms a person has. A physical exam may also be done, including moving the neck to check whether the person feels pain or discomfort.

In addition, urine tests, blood tests, and imaging tests such as a CT scan or MRI may be ordered when there is suspicion of brain injury or complications caused by meningitis.

The gold standard for diagnosing meningitis is a cerebrospinal fluid culture, also called a CSF culture. This test involves collecting a sample of cerebrospinal fluid through a lumbar puncture (spinal tap), which is then sent to the lab for evaluation.

Once the disease is confirmed, the person usually needs to stay in the hospital for a few days so treatment can begin. This may include antibiotics for bacterial meningitis or medications to reduce fever and relieve discomfort in cases of viral meningitis.

Transmission and spread

The way meningitis spreads can vary significantly depending on the microorganism causing the inflammation.

In viral meningitis, the risk of transmission is very low. Although the virus can pass to another person, it usually does not cause meningitis, but rather another illness, such as mumps or measles, depending on the type of virus.

In meningitis caused by bacteria, transmission is easier and can happen through sharing the same eating utensils or through saliva droplets spread by coughing, sneezing, kissing, or talking.

In addition, if an infected person uses the bathroom and does not wash their hands properly, they may also spread the bacteria.

Even though the microorganism that causes meningitis may spread easily, not everyone who becomes infected develops meningitis or another illness, since this also depends on the person's immune system and whether they have been vaccinated.

Prevention measures

According to the CDC, meningococcal vaccines are the most effective way to protect against meningococcal disease, particularly for people in recommended age or risk groups.

When someone is vaccinated, their risk of developing meningitis is much lower, even if they are exposed to the viruses or bacteria that commonly cause the infection.

Some measures that may help lower the risk of getting meningitis include:

• Getting a pneumococcal vaccine, such as PCV15, PCV20, or PPSV23

• Avoiding close contact with people who are sick

• Washing your hands after being in public places

• Avoiding smoking

People with meningitis should also take some precautions to avoid spreading the disease, such as washing their hands often, avoiding public places, and covering their mouth and nose when coughing or sneezing.

Treatment options

Treatment for meningitis should begin as soon as possible after the first symptoms appear. Treatment depends on the type of microorganism causing the disease and should be started in the hospital after the cause is identified through diagnostic tests.

In cases of bacterial meningitis, antibiotics such as penicillin may be used, while in cases of viral meningitis, antiviral medications may be recommended in more severe cases.

In eosinophilic and fungal meningitis, antimicrobial medicines may be used, including antibiotics, antiparasitics, or antifungals, depending on the person’s overall health status, since these types of meningitis are more common in people with weaker immune systems.

In addition, the doctor may recommend pain relievers and anti-inflammatory medications to help relieve symptoms.

The person being treated for meningitis should have regular medical follow-up, including tests and symptom checks, so the doctor can confirm that the treatment is working and adjust it if needed.

Potential complications

Complications of meningitis can happen when the disease is not identified early, when treatment is not given or not followed as directed, or when the person has a very weakened immune system.

The most common complications of meningitis are:

• Partial or total hearing loss and vision loss

• Epilepsy

• Problems with memory and concentration

• Learning difficulties in both children and adults

• Delayed motor development, with difficulty walking and balancing

• Paralysis on one or both sides of the body

• Arthritis and bone problems

• Kidney problems

• Difficulty sleeping

• Urinary incontinence

Although complications can happen, this does not mean everyone will develop them. People who recover may have no complications at all or may have only mild complications.