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What is meningitis?

Meningitis is an infection that causes inflammation of the three thin layers of tissue, known as meninges, which cover the brain and spinal cord. Meningitis may be caused by a virus or by bacteria.

In general, bacterial meningitis is more dangerous than viral meningitis. Bacterial meningitis may cause permanent damage, including hearing loss, mental retardation, or even death. Approximately 3,000 people in the U.S. or one in 100,000 are diagnosed with bacterial meningitis each year.

Typical treatment includes hospitalization and antibiotics.

What is the difference between bacterial meningitis and viral meningitis?

Symptoms:

  • viral meningitis: fever, headache, stiff neck, sensitivity to light, drowsiness, confusion
  • bacterial meningitis: high fever, severe headache, stiff neck, sensitivity to light, drowsiness, confusion. A rash, nausea, vomiting, and sore throat can also occur.

Effects:

  • viral meningitis: temporary, flu-like symptoms, headache, and stiff neck.
  • bacterial meningitis: possibility of varying degrees of brain damage, including hearing loss and mental retardation. Can be fatal if not treated in time.

Severity:

  • viral meningitis: goes away on its own usually within three to 10 days.
  • bacterial meningitis: life-threatening; medical treatment is needed immediately

Treatment:

  • viral meningitis: bed rest, Tylenol
  • bacterial meningitis: hospitalization and antibiotics

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. People who show symptoms in the summer time are more likely to have viral meningitis rather than bacterial meningitis.

Preventing 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 Boston Children's Hospital in 1990.

  • Before then, approximately 10,000 children were diagnosed with meningitis each year, and 5 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 the Prevnar pneumococcal vaccine.

A 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.

Symptoms & Causes

What are the symptoms and warning signs of bacterial meningitis?

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. Watchful waiting is not advised; if you suspect meningitis, consult a doctor immediately.

What causes bacterial meningitis?

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 infect the protective membranes that cover the brain and spinal cord, causing dangerous swelling and inflammation that is only relieved with antibiotic treatment.

What are the risk factors for bacterial meningitis?

  • 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.

Diagnosis & Treatments

How is bacterial meningitis diagnosed?

If your pediatrician suspects that your child may have meningitis, they will order blood work and may collect spinal fluid to see what is causing the infection. Understanding the specific cause of meningitis will inform the doctor how to treat it.

How is bacterial meningitis 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 we care for bacterial meningitis

Because of the fast and severe nature of bacterial meningitis, Boston Children's urges all parents to seek treatment immediately once you suspect bacterial meningitis. After admission, doctors will find the specific cause of your child's meningitis and administer treatment accordingly. The ultimate goal of quick treatment is to make sure your child recovers without any permanent damage.

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The Neuroanesthesia Program provides anesthesia for neurosurgical procedures varying from simple to complex.

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The Department of Neurology cares for infants, children, and adolescents with all types of neurologic and developmental disorders.
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