Signs & Symptoms of Spinal Meningitis

sick child Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. There are several types of meningitis. The most common is viral meningitis, which you get when a virus enters the body through the nose or mouth and travels to the brain. Bacterial meningitis is rare, but can be deadly. It usually starts with bacteria that cause a cold-like infection. It can block blood vessels in the brain and lead to stroke and brain damage. It can also harm other organs.

Anyone can get meningitis, but it is more common in people whose bodies have trouble fighting infections. Meningitis can progress rapidly. You should seek medical care quickly if you have a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as:

Nausea
Vomiting
Photophobia - which is sensitivity to light
Altered mental status

Bacterial Meningitis

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.

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.

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

Meningitis Questions & Answers

Q: What is meningitis?

A: Meningitis is an inflammation of the membranes that cover the brain and spinal cord. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ depending on the cause. Viral meningitis is generally less severe and clears up without specific treatment. But bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disabilities. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis. Hib vaccine is now given to all children as part of their routine immunizations. This vaccine has reduced the number of cases of Hib infection and the number of related meningitis cases. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis.

Q: What are the signs and symptoms of meningitis?

A: High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. Infants with meningitis may appear slow or inactive, have vomiting, be irritable, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

Bacterial Meningitis Questions

Q: How is bacterial meningitis diagnosed?

A: Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal can be collected. Identification of the type of bacteria responsible is important for selection of correct antibiotics.

Q: Can bacterial meningitis be treated?

A: Bacterial meningitis can be treated with a number of effective antibiotics. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment of 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.

Q: Is bacterial meningitis contagious?

A: Yes, some forms of bacterial meningitis are contagious. The bacteria can mainly be spread from person to person through the exchange of respiratory and throat secretions. This can occur through coughing, kissing, and sneezing. Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

However, sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by Neisseria meningitidis (also called meningococcal meningitis) or Hib. People in the same household or daycare center, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease. This is known as prophylaxis. Prophylaxis for household contacts of someone with Hib disease is only recommended if there is 1 household contact younger than 48 months who has not been fully immunized against Hib or an immuno compromised child (a child with a weakened immune system) of any age is in the household. The entire household, regardless of age, should receive prophylaxis in these cases.

Q: Are there vaccines against bacterial meningitis?

A: Yes, there are vaccines against Hib, against some serogroups of N. meningitidis and many types of Streptococcus pneumoniae. The vaccines are safe and highly effective.

vaccine Keeping up to date with recommended immunizations is the best defense against meningitis. Good hygiene is also an important way to prevent most infections.

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of all persons 11-18 years of age with 1 dose of meningococcal conjugate vaccine at the earliest opportunity. Pre-teens who are 11-12 years old should be routinely vaccinated at the 11-12 year old check-up as recommended by ACIP. This visit is the best time for adolescents to receive meningococcal conjugate vaccine. Also, since the occurrence of meningococcal disease increases during adolescence, health-care providers should vaccinate previously unvaccinated pre-teens and teens 11-18 years of age with meningococcal conjugate vaccine at the earliest possible health-care visit.

College freshmen living in dormitories are at increased risk for meningococcal disease and should be vaccinated with meningococcal conjugate vaccine before college entry if they have not previously been vaccinated. The risk for meningococcal disease among non freshmen college students is similar to that for the general population of similar age (age 18-24 years). However, since the vaccines are safe and produce immunity, they can be provided to non freshmen college students who want to reduce their risk for meningococcal disease.

Routine vaccination also is recommended for certain persons who have increased risk for meningococcal disease. Use of meningococcal conjugate vaccine is preferred among people aged 2-55 years; however, use of meningococcal polysaccharide vaccine is recommended among adults over 55 years of age.

Learn more about meningococcal vaccination and who should be vaccinated.

There are also vaccines to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis), which can also prevent other forms of infection due to S. pneumoniae. The pneumococcal polysaccharide vaccine (PPSV) is recommended for all persons over 65 years of age, younger persons at least 2 years old with certain chronic medical problems, and 19-64 year olds who smoke or have asthma. There is a vaccine (pneumococcal conjugate vaccine, or PCV13 ) that is effective in infants for the prevention of pneumococcal infections and is routinely recommended for all children younger than 2 years of age.

Viral Meningitis Questions

Q: What is viral meningitis?

A: Meningitis is an inflammation of the membranes ("meninges") that cover the brain and spinal cord. Viral infections are the most common cause of meningitis; bacterial infections are the second most common cause. Other, rarer causes of meningitis include fungi, parasites, and non-infectious causes, including those that are related to drugs.

Meningitis caused by viral infections is sometimes called "aseptic meningitis."

Q: Is viral meningitis a serious disease?

A: Viral ("aseptic") meningitis is serious but rarely fatal in people with normal immune systems. Usually, the symptoms last from 7 to 10 days and the patient recovers completely. Bacterial meningitis, on the other hand, can be very serious and result in disability or death if not treated promptly. Often, the symptoms of viral meningitis and bacterial meningitis are the same. For this reason, if you think you or your child has meningitis, see your doctor as soon as possible.

Q: What causes viral meningitis?

A: Different viral infections can lead to viral meningitis. But most cases in the United States, particularly during the summer and fall months, are caused by enteroviruses (which include enteroviruses, coxsackieviruses, and echoviruses). Most people who are infected with enteroviruses either have no symptoms or only get a cold, rash, or mouth sores with low-grade fever. And, only a small number of people with enterovirus infections develop meningitis.

Other viral infections that can lead to meningitis include mumps, herpesvirus (such as Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus — the cause of chickenpox and shingles), measles, and influenza.

Arboviruses, which mosquitoes and other insects spread, can also cause infections that can lead to viral meningitis. And lymphocytic choriomeningitis virus, which is spread by rodents, is a rare cause of viral meningitis.

Q: What are the signs and symptoms of viral meningitis?

A: Symptoms can appear quickly or they can also take several days to appear, usually after a cold or runny nose, diarrhea, vomiting, or other signs of infection show up. Symptoms in adults may differ from those in children:

Common in infants
- Fever
- Irritability
- Poor eating
- Hard to awaken
Common in older children and adults
- High fever
- Severe headache
- Stiff neck
- Sensitivity to bright light
- Sleepiness or trouble waking up
- Nausea, vomiting
- Lack of appetite

Q: How is viral meningitis diagnosed?

A: Viral meningitis is usually diagnosed by laboratory tests of a patient’s spinal fluid (from a "spinal tap"). The test can reveal whether the patient is infected with a virus or a bacterium. The exact cause of viral meningitis can sometimes be found through tests that show which virus has infected a patient; however, identifying the exact virus causing meningitis may be difficult.

Because the symptoms of viral meningitis are similar to those of bacterial meningitis, which is usually more severe and can be fatal, it is important for people suspected of having meningitis to seek medical care and have their spinal fluid tested. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

Q: How is viral meningitis treated?

A: There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

A hospital stay may be necessary in more severe cases or for people with weak immune systems.

Q: How is the virus spread?

A: Different viruses that cause viral meningitis are spread in different ways. Enteroviruses, the most common cause of viral meningitis, are most often spread through direct contact with an infected person’s stool. The virus is spread through this route mainly among small children who are not yet toilet trained. It can also be spread this way to adults changing the diapers of an infected infant.

Enteroviruses and other viruses (such as mumps and varicella-zoster virus) can also be spread through direct or indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. This usually happens through kissing or shaking hands with an infected person or by touching something they have handled and then rubbing your own nose or mouth. The viruses can also stay on surfaces for days and can be transferred from objects. Viruses also can spread directly when infected people cough or sneeze and send droplets containing the virus into the air we breathe.

The time from when a person is infected until they develop symptoms (incubation period) is usually between 3 and 7 days for enteroviruses. An infected person is usually contagious from the time they develop symptoms until the symptoms go away. Young children and people with low immune systems may spread the infection even after symptoms have resolved.

Q: Can I get viral meningitis if I’m around someone who has it?

A: If you are around someone with viral meningitis, you may be at risk of becoming infected with the virus that made them sick. But you have only a small chance of developing meningitis as a complication of the illness.

Q: How can I reduce my chances of becoming infected with viruses that can lead to viral meningitis?

A: Viral meningitis most commonly results from infection with enteroviruses. But there are other causes, such as measles, mumps, and chickenpox. Viral meningitis can also be caused by viruses that are spread by mosquitoes and other insects that bite people.

The specific measures for preventing or reducing your risk for viral meningitis depend on the cause.

Following good hygiene practices can reduce the spread of viruses, such as enteroviruses, herpes viruses, and measles and mumps viruses. Preventing the spread of virus can be difficult, especially since sometimes people are infected with a virus (like an enterovirus) but do not appear sick. In such cases, infected people can still spread the virus to others. Thus, it is important to always practice good hygiene to help reduce your chances of becoming infected with a virus or of passing one on to someone else:
- Wash your hands thoroughly and often. This is especially important after changing diapers, using the toilet, or coughing or blowing your nose in a tissue. Put
- Cleaning contaminated surfaces, such as handles and doorknobs or the TV remote control, with soap and water and then disinfecting them with a dilute solution of chlorine-containing bleach also may decrease the spread of viruses. This solution can be made by mixing ¼ cup of bleach with 1 gallon (16 cups) of water.
- Cover your cough. The viruses that cause viral meningitis can be spread by direct and indirect contact with respiratory secretions, so it is important to cover your cough with a tissue or, if you do not have a tissue, to cough into your upper arm. After using a tissue, place it in the trash and wash your hands.
- Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
Receiving 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 (the MMR vaccine) and chickenpox (the varicella-zoster vaccine).
Avoiding bites from mosquitoes and other insects that carry diseases that can infect humans may help reduce your risk for viral meningitis.
If you have a rodent infestation in and around your home, follow the cleaning and control precautions listed on CDC’s Web site about lymphocytic choriomeningitis.

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.

Help Prevent Meningitis

teenagers Meningococcal disease is a serious, vaccine-preventable infection. The meningococcal conjugate vaccine is recommended for all 11-18 year olds. Kids should get this vaccine at their 11-12 year old check-up with other preventive services. Kids 13-18 years old who haven’t gotten the vaccine can get it any time.

The meningococcal conjugate vaccine is recommended for 11-18 year olds.

Did you know that there are approximately 1,000-1,200 cases of meningococcal disease in the United States each year? Meningococcal disease, a type of bacterial meningitis, can be very serious -- even life-threatening -- in 48 hours or less.

Symptoms of meningococcal disease are usually sudden onset of fever, headache, and stiff neck. It can start with symptoms similar to influenza (flu), and will often also cause nausea, vomiting, sensitivity to light, rash, and confusion. Even with antibiotic treatment, people die in about 10-15% of cases. About 15% of survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.

Meningococcal disease can be spread from person to person. The bacteria are spread by exchanging respiratory and throat secretions during close or lengthy contact (for example, coughing or kissing), especially if living in the same dorm or household. Many people carry the bacteria in their throats without getting meningococcal disease. Since so many people carry the bacteria, most cases of meningococcal disease appear to be random and aren't linked to other cases. Although anyone can get meningococcal disease, adolescents and college freshmen who live in dormitories are at an increased risk.

The good news is that there's a vaccine to help prevent meningococcal disease and it can prevent two of the three most common disease-causing strains. The vaccine is routinely recommended for all 11-18 year olds. Kids should get this vaccine, known as the meningococcal conjugate vaccine, at their 11-12 year old check-up, along with other vaccines and preventive services. If your teenager missed getting the vaccine at his/her check-up, ask the doctor about getting it now…especially if your child is heading off to college to live in a dorm.

CDC created a video to help you learn more about meningococcal disease and how to prevent it. This video features a CDC doctor who is an expert in meningitis and, most importantly, a concerned mom. You can download the video or podcast at CDC-TV or access it on your mobile phone.

Your pre-teen or adolescent is at risk for other diseases like pertussis (whooping cough) and HPV that can be prevented with vaccines. If your child hasn't had a check-up within the last year, make an appointment now and ask your child's doctor what vaccines are recommended.