- How to Treat and Prevent the Different Types of Meningitis
- How Is Viral Meningitis Treated?
- How Is Bacterial Meningitis Treated?
- Other Meningitis Treatments
- Can You Get a Vaccine to Prevent Meningitis?
- What Are the Vaccines for Meningococcal Meningitis?
- What Are the Vaccines for Pneumococcal Meningitis?
- What Are the Vaccines for Haemophilus pneumoniae type B (Hib)?
- What Are the Vaccines for Viral Meningitis?
- Partially treated meningitis
- Duration of treatment and choice of antibiotic
- Antibiotic resistance
- Use of intravenous fluids
- Use of dexamethasone
- Recommendations for prevention of secondary cases among close contacts
- Treatment of raised intracranial pressure
- Chemoprophylaxis and prevention of secondary cases
- Bacterial Meningitis
- Meningitis, Viral
- Further Information and Support
How to Treat and Prevent the Different Types of Meningitis
Medication is available to treat some forms of meningitis, but not all.
Bacterial meningitis is treated with antibiotics, but there are no specific treatments for viral meningitis.
If your doctor suspects you have meningitis, he or she will likely put you on a round of broad-spectrum antibiotics to fight potential nonviral types of infectious meningitis. Once the type of meningitis has been determined — viral, bacterial, fungal, or noninfectious — your doctor will provide a more specific treatment.
How Is Viral Meningitis Treated?
Antibiotics cannot kill viruses. If you have viral meningitis, you will be taken off whatever antibiotic therapy you may have been initially given.
There is no specific treatment for viral meningitis, which is often mild.
Most of the time, people recover from viral meningitis in 7 to 10 days with little more than rest, over-the-counter fever reducers or pain medication, and proper fluid intake.
But if you have meningitis caused by a herpes virus or influenza, your doctor may prescribe an antiviral medication, such as:
- Cytovene (ganciclovir) or Foscavir (foscarnet), which are sometimes used to treat cytomegalovirus meningitis (CMV meningitis) in people with weakened immune systems
- Zovirax (cyclovir), which may be used to treat meningitis from the herpes simplex virus
How Is Bacterial Meningitis Treated?
If you have bacterial meningitis, you will be treated with one or more antibiotics that target the bacteria causing your infection.
These antibiotics commonly include:
- Cephalosporin antibiotics, such as Claforan (efotaxime) and Rocephin (ceftriaxone), for Streptococcus pneumoniae, Neisseria meningitidis, and ampicillin-resistant Haemophilus influenza type B (Hib) meningitis
- Ampicillin (a penicillin-class drug), for Haemophilus influenzae type B and Listeria monocytogenes
A number of other antibiotics may also be used, such as:
- Merrem (meropenem)
- The aminoglycoside antibiotics tobramycin (Tobi, Tobi Podhaler, Tobrex) and gentamicin (Garamycin, Gentak)
- Cipro (ciprofloxacin) and Rifadin (rifampin), which are sometimes given to family members of people with bacterial meningitis to help protect them from catching the infections
Other Meningitis Treatments
Fungal meningitis is treated with long courses of high-dose intravenous (IV) antifungal drugs.
These medicines are often part of the azole class of antifungal drugs, such as Diflucan (fluconazole), which is used to treat infections from Candida albicans, the fungus behind yeast infections.
Depending on the type of infection, other antifungals may also be used.
For example, amphotericin B (AmBisome, Amphotec) is one of the most common treatments for cryptococcal meningitis, caused by the fungus Cryptococcus neoformans.
Amphotericin B may also be used to treat a rare type of parasitic meningitis caused by Naegleria fowleri.
Alternatively, the antifungal agent miconazole and the antibiotic rifampin may be used.
In addition to the above drugs, corticosteroids may be used to reduce meningitis inflammation. This is especially important in bacterial meningitis; for this reason, steroids are often given in conjunction with antibiotics.
Can You Get a Vaccine to Prevent Meningitis?
Vaccines cannot protect you from the noninfectious causes of meningitis, which include:
- Autoimmune disorders
- Certain drugs
But meningitis vaccines can protect you from the three most common bacteria that cause the disease in children and adults — Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib) — and certain meningitis-causing viruses.
RELATED: 10 Ways to Ease Your Baby’s Vaccination Pain
What Are the Vaccines for Meningococcal Meningitis?
Meningococcal disease is any illness caused by the bacterium N. meningitidis.
At least 12 different serogroups, or strains, of N. meningitidis have been identified so far, with five of them (A, B, C, W-135, and Y) causing the majority of meningococcal disease cases in the world. (1)
Menomune, an older vaccine that protected against these four strains, was discontinued in February 2017.
The two available meningococcal conjugate vaccines that protect against strains A, C, W-135, and Y are:
The Centers for Disease Control and Prevention (CDC) recommends that all children ages 11 and 12 receive one of these vaccines, followed by a booster shot at age 16. (2)
These vaccines are also recommended for babies, children, and adults at particular risk for meningococcal meningitis.
No booster shot is needed if the vaccine is given for the first time at age 16 or older.
The Food and Drug Administration (FDA) recently approved the first two vaccines for N. meningitis group B for people between ages 10 and 25.
What Are the Vaccines for Pneumococcal Meningitis?
Approved in 2010, the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) protects against 13 strains of pneumococcal bacteria.
It’s recommended for all infants and young children, and for adults older than 65.
The pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax), approved in 1983, protects against 23 strains of pneumococcal bacteria.
It’s recommended for all adults who are at least 65 years old, and everyone older than age 2 with a high risk of pneumococcal disease due to health issues or medication they take.
RELATED: Pneumonia Resource Center: 10 Terms You Should Know
What Are the Vaccines for Haemophilus pneumoniae type B (Hib)?
Four Hib vaccines are available. Depending on the brand, they’re given in two doses (PedvaxHIB) or four doses (like Pentacel).
They’re recommended for all U.S. children under age 5, and the first dose is usually given when a child is 2 months old. (3)
What Are the Vaccines for Viral Meningitis?
No vaccines are available to protect against non-polio enteroviruses, by far the most common cause of viral meningitis.
But vaccines can prevent other meningitis-causing viruses, including mumps, measles, influenza, and chickenpox (varicella).
The measles, mumps, rubella, and varicella (MMRV) vaccine, approved in 2005, protects against four meningitis-causing viruses.
Separate MMR and varicella vaccines are also available.
The vaccines are recommended for all children between 12 months and 12 years old, with the first of two shots given between ages 12 and 15 months, and the second given between ages 4 and 6 years.
The CDC recommends that everyone older than 6 months get a flu vaccine every flu season. (4)
Routine shots of the flu vaccine are necessary because the formulation of the vaccine is updated yearly to account for the ever-mutating flu viruses.
Additional reporting by Carlene Bauer.
The choice of antibiotic depends on the organism isolated. In most cases the initial treatment has to be empirical, but nonetheless based on epidemiological knowledge of the commonest organisms for each age group and local antibiotic resistance patterns. The chosen antibiotic should have bactericidal activity in the CSF. Patients with pneumococcal or Gram negative bacillary meningitis who are treated with bacteriostatic antibiotics may have a poor clinical outcome.24 Animal studies have shown that a bactericidal effect is necessary for sterilisation of the CSF and survival.25
There are three factors affecting antibiotic activity: ability to penetrate the CSF, concentration, and intrinsic activity in infected fluid.26,27 When the blood-brain barrier is intact, penetration is limited, because transport across cells is minimal and the junctions between endothelial cells of the cerebral microvasculature are tight. In meningitis, the integrity of the barrier is altered, resulting in increased permeability and enhanced CSF penetration of most antibiotics. The antibiotic concentration in CSF needed for optimal bactericidal activity is uncertain. However, in experimental studies, maximal bactericidal activity occurs when the concentration of an antibiotic is approximately 10–30 times the minimal bactericidal concentration against the organism in vitro.28,29
Bactericidal antibiotics promote the release of bacteria cell wall products such as endotoxins, teichoic acid, and peptidoglycans. These products provoke the production of the inflammatory mediators such as tumour necrosis factor α (TNF-α), interleukin 1 (IL-1), and platelet activating factor (PAF). The release of inflammatory mediators can be associated with worsening of disease and poor outcome. However, one experimental study showed that the release of bacterial toxins after initiation of antibiotics was much less than that released by bacteria not exposed to antibiotics.30
In a child with suspected meningitis, urgent transfer to hospital, followed by concurrent microbiological investigation and antibiotic treatment are the cornerstones of management.
Lack of adequate blood and CSF culture may result in difficulty deciding on the duration of treatment and uncertainty over the antimicrobial susceptibility of the organism.
Partially treated meningitis
As the early symptoms and signs of bacterial meningitis are non-specific, up to 50% of cases may initially receive oral antibiotics.31 This partial treatment may delay the child’s presentation to hospital and result in a diagnostic dilemma. The CSF findings may be altered; Gram stain and growth of organism may be negative, however antibiotics rarely interfere with CSF protein or glucose. In this situation CSF should be sent for both PCR and bacterial antigen detection, as these are not affected by prior antibiotic administration.31
Duration of treatment and choice of antibiotic
The duration of antibiotic therapy depends on the organism isolated. For S pneumoniae and H influenzae, 10–14 days treatment is generally recommended while for N meningitidis a seven day course is sufficient. In Listeria monocytogenes and group B streptococcal meningitis, antibiotics should be given for 14–21 days. For Gram negative bacilli a minimum of three weeks is needed.32
In most cases of bacterial meningitis a broad spectrum cephalosporin (cefotaxime or ceftriaxone) is the most appropriate empirical choice in children over 3 months old. These cover Neisseria meningitides, Streptococcus pneumoniae, and Haemophilus influenzae, and penetrate CSF well. Ampicillin should be added in young infants (less than 3 months old) to cover Listeria monocytogenes. The treatment of choice for Gram negative bacillary meningitis is cefotaxime or ceftriaxone. Aminoglycosides are sometimes used in addition, but not alone as they often do not exceed the minimum inhibitory concentrations (MIC) for Gram negative bacteria and may not be successful in eradicating the pathogen.
Ceftriaxone may be effective when given as a single daily dose (80–100 mg/kg) to treat serious bacterial infections including meningitis in children.33 Although this regimen may be cost effective, safe, and convenient, one concern is that missing a single dose or delaying it may result in inadequate CSF drug concentration. A randomised trial in 100 infants who were already showing signs of recovery revealed that four days of ceftriaxone treatment is as effective as seven days with no difference in complications.34 We suggest that confirmation is required from larger studies of these encouraging results before recommending a shorter treatment period.
Antibiotic therapy may need to be modified once a pathogen is cultured and antibiotic susceptibility testing becomes available. If pneumococcal meningitis is high on the differential diagnosis and there is a clear history of anaphylaxis to β lactams, and keeping in mind that perhaps 10% of those allergic to penicillin cross react to cephalosporin, a combination of vancomycin and chloramphenicol is an alternative. Vancomycin is added because of the risk of penicillin resistant pneumococci and the possibility of failure of chloramphenicol in this group.35
For more complicated cases such as immunosuppressed patients or those with recent history of head trauma or neurosurgery, and those with cerebrospinal fluid shunts, broad spectrum antibiotics against Gram positive and Gram negative organisms should be given, such as a combination of vancomycin and ceftazidime.32
Studies comparing the use of rifampicin with ceftriaxone in experimental S pneumoniae meningitis support the use of rifampicin because of a reduction in the release of proinflammatory mediators, decreased secondary brain injury, and a lower early mortality rate.36,37 As the release of bacterial cell wall products and the production of proinflammatory mediators may be associated with more severe disease and worse outcome in some patients with bacterial meningitis, the initial use of rifampicin (for say 1–2 hours) followed by addition of a β lactam may result in reduction of tissue damage and a better outcome. However this approach is not human evidence based.
Other less frequently used carbapenem antibiotics, such as imipenem and meropenem, are very active in vitro against most isolates of S pneumoniae, although some penicillin resistant strains have shown reduced susceptibility.38 Fluroquinolones, such as trovafloxacin, gatifloxacin, and moxifloxacin are potentially effective in the treatment of multiply resistant pneumococcal isolates because of their activity and CSF penetration, even when dexamethasone is also given.39,40
Table 1 shows the dosages and the frequency of the common antibiotics used.
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Dosages and frequency of the common antibiotics used in bacterial meningitis
There has been a worldwide increase reported in infection with penicillin and cephalosporin resistant strains of S pneumoniae, for example in Europe, South Africa, Asia, and the United States.41–45 The rate in the UK remains low but has increased.46 Such meningitis may not respond to high dose penicillin therapy and those resistant to cephalosporin may not respond to the standard dose.47 The resistance of S pneumoniae to penicillin and other β lactam antibiotics is caused by either alteration in the penicillin binding proteins involved in the synthesis of bacterial cell wall or the production of β lactamase.48 In view of the increasing reports of resistant strains of S pneumoniae in the United States, the American Academy of Pediatrics recommended combination therapy, initially with vancomycin and either cefotaxime or ceftriaxone for all children 1 month of age or older with definite or probable bacterial meningitis. Studies in adults have shown that vancomycin should not be used alone in resistant cases as there are doubts about its penetration into the CSF, especially in those given dexamethasone concurrently.49,50 A recent study in children showed that vancomycin need not be given if LP is done early and Gram positive diplococci are not seen on Gram stain.51 We suggest that in the majority of UK centres where cephalosporin resistance remains at very low levels, empirical use of vancomycin is not necessary. Where vancomycin is used empirically, it should be discontinued if the organism is later shown to be susceptible to penicillin, or to cefotaxime or ceftriaxone.52
In the case of N meningitidis isolates, the great majority are susceptible to penicillin and ampicillin, although strains with reduced susceptibility have been reported in Europe, South Africa, and the United States.53 Such resistant strains usually respond to the standard high dose of penicillin recommended for meningitis.54
Use of intravenous fluids
In general, most children admitted with meningitis are given intravenous fluids. A common practice has been to restrict fluids to two thirds or three quarters of the daily maintenance: the reasoning is that this reduces the likelihood of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The incidence of SIADH reported in studies varies considerably, from 4% to 88%, which can be attributed to the different criteria used in its definition. SIADH leads to hyponatraemia and fluid retention, which may worsen cerebral oedema. However, a significant proportion of meningitis cases present with dehydration or hypovolaemia and are in clinical need of fluid resuscitation.55 As the mechanism of antidiuretic hormone (ADH) secretion in meningitis is still unknown, the debate on whether the increased secretion of ADH is appropriate or not, remains unclear. This has resulted in the clinical dilemma of whether fluids should be restricted or not. Children with meningitis have excess total and extracellular water (ECW), an appropriate increased secretion of ADH, and mild systemic hypertension. All these changes are needed to overcome the raised intracranial pressure and to maintain adequate cerebral blood flow and perfusion. Consequently fluid restriction may increase the likelihood of adverse outcome.56 One experimental study showed that liberal fluid administration in Escherichia coli meningitis did not aggravate brain oedema.57 Interestingly, a recent multicentre randomised trial from Papua New Guinea comparing moderate oral fluid restriction to total maintenance intravenous fluids in the first 48 hours in children, did not show any increase in adverse outcome in the non-restricted group; however, signs of dehydration at presentation were a risk factor for adverse outcome in the fluid restricted group.58 Hyponatraemia has been correlated with an increased risk of seizures and neurological abnormalities.59 Although hyponatraemia can occur as a result of excessive fluid administration or SIADH, it can also occur in children with dehydration.60 It is therefore important that the degree of hydration is carefully assessed in order to correctly manage the fluid balance. If the decision is not to restrict fluid intake, extra care should be taken to avoid over-hydration, as this can easily occur inadvertently when maintenance fluids are given intravenously and other oral intake (for example, breast feeding) is allowed.57
The British Infection Society working party recommended that adult patients with meningitis should be kept euvolaemic and not fluid restricted in an attempt to reduce cerebral oedema.35 Similarly we suggest that the evidence does not support fluid restriction in children.
Use of dexamethasone
Steroids have anti-inflammatory effects and decrease the release of various cytokines. They inhibit the transcriptions of mRNA for TNF-α and IL-1, and the production of prostaglandins and PAF, reduce vasogenic cerebral oedema, and reduce the production of inducible nitric oxide synthase.61–63 Inflammatory changes in meningitis may ultimately lead to nerve damage and deafness. The use of corticosteroids in bacterial meningitis has been debated for more than 40 years.64 Recent meta-analyses of steroid use in bacterial meningitis have reached different conclusions, perhaps because of the difference in their eligibility criteria.65,66 A study showed that conclusions derived from some of the randomised controlled trials (RCTs) of antibiotic use in bacterial meningitis may be inaccurate because they are underpowered to show clinically significant differences.67 We can speculate that the same has occurred with RCTs of steroid use in meningitis. This may explain why some RCTs have shown that dexamethasone reduces overall mortality, hearing loss, and the incidence of long term neurological sequelae in children, whereas others did not show similar benefits.66,68–70
Different doses of dexamethasone have been used. A dose of 0.4 mg/kg given every 12 hours for a total duration of two days proved to be safe and as efficacious as the dose of 0.15 mg/kg given every six hours for four days.71 The short course may perhaps help to reduce the risk of gastric haemorrhage.
There are concerns regarding the penetration of antibiotics into the CSF when steroids are used. Animal studies showed that penetration of antibiotics such as vancomycin is reduced in steroid treated compared with non-steroid treated animals. However in children, vancomycin achieved adequate concentration in the CSF even when dexamethasone was concurrently given.72,73
A recent large double blind placebo controlled trial from Malawi showed no benefit of dexamethasone as an adjuvant treatment in children with acute bacterial meningitis in a developing country. Delayed presentation and underling illnesses such as anaemia, malnutrition, and HIV-1 infection may have influenced the effect of dexamethasone in this setting.74
The best evidence for the benefits of dexamethasone is in H influenzae type b meningitis. However, the evidence of benefit for pneumococcal meningitis is less certain. There does appear to be benefit if dexamethasone is commenced before or simultaneously with the antibiotic.71,75 We favour its use empirically in developed countries for children with suspected meningitis.
As a result of the changing epidemiology of bacterial meningitis, for example, the massive reduction in H influenzae type b meningitis and the emergence of antibiotic resistance, the question of the efficacy of steroids in bacterial meningitis will continue to be debated.
Recommendations for prevention of secondary cases among close contacts
All home contacts should be given rifampicin 20 mg/kg/day (max. 600 mg/day) for four days.
Any unvaccinated children aged 12–48 months, should be given one dose of the vaccine.
Unvaccinated children aged 2–11 months should be given three doses of the vaccine.
H influenzae type b infection
Rifampicin 600 mg every 12 hours for two days for adults; for children the dose is 10 mg/kg (under 1 year, 5 mg/kg) every 12 hours for two days orally.
Ceftriaxone 250 mg in adults (child <12 years, 125 mg) intramuscularly as a single dose.
Ciprofloxacin 500 mg orally as a single dose in adults and children aged >12 years (not licensed but extensively used).
Unvaccinated children and close contacts aged >2 years and exposed to meningococcus A, C, Y, or W135, should be offered quadrivalent meningococcal vaccine.79
Meningococcal infection(should be given one of the following)
For details of those who should receive chemoprophylaxis, contact a consultant in communicable disease control (or a consultant in infectious diseases, or the local public health laboratory).
Unless there has been mouth-to-mouth contact (or direct exposure to infectious droplets from a patient with meningococcal disease), healthcare workers do not generally require chemoprophylaxis
Chemoprophylaxis not normally indicated for close contacts.
Secondary prevention not required.
Other types of bacterial meningitis
Treatment of raised intracranial pressure
Raised intracranial pressure (ICP) is a well recognised complication of meningitis. The signs of raised ICP include altered level of consciousness, bradycardia, hypertension or hypotension, and altered respiratory pattern. A normal fundoscopy examination does not rule out a raised ICP, as papilloedema is a late sign.
Osmotic diuretics such as 20% mannitol, glycerol, and hypertonic saline are used in the treatment of cerebral oedema and raised ICP. Their action is through shifting fluids from the extravascular to the intravascular space, resulting in a reduction of intracranial pressure. Mannitol is given as an infusion in a dose of 0.25–1 g/kg. Mannitol is not without side effects; a hyperosmolar state may follow repeated doses, worsening cerebral oedema and impairing cardiac output.76
No published evidence is yet available, but there is a randomised controlled trial of glycerol, mannitol, and steroids in the treatment of raised ICP for children with bacterial meningitis, which will close in 2004 (Heikki Peltola, personal communication).
Measures to optimise brain homoeostasis by ensuring adequate delivery of oxygen and nutrients as well as maintaining cerebral perfusion and ensuring adequate mean arterial pressure are as essential as interventions to reduce raised ICP.77 Such interventions range from nursing the child in a head up position of 20–30° and in a quiet environment, to elective intubation and sedation and appropriate treatment, to lower intracranial pressure.76,77 The beneficial effect of hyperventilation in the treatment of raised ICP is still debated. It is generally recommended to aim for a minimal hypocapnia (PaCO2 not less than 3.5 kPa) to avoid excessive cerebral vasoconstriction.
Chemoprophylaxis and prevention of secondary cases
There are no published systematic reviews or randomised controlled trials studying the effect of prophylactic antibiotics in preventing subsequent cases in meningococcal disease. An RCT that is large enough to find a significant difference is unlikely to be performed. One RCT showed benefit of rifampicin in preventing secondary cases of Haemophilus influenzae meningitis among close contacts.78
Suspected cases should be reported as soon as possible to the local public health services, and general practitioners should be informed about policies for secondary prevention of cases.35
The box gives recommendations for chemoprophylaxis and prevention of secondary cases among close contacts.
What is meningitis?
Meningitis is an infection of the membranes (meninges) surrounding the brain and spinal cord. Meningitis can be caused by a bacterial, fungal or viral infection. Meningitis can be acute, with a quick onset of symptoms, it can be chronic, lasting a month or more, or it can be mild or aseptic. Anyone experiencing symptoms of meningitis should see a doctor immediately.
Acute bacterial meningitis is the most common form of meningitis. Approximately 80 percent of all cases are acute bacterial meningitis. Bacterial meningitis can be life threatening. The infection can cause the tissues around the brain to swell. This in turn interferes with blood flow and can result in paralysis or even stroke.
Who gets bacterial meningitis?
Children between the ages of 1 month and 2 years are the most susceptible to bacterial meningitis.
Adults with certain risk factors are also susceptible. You are at higher risk if you abuse alcohol, have chronic nose and ear infections, sustain a head injury or get pneumococcal pneumonia.
You are also at higher risk if you have a weakened immune system, have had your spleen removed, are on corticosteroids because of kidney failure or have a sickle cell disease.
Additionally, if you have had brain or spinal surgery or have had a widespread blood infection you are also a higher risk for bacterial meningitis.
Outbreaks of bacterial meningitis also occur in living situations where you are in close contact with others, such as college dormitories or military barracks.
The bacteria most often responsible for bacterial meningitis are common in the environment and can also be found in your nose and respiratory system without causing any harm.
Sometimes meningitis occurs for no known reason. Other times it occurs after a head injury or after you have had an infection and your immune system is weakened.
You want to watch for high fever, headaches, and an inability to lower your chin to your chest due to stiffness in the neck.
In older children and adults, you may see confusion, irritability, increasing drowsiness. Seizures and stroke may occur.
In young children, the fever may cause vomiting and they may refuse to eat. Young children may become very irritable and cry. There may be seizures. Also, because the fluid around the skull may become blocked their heads may swell.
The onset of symptoms is fast, within 24 hours. If allowed to progress, you can die from bacterial meningitis.
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Meningitis is a medical emergency. It can develop quickly, over a matter of hours.
Diagnosis and treatment of meningitis varies from country to country, depending on access to medial care, availability of antibiotics and local antibiotic resistance patterns.
Wherever you are, it’s important to know the signs and symptoms and to get medical treatment fast.
In order to diagnose meningitis, doctors may do a blood test and take a sample of cerebrospinal fluid (CSF), the watery fluid that flows in and around the brain and spinal cord.
CSF is collected through a lumbar puncture and examined for the presence of white blood cells and bacteria. Blood and CSF samples will be cultured for the presence of bacteria.
Treatment should not be delayed for more than 1-2 hours while diagnostic tests are taking place.
Bacterial meningitis requires injectable antibiotics and fluid replacement. Transfer to a hospital with an intensive care department may be necessary.
If signs of septicaemia are present, treatment should be started as soon as possible. Diagnostic tests should be deferred until antibiotics have been given.
The choice of antibiotic will be based on the susceptibilities of the meningitis bacteria in each patient’s area. Because of the worldwide prevalence of penicillin-resistant pneumococci, ampicillin-resistant Hib and sulfonamide-resistant meningococci, treatment with a third generation cephalosporin (such as cefotaxime or ceftriaxone) is the current standard of care.
In areas with high-level penicillin-resistant pneumococci, vancomycin is usually added until the susceptibility of the infecting bacteria is known. If patients are allergic to these antibiotics, chloramphenicol may be used as an alternative.
Antibiotics do not kill viruses. Although viral meningitis is more common than bacterial meningitis, treatment with injectable antibiotics should be started until a bacterial cause can be excluded. Treatment for viral meningitis is generally rest and pain relievers.
Survivors of bacterial meningitis may require ongoing treatment or therapy after their recovery.Almost all patients with viral meningitis recover without any permanent damage, although full recovery may take weeks to months.
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What is viral meningitis?
Meningitis is an infection of the membranes (meninges) surrounding the brain and spinal cord. Viral meningitis, also known as “aseptic” meningitis, is a condition in which bacteria don’t grow in cultures of cerebrospinal fluid (taken from a spinal tap) despite there being symptoms. Viral meningitis usually isn’t serious for patients with normal immunity, and typically runs an uneventful, albeit potentially uncomfortable, course with little to no complications. However, since the symptoms are practically the same as bacterial meningitis – a much more serious condition – immediate medical evaluation should be sought if symptoms of an infection of this nature occur.
What are the symptoms?
Early symptoms, which may develop over several hours or even days, can often be mistaken for the flu. They classically include high fever, headache (that can be severe) with a stiff neck, nausea and vomiting, confusion, sleepiness or difficulty waking up, light sensitivity, a decreased appetite, and, rarely, seizures.
Newborns and young infants may not have classic signs and symptoms of meningitis, but instead may cry inconsolably, have excessive sleepiness or irritability, a poor suck or decreased feeding, a bulging fontanelle – the soft spot on the top of a baby’s head – or stiffness in the body, head and neck. Infants with meningitis are often difficult to comfort, and may even cry harder when held. Of note, viral meningitis most commonly occurs in the first year of life.
Viruses are contagious, but many people who are exposed to the viruses that cause meningitis have no symptoms at all or develop only a cold or rash with low-grade fever. Only a small proportion of infected persons actually go on to develop meningitis. Infrequently, viral meningitis can cause a more severe illness, which usually occurs in elderly people or those with a suppressed immune system. These complications seem to be associated with more uncommon viral infections like with the West Nile virus or with herpes viruses, and include encephalitis (inflammation in the actual brain tissue) that can lead to seizures or brain damage, memory or hearing loss, and sometimes a paralysis similar to that seen in polio.
What are the causes?
A number of different viruses can cause meningitis, about 90 percent of them coming from the enterovirus family (coxsackie viruses and echoviruses). These viruses are more common during summer and fall months, and are most often spread through direct contact with respiratory secretions. The virus is also shed in the stool of infected individuals, and is spread this way by infants who are not yet toilet trained as well as by adults who change their diapers.
West Nile virus is a cause of viral meningitis that has recently spread across the United States, and is spread through the bite of an infected mosquito.
Herpes viruses and the mumps virus can also cause viral meningitis. Both herpes simplex type 1 (herpes labialis) and type 2 (genital herpes) can cause meningitis, typically in infants and children who have been exposed by infected adults. Chickenpox or shingles (herpes zoster) can also cause meningitis and encephalitis, typically in the elderly or immune-suppressed.
The rabies virus leads to a meningitis picture in those who have been infected and don’t get adequate treatment.
Finally, HIV can cause viral meningitis, especially after initial exposure – this is known as acute HIV syndrome.
Risk factors for viral meningitis include exposure to individuals with a recent viral infection, infected children in daycares, individuals living in crowded conditions where infections are easily spread, being a health care worker, or having a suppressed immune system.
What is the conventional treatment?
Most cases of viral meningitis improve on their own in a week or two without antiviral therapy. Treatment is mainly conservative, usually consisting of bed rest, plenty of fluids and over-the-counter pain medications to help reduce fever and relieve body aches.
If the cause of meningitis is the herpes virus, your doctor will recommend an antiviral medication like Acyclovir or Famciclovir to treat the infection – this may require an IV and hospitalization . If you have rabies, you will be treated with the rabies vaccine over several days as well as receiving immune globulin. Individuals infected with HIV will receive antiretroviral therapy. Meningitis from these viruses may require hospitalization.
What therapies does Dr. Weil recommend for viral meningitis?
Because people who are exposed may not get sick, it can sometimes prove difficult to prevent viral infections. However, adhering to good personal hygiene can certainly help reduce the chances of getting infected. If you are in close contact with someone who has viral meningitis, the most effective method of prevention is to wash hands thoroughly and often. Wearing isolation masks can help, as well as cleaning contaminated surfaces and soiled articles first with soap and water, then disinfecting them with a dilute solution of chlorine-containing bleach. This can be a very effective way to inactivate the virus, especially in institutional settings such as daycare centers, nursing homes, and college dormitories.
Maintain your immune system by getting enough rest and regular exercise, eating Dr. Weil’s anti-inflammatory diet, taking an antioxidant cocktail and multivitamin-mineral supplement (especially adequate doses of vitamin D), and attending to the stress in your life.
Educate yourself about immune boosting tonics. Dr. Weil recommends astragalus – his favorite immune-boosting herb, traditionally used in China to prevent illness and strengthen sick people. You can buy extracts of astragalus in liquid, capsule or tablet form. Follow the dosing directions on the package. You can also take immune-stimulating mushrooms to enhance resistance, especially in combinations of maitake (Grifola frondosa), reishi (Ganoderma lucidum), and royal sun agaricus (Agaricus blazei), which seem to act better when taken together than by themselves.
- Meningitis is a rare but serious infection of the membranes (meninges) that cover the brain and spinal cord.
- Meningitis can be caused by a range of different bacteria, fungi and viruses.
- Viral meningitis is usually mild and recovery is swift.
- Bacterial meningitis is a medical emergency and can be fatal without prompt treatment.
- Fungal meningitis is most commonly caused by an infection of the fungus, Cryptococcus. It does not develop acutely, but usually progresses slowly, causing headaches and cranial nerve palsies. It may be fatal or cause permanent brain damage.
- Haemophilus (Hib) meningitis used to be the most common type of meningitis in Australia until a national vaccination program was set up in 1992.
- Today the most common types of bacterial meningitis are caused by the Meningococcus bacteria and the Pneumococcus bacteria.
- A new type of vaccine is now available that can give long lasting protection against Group C meningococcal disease, one of the most common groups of the disease in Australia.
- A national Group C meningococcal vaccine program commenced in Australia in 2003. The vaccine is given free to children aged 12 months to 15 years and adolescents aged 16 and 17 years.
- Unfortunately there is no vaccine for meningococcal Group B disease, the other most common type in Australia.
- The germs that cause bacterial meningitis may live in the nose and throat. People of any age can carry them without becoming ill, but they can infect someone else through coughing or sneezing.
- The symptoms of meningitis in babies and young children include: fever, food refusal, fretfulness, drowsiness, purple-red skin rash or bruising, high moaning cry, light sensitivity and pale or blotchy skin.
- Symptoms in older children and adults include; headache, fever, vomiting, neck stiffness and joint pains, drowsiness and confusion, purple-red skin rash or bruising, light sensitivity.
- If you are concerned you should contact your GP immediately. If your doctor is not available, go to the emergency department of your nearest hospital.
Viral meningitis is usually mild and antibiotics are not needed. It is usually treated like the flu with patients advised to get bed rest and drink plenty of fluids.
Bacterial meningitis is a medical emergency and can be fatal if not treated quickly. Intravenous antibiotics are usually started as soon as bacterial meningitis is suspected. Close contacts are sometimes given clearance antibiotics to reduce the risk of further infection.
Fungal meningitis is treated with intravenous and oral anti-fungal agents.
Prompt treatment of meningitis is vital. Early diagnosis and treatment reduce the risk of infection and the risk of complications from infection.
Viral meningitis is usually mild and recovery is swift with the illness getting better on its own in 7-10 days.
Bacterial meningitis can be severe. Recovery can be slow and not everyone has a full recovery.
The death rate is about 5 per cent and some patients are left with permanent disabilities such as cerebral palsy and deafness.
Further Information and Support
Read More at Virtual Medical Centre
Better Health Channel
Meningitis Foundation of America
National Institute of Neurological Disorders and Stroke
Reviewed by Professor James McLeod, Neurologist
DISCLAIMER: The information provided is designed to support, not replace, the relationship that exists between a patient / site visitor and his / her existing health care professionals.