Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 12, 2016

Meningitis is the inflammation of the membranes covering the brain and spinal cord typically caused by infection. The three membranes that line the brain are the dura mater, pia mater and arachnoid mater. These membranes are known as the meninges.


Definition & Facts

There are many different types and causes of meningitis. Viral meningitis occurs more frequently and is less severe. The more deadly and less common form is bacterial meningitis. Additional types of meningitis include:

Symptoms & Complaints

When exposed to meningitis, it is common to initially experience a high grade fever, headache and vomiting. These symptoms are similar to and often are mistaken for the flu, or influenza. Additional symptoms include the chills, cold hands and cold feet, a pallid complexion or blotchy skin, pain in the body’s limbs and an overall malaise. Later, a rash and neck pain, or a stiff neck, tend to arise. Feelings of confusion, seizures and sleepiness also may occur.

The symptoms also tend to progress more rapidly in the very young and those with a compromised immune system. Infants and new born babies may suffer a variety of symptoms. Excessive crying, sleeping and irritability are not uncommon. The fontanel, the soft spot atop the infant’s head may develop a lump.


Viral meningitis can be caused by several types of viruses including enteroviruses, influenza virus, Epstein-Barr virus, measles virus, and mumps virus. An enterovirus that resides in the intestine can be transported via food, water or other contaminated entities. Epstein-Barr virus is often spread through saliva whereas the measles virus and mumps virus primarily spread through coughing and sneezing.

Bacterial meningitis is transmitted across people through mucus and saliva. More than likely those suffering from bacterial meningitis were infected by the bacteria, streptococcus pneumoniae or Neisseria meningitidis. The former may alternatively result in pneumonia, a sinus infection or ear infection. The latter typically sits in the throat without causing inflammation or infection but is still contagious and a major cause of meningococcal disease in general.

There are other bacteria that also cause bacterial meningitis including group B streptococcus, known to occur in newborns where infection occurs during birth. Older adults are also known to obtain this. Haemophilus influenza and Listeria monocytogenes tends to occur most often in infants and older adults.

Diagnosis & Tests

The diagnostic process may begin with a doctor’s physical examination which may spot rashes symptomatic of meningitis. Testing can be done to determine a positive diagnosis usually from a mucus or nasal swab, a stool sample or rectal swab, or blood samples. The use of polymerase chain reaction tests can assist to detect viral meningitis. A spinal tap may also be performed to test the cerebrospinal fluid which can provide the most reliable information to make a diagnosis.

The samples will be sent to the lab for testing. The lab may grow or culture the bacteria in order to confirm its presence and identify the specific type of bacteria. Samples may also be studied for the presence of antibodies that the body generates to fight against particular viral strains that cause viral meningitis.

Treatment & Therapy

Viral meningitis will often take its course and resolve on its own with plenty of bed rest, fluids and medication to reduce the fever. The doctor may prescribe an antiviral drug if a herpes virus is the cause. Bacterial meningitis is best treated with intravenous therapy antibiotics. Treatment for bacterial meningitis may also include the use of corticosteroids.

Proper treatment reduces the risk of death substantially though the elderly and newborns are at a higher risk of death. Identifying the specific bacteria enables the doctor to determine the specific antibiotic needed for treatment. Without that information, the doctor will use a broad-spectrum antibiotic, treating a wide range of bacteria until the specific bacteria is identified. The doctor may also drain the infected area, the sinuses, or the bones behind the ear. This too depends upon the type of bacterial meningitis.

Prevention & Prophylaxis

There are vaccines available for three types of bacterial meningitis: neisseria meningitides, streptococcus pneumoniae, and haemophilus influenzae type B, known as Hib. Antibiotics are often recommended for those in close contact with someone suffering the bacteria. There are also vaccines for certain causes of viral meningitis including influenza vaccines, mumps vaccines and measles vaccines.

The best prevention is to maintain a healthy lifestyle, keeping the immune system strong. Minimizing the spread of the viruses that cause viral meningitis can be accomplished by washing hands frequently especially following use of the bathroom, after coughing or sneezing and after changing diapers. Disinfecting surfaces such as doorknobs and toys, washing your hands before touching your face, avoiding sharing utensils and cups with those that are ill can all reduce the risk of transmission.

Eliminating rodent infestations is important too as they carry disease and can contribute to the problem. Likewise, insect and mosquito bites should be prevented as much as possible as they too may carry viruses that can cause meningitis.