Bacterial Meningitis

Bacterial Meningitis is inflammation of the meninges. The meninges are the membranes that cover the brain and spinal cord.

Causes

Three types of bacteria cause the majority of cases of bacterial meningitis:
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haemophilus influenza b bacteria (Hib)
Bacterial meningitis is spread by direct contact with discharge from the mouth or throat of an infected person. (For example: kissing) It is not spread by casual contact or through the air.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Infants and young children
  • People in close and prolonged contact with patients with Hib or Neisseria meningitidis bacterialmeningitis
  • A weakened immune system
  • Age: over 60 years old (to a lesser degree)

Symptoms

Classic symptoms can develop over several hours, or may take 1-2 days:
  • High fever
  • Headache
  • Very stiff, sore neck
Other symptoms can include:
  • Red or purple skin rash
  • Cyanosis (bluish skin color)
  • Nausea
  • Vomiting
  • Sensitivity to bright lights (photophobia)
  • Sleepiness
  • Mental confusion
In newborns and infants, classic symptoms are difficult to detect. Because symptoms in newborns and infants are unreliable, infants under 3 months old with a fever are often evaluated for meningitis. Symptoms include:
  • Inactivity
  • Unexplained high fever
  • Irritability
  • Vomiting
  • Feeding poorly or refusing to eat
  • Tautness or bulging of soft spots between skull bones
  • Difficulty awakening
As bacterial meningitis progresses, patients of all ages may experience seizures.

Diagnosis

Bacterial meningitis can cause death within hours, so quick diagnosis and treatment is vital. Initial diagnosis is based on symptoms and a physical exam, with emphasis on the nervous system.

Tests may include:
  • Lumbar puncture (spinal tap) – removal of fluid from the lower spinal column to be tested for bacteria (bacterial cultures)
  • Other cultures – blood, urine, mucous and/or pus from skin infections
  • MRI or CT scan – to be sure the inflammation is not from some other cause (such as a tumor)

Treatment

When treatment is provided immediately, more than 90% of all people with bacterial meningitis survive. Antibiotics and corticosteroids are given concurrently to treat bacterial meningitis. Fluid replacement may also be given.

Antibiotics

Intravenous antibiotics are given as soon as bacterial meningitis is suspected. The antibiotics may be changed once tests identify the exact bacterial cause. Patients stay in the hospital until fever has subsided and the cerebrospinal fluid is clear of infection.

Corticosteroids

Intravenous corticosteroids are given immediately to control inflammation and reduce swelling of the brain and spinal cord.

Fluid Replacement and Additional Treatment

Fluids lost due to fever, sweating, vomiting, anorexia or low blood pressure are replaced.

Prevention

Strategies to prevent bacterial meningitis include:
  • Vaccination against certain strains of Neisseria meningitidis and Streptococcus pneumonie given to:
  • Health care workers or family members in repeated contact with infected patients
  • People traveling outside the U.S. to destinations where Neisseria meningitidis outbreaks are common
     
  • Preventative antibiotics given to health care workers or family members in repeated contact with infected patients
  • Routine vaccination of young children with Hib vaccine