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For Patients & Families:
Bacterial Meningitis
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Marvin Harper, MD
What is bacterial meningitis vs. viral meningitis?
Meningitis is an infection that causes inflammation of the three thin layers of tissue, known as meninges, that cover the brain and spinal cord. The two most common types of meningitis are bacterial and viral, and although they have similar symptoms (viral meningitis symptoms may be milder), the two diseases are quite different and require different treatment.

When caused by a virus, meningitis is usually far less severe and is typically treated with bed rest or over-the-counter medications such as Tylenol. But because some other viruses are very serious and can invade the brain, it's important to seek medical attention as a precaution.

Bacterial meningitis is generally much more severe than simple viral meningitis because it can cause serious complications. If not treated immediately, it can be fatal or cause permanent damage to the brain, so it's important to get medical attention as soon as symptoms are discovered.

Type of Meningitis Viral Meningitis Bacterial Meningitis
Symptoms Fever, headache, stiff neck, sensitivity to light, drowsiness, confusion. High fever, severe headache, stiff neck, sensitivity to light, drowsiness, confusion. A rash, nausea, vomiting, and sore throat can also occur.
Effects Temporary, flu-like symptoms, headache, and stiff neck. Possibility of varying degrees of brain damage, including hearing loss and mental retardation. Can be fatal if not treated in time.
Severity Goes away on its own usually within three to 10 days. Life-threatening. Medical treatment is needed immediately
Treatment Bed rest, Tylenol Hospitalization and antibiotics
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Don Goldmann, MD
What are the effects of bacterial meningitis?
With early antibiotic treatment, the risk of bacterial meningitis being fatal is less than 15 percent, however, there is still a 10 to 15 percent chance of permanent brain damage. The level of damage depends on how much swelling and inflammation occurs near the brain. The stroke-like effects caused by the swelling can include:
  • Hearing loss
  • Mental retardation
  • Organ damage
  • Paralysis
What are the symptoms?
Bacterial meningitis usually starts with headache and fever, which are common to many illnesses, making bacterial meningitis difficult to diagnose at this stage. Symptoms more specific to bacterial meningitis include severe headache, pain when bending the neck forward or a stiff neck, and sometimes sensitivity to light. Later symptoms can include confusion, lethargy, or seizures. Symptoms can progress rapidly, and some patients experience delirium or coma by the time they seek treatment. In infants, the symptoms to be aware of are:
  • Fever
  • Irritability (fussy and crying a lot)
  • Lethargy
  • High-pitched cry
  • Arching back
  • Crying when moved
  • A bulging fontanelle (the soft spot on an infant's head)
  • Seizures
For children older than 1 year, look for:
  • Fever
  • Neck or back pain (or stiff neck)
  • Headache
  • Confusion
  • Sensitivity to light
  • Refusing to eat
  • Decreased level of consciousness
  • Seizures
  • Nausea and vomiting
It is important to emphasize that children may not display all of the above signs and symptoms. "There is no way a parent can definitively tell if a child has bacterial meningitis, but parents are generally pretty aware of when their child is sick and in need of medical care," says Donald Goldmann, MD, an infectious disease expert at Children's Hospital Boston. "It's important that a patient shows up at the hospital quickly or it may be too late in the game."
How is it treated?
Early treatment of antibiotics can reduce swelling and inflammation in the brain and prevent injury and death. Corticosteroids also may be given to reduce inflammation. It is important to remember that timing is crucial. If you or your child has symptoms of bacterial meningitis, go to the nearest emergency room right away. If doctors suspect meningitis, they will diagnose it using a spinal tap, blood tests (including blood cultures) and sometimes a CT Scan. Because of the small window of time between when swelling in the brain begins and when brain damage occurs, antibiotics are administered - usually intravenously. Antibiotics are typically continued for one to three weeks. Children with bacterial meningitis are admitted to the hospital for treatment and monitoring while awaiting the results of spinal fluid tests, and for doctors to look for a source of the infection, such as a sinus infection. It is also important that doctors find out which type of bacteria has caused the meningitis because some strains of bacteria, such as meningococcus, are more contagious than others.
How common is bacterial meningitis?
Approximately 3,000 people in the United States - or one in 100,000 - are diagnosed with bacterial meningitis each year, most of them infants, children, college students and the elderly. Incidences of bacterial meningitis usually peak in the winter or early spring. "In the summer, most cases of people coming in with headaches and other symptoms are more likely to have viral and not bacterial meningitis," says Dr. Goldmann. "But if there's a case of meningitis, it's important to find out what kind it is."
What causes bacterial meningitis?
Most people are exposed to the bacterium that causes meningitis at some point in their lives, though they may never know it because only a small fraction of people develop meningitis from it. Many healthy people carry the bacteria in their mouth or throat and never get sick from it, but in rare cases, it breaks through a person's immune system and travels through the bloodstream - or sometimes through the sinuses - to the brain. The bacteria then infects the protective membranes that cover the brain and spinal cord, causing dangerous swelling and inflammation that is only relieved with antibiotic treatment.

"Why some people get infected and others don't, nobody knows," says Dr. Goldmann. "So you can't worry about it on a day to day basis, but there are clearly some factors that may make a person more susceptible than others." Those factors include:

Those factors include:
  • Having been in close contact with someone who has bacterial meningitis (especially when it's due to meningococcus, a type of bacteria that is more contagious than others)
  • Having a compromised immune system
  • Having traveled to an area of the world where meningitis is widespread (consult your doctor for the recommended vaccinations before traveling overseas).
  • While some forms of bacterial meningitis are contagious, especially meningococcus, none is transmitted as easily as the common cold or the flu. However, bacterial meningitis can be spread through the exchange of respiratory and throat secretions, such as:
  • Coughing or sneezing
  • Kissing
  • Sharing drinks
If someone is in close contact with a person who has bacterial meningitis, such as a roommate, parent, sibling, daycare worker, classmate, or boyfriend or girlfriend, they are at an increased risk and should go to the doctor for antibiotics to prevent bacterial meningitis before symptoms occur.
Is there a vaccine available for bacterial meningitis?
The most common cause of bacterial meningitis in children, Haemophilus influenzae b (Hib), has been almost eliminated due to a vaccine that was developed at Children's Hospital Boston in 1990. Before then, approximately 10,000 children were diagnosed with meningitis each year and five percent of them did not survive. The Hib immunization is now a routine childhood vaccination that prevents hundreds of deaths a year.

The rate of another major cause of bacterial meningitis - the pneumococcus bacteria - also has been reduced dramatically by the widespread use of Prevnar pneumococcal vaccine. Meningococcal vaccine, specifically for meningococcus bacteria, is recommended for students entering dormitory situations in high school or college. It is effective for three to five years, however, it does not protect against all strains of meningococcus bacteria.

Source: Reviewed by Don Goldmann, MD, Senior Associate in Medicine at Children's Hospital Boston, specializing in bacterial infections, clinical effectiveness, and infection control; and Marvin Harper, MD, Assistant in Medicine at Children's Hospital Boston, specializing in pediatric emergency medicine, pediatric infectious diseases, travel and geographic medicine.

Please keep in mind that the text provided is for informational purposes only and is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment.

Children's Hospital Boston©, 2005. This page may be reproduced for educational purposes. Reprint permission is required for all other uses.

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