Meningitis and sore throat

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When Neck Stiffness May Mean Meningitis

Meningitis is a serious condition that occurs when the meninges—protective membranes covering the brain and spinal cord—become infected and inflamed. Early symptoms can be similar to the flu. However, having a stiff neck in addition to flu-like symptoms could be a key clue that meningitis is the problem and should be checked by a doctor.

See Spinal Cord Anatomy in the Neck

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Patients should seek immediate medical attention if a stiff neck is accompanied by a fever, headache and/or nausea. See When Is a Stiff Neck Serious?

There are several types of meningitis, but this article focuses on the two most common ones: viral and bacterial. In cases where someone has contracted bacterial meningitis, finding medical attention immediately (within a few hours of initial symptoms) can be the difference between making a full recovery and permanent disability or death.

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Common Symptoms

Meningitis can start suddenly, and early symptoms may include one or more of the following:

  • Fever. Running a fever is a common part of the immune system’s defense against infections. A fever with meningitis will usually be above 103 degrees, but not always.
  • Headache. A headache caused by meningitis is typically described as severe and unrelenting. It does not subside by taking an aspirin.
  • See How Neck Pain and Headache Can Occur Together

  • Stiff neck. This symptom most commonly involves a reduced ability to flex the neck forward, also called nuchal rigidity. Depending on the severity of the nuchal rigidity, the neck might be able to flex about half of what it could do before, or it might hardly flex at all.

See Stiff Neck Causes, Symptoms, and Treatment

As time goes on, other symptoms can develop, such as nausea, vomiting, sensitivity to light or noises, cognitive problems with concentration and memory, and many other latter-stage symptoms.

See Neck Pain Symptoms

In addition, it should be noted that bacterial and viral meningitis are both contagious, so they are more likely to be contracted and spread in areas where people live in close quarters, such as college dorms or military barracks.

In This Article:

  • When Neck Stiffness May Mean Meningitis
  • How Meningitis Causes Neck Pain and Stiffness
  • Video: What Causes a Stiff Neck?

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Because meningitis is such a serious condition, patients with symptoms of the disease will often start treatment before an official diagnosis is confirmed through diagnostic tests.

Meningitis Diagnosis

Diagnosing meningitis is difficult and requires the insight of a medical professional. If meningitis is suspected based on the patient history and physical exam, diagnostic tests will need to be done. These tests could include one or more of the following:

  • Spinal tap. A spinal tap, also called a lumbar puncture, involves inserting a needle into the spinal canal in the lower back (a safe distance beneath the spinal cord) and drawing a sample of cerebrospinal fluid. Numerous lab tests will be run on the cerebrospinal fluid, such as to measure glucose, protein, red and white blood cell counts, and to determine which specific bacteria, virus, or other microorganisms might be present. The spinal tap and its associated tests are critical to achieving an official meningitis diagnosis.
  • Blood tests. Before the spinal tap, typically blood tests will be done for a quick analysis to look for inflammatory markers suggestive of an infection or other illness. In some cases, a blood test could indicate meningitis is unlikely, preventing the need for the patient to undergo an invasive spinal tap.
  • Imaging study. A CT scan or MRI scan of the brain is usually done before the spinal tap, especially if symptoms include any neurological deficits such as confusion or light sensitivity. An imaging study may show brain swelling and whether it is safe for a spinal tap to be performed. If it is determined that a change in cerebrospinal fluid (CSF) pressure from a spinal tap could cause the brain to herniate and move downward, the procedure will need to be delayed until the pressure on the brain is reduced.

See Diagnosing Neck Pain

The spinal tap’s lab results for potential bacterial or viral cultures can take a few days for enough growth to be analyzed, which is why an official meningitis diagnosis cannot typically be made the same day. However, faster tests are being researched and may be available in the future.1

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Treatment for Meningitis

Minutes matter when it comes to treating bacterial meningitis. As such, doctors cannot wait several hours or days to see if a lab test comes back positive for bacterial meningitis. If meningitis is suspected and cannot be ruled out by the initial examination, doctors will usually start treating the patient with a broad-spectrum antibiotic to prevent any potential bacterial meningitis from growing out of control.

After the test results come back, the doctor will know if meningitis is the official diagnosis, as well as what type. For viral meningitis, there is typically no specific treatment aside from getting rest and trying to maintain a healthy intake of fluids and nutrition. For bacterial meningitis, the broad-spectrum antibiotic will be replaced by an antibiotic that targets the specific bacteria causing the meningitis.

Depending on the patient and severity of the meningitis, other medications may also be used.

  • 1.Mayer L, et al. Chapter 6: Primary Culture and Presumptive Identification of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. In: Laboratory Methods for the Diagnosis of Meningitis Caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. 2nd ed. https://www.cdc.gov/meningitis/lab-manual/chpt06-culture-id.html. Updated 2011.

What are the effects of meningitis? 22 symptoms

Share on PinterestA severe headache is one of the common symptoms of meningitis.

Meningitis can affect the body in many different ways. Some symptoms, such as fever and stiff neck, may occur right away. Others, however, may appear after a person’s meningitis infection is gone.

While many people recover from meningitis with proper medical treatment, some people may have lifelong effects. Meningitis may cause the following effects during or after the infection:

1. Headache

One of the most common symptoms of meningitis is a severe headache. The inflammation that occurs near the brain and spinal cord can result in significant pain. This headache may be mistaken for a migraine.

2. Sudden fever

A fever is the body’s way of trying to fight a foreign invader, such as a virus or bacteria. A high fever is common in both the early and later stages of the illness.

3. Confusion and learning problems

The swelling and inflammation can cause confusion and behavioral changes. In some cases, long-term problems with memory and concentration can occur. Children may experience learning difficulties.

4. Bulging soft spot

Babies have areas on the head known as fontanels, which are gaps where the skull’s bones have not yet fused together. The largest fontanel is on top of the head and should feel firm and slightly indented. If a baby’s fontanel appears to be bulging, this could be a sign of brain swelling or fluid buildup, which requires emergency medical attention.

5. Stiff neck

A child or baby with a stiff neck from meningitis may hold their head and neck straight and be unwilling or unable to bend the head forward. An adult may notice a painful, stiff neck during the acute phase of meningitis.

6. Sensitivity to light

Brain swelling and headache resulting from meningitis can result in light sensitivity and a worsening headache when looking toward a light. Babies or children may cry or turn away from light.

7. Sleepiness or difficulty waking

If a person cannot be woken up or seems to be excessively sleepy, this may be an early symptom of meningitis infection. The illness may affect the brain’s alertness, making it hard for a person to stay awake.

8. Extreme fatigue

As the body tries to fight the infection, a person with meningitis may become extremely lethargic with little to no energy.

9. Lack of appetite

All systems of the body can be altered when the brain is swollen from a meningitis infection. This means a person may not feel like eating or may be feeling too ill to eat.

10. Nausea and vomiting

Share on PinterestStomach upset and vomiting may be effects of meningitis.

A severe headache, brain swelling, and the body’s defense against the illness can cause stomach upset and vomiting, especially in children.

11. Loss of consciousness

If swelling and inflammation put too much pressure on the brain, a person may faint or lose consciousness.

12. Rash

Several different types of meningitis may cause a rash. If a person is significantly ill with fever and develops a rash, they should seek medical care.

13. Seizures or epilepsy

When meningitis causes brain swelling or pressure, it can disrupt the brain’s normal function, causing a seizure. Having seizures during an episode of meningitis does not mean that a person has, or will develop, epilepsy. However, because this pressure and inflammation can permanently damage the brain, occasionally people develop epilepsy after recovering from meningitis.

14. Coma

In severe cases of meningitis, a person may experience enough brain damage to cause a coma.

15. Memory loss

After recovering from meningitis, some people experience problems with memory. This can be a result of damage to the brain during the illness.

16. Trouble concentrating

Children who have recovered from meningitis may have difficulty concentrating due to lingering brain damage. Adults may struggle to focus at work or in everyday activities, such as conversations or reading a book.

17. Hearing loss, ringing in the ears, or deafness

Hearing loss is a common effect after meningitis infection in children and adults. After recovering from meningitis, people should have a hearing test to check for potential hearing problems. The hearing loss may range from mild to severe, and it can be permanent in some cases. Ringing in the ears or tinnitus can also occur after meningitis.

18. Vision loss or blindness

The optic nerve, which plays an essential role in vision, can occasionally be damaged after a meningitis infection. This can cause temporary or permanent blurry vision or even blindness. During the acute stage of illness, a person may also experience double vision.

19. Speech problems

The brain controls a person’s speech, and if it becomes damaged through meningitis, a person’s speech patterns may change, although this is rare. Speech therapy can sometimes help a person regain their ability to speak after recovering from the illness.

20. Dizziness or loss of balance

The brain and ears interact to help a person keep their balance and their awareness of space around them. This can be disrupted by swelling in the brain, leading to a loss of coordination, dizziness, and falls. If this happens, it usually goes away after the meningitis resolves.

21. Kidney failure

Some types of bacterial meningitis can cause kidney (renal) failure or long-term kidney damage. Some medications for meningitis can also damage the kidneys.

22. Adrenal gland failure

A rare but severe complication of bacterial meningitis (usually meningococcal meningitis) known as Waterhouse-Friderichsen syndrome can cause the adrenal glands to stop working. This causes the body to go into shock and can be fatal.

First Aid: Stiff Neck

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A stiff neck without other symptoms might be caused by minor muscle strain from sleeping in an odd position or looking down at a phone too long.

If your child has a stiff neck along with a fever and a headache, it could be more serious. For instance, meningitis is a rare infection of the covering of the brain and spinal cord that can cause a stiff neck, headache, and fever.

What to Do

If your child has a stiff or sore neck but no fever or other symptoms:

  • put a warm moist cloth on the neck as often as needed for pain
  • give acetaminophen or ibuprofen for pain
  • call the doctor if symptoms last more than a few days

Get Medical Care if Your Child Has a Stiff Neck and:

  • had a recent injury
  • has been bitten by a tick within the last month
  • has a fever (or lower-than-normal temperature in babies)
  • seems very tired or drowsy
  • is very cranky (or is a baby and can’t be comforted)
  • has a lasting headache
  • is vomiting
  • has a skin rash
  • has flu-like symptoms
  • is an infant and has a weak suck, high-pitched cry, or a bulging soft spot on the skull

Think Prevention!

  • Get all routine immunizations on time, especially the meningococcal vaccine, which protects against bacterial meningitis.
  • Help kids avoid tick bites:
    • Use insect repellent (with no more than 10% to 30% concentration of DEET).
    • Check kids and pets often for ticks.
    • Make sure kids wear long pants and long-sleeved shirts in high-risk outdoor areas.
  • Have children avoid activities and equipment known to be risky for neck injuries.

Reviewed by: Kate M. Cronan, MD Date reviewed: February 2019

5. Who is at risk for meningitis?
A person of any age may develop bacterial meningitis. But it is more common in infants and young children and in people older than age 60. Because of close contact with peers, teens and college students are at greater risk, too. Although more common in children, viral meningitis occurs in people of all ages. Having a weakened immune system or traveling to certain foreign countries also increases your risk for meningitis.

6. Is meningitis contagious?
Close contact – not casual contact at work or school – can spread the bacteria and viruses that cause meningitis. This includes kissing, coughing, or sneezing. Sharing eating utensils, glasses, food, or towels can also spread these bacteria and viruses.

7. What are the signs and symptoms of meningitis?
Although symptoms may vary, the more common signs and symptoms of meningitis include:

    • High fever
    • Severe, persistent headaches
    • Neck stiffness
    • Vomiting
    • Discomfort in bright lights
    • Drowsiness
    • Lack of appetite

Later symptoms can include rash, seizure, and coma. Infants with meningitis may be lethargic, irritable, or not feed well.

8. What should I do if someone I know has symptoms of meningitis?
Call the doctor and describe the signs and symptoms. If you cannot reach a doctor, go to the nearest emergency room right away. If you do not have transportation, call 911.

9. How do doctors diagnose meningitis?
In addition to taking a history and doing a physical exam, the doctor will collect a sample of spinal fluid, called a spinal tap. The doctor inserts a needle into the lower back to remove the fluid. The doctor examines this sample for signs of inflammation and infection.

Other tests may include:

    • A neurological exam to test nerve, motor, and sensory function; hearing, speech, and vision; balance; mental status
    • Blood and urine tests
    • Throat culture
    • Computed tomography (CT), magnetic resonance imaging (MRI), or electroencephalography (EEG) to spot problems in the brain

10. How do doctors treat meningitis?
Depending upon the severity of illness, you may need to be hospitalized. Bacterial infections require prompt treatment with intravenous antibiotics. This may begin even before diagnosis is confirmed. Treatment for viral infections is mainly aimed at relieving symptoms.
As needed, treatment may also include:

    • Intravenous fluids
    • Anticonvulsants for any seizures
    • Pain relievers
    • Other treatments for brain swelling

Meningitis and Encephalitis Fact Sheet

What is meningitis? What is encephalitis?

Infections and other disorders affecting the brain and spinal cord can activate the immune system, which leads to inflammation. These diseases, and the resulting inflammation, can produce a wide range of symptoms, including fever, headache, seizures, and changes in behavior or confusion. In extreme cases, these can cause brain damage, stroke, or even death.

Inflammation of the meninges, the membranes that surround the brain and spinal cord, is called meningitis; inflammation of the brain itself is called encephalitis. Myelitis refers to inflammation of the spinal cord. When both the brain and the spinal cord are involved, the condition is called encephalomyelitis.

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What causes meningitis and encephalitis?

Infectious causes of meningitis and encephalitis include bacteria, viruses, fungi, and parasites. For some individuals, environmental exposure (such as a parasite), recent travel, or an immunocompromised state (such as HIV, diabetes, steroids, chemotherapy treatment) are important risk factors. There are also non-infectious causes such as autoimmune/rheumatological diseases and certain medications.

Meningitis

Bacterial meningitis is a rare but potentially fatal disease. Several types of bacteria can first cause an upper respiratory tract infection and then travel through the bloodstream to the brain. The disease can also occur when certain bacteria invade the meninges directly. Bacterial meningitis can cause stroke, hearing loss, and permanent brain damage.

  • Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. Some 6,000 cases of pneumococcal meningitis are reported in the United States each year. The disease is caused by the bacterium Streptococcus pneumoniae, which also causes pneumonia, blood poisoning (septicemia), and ear and sinus infections. At particular risk are children under age 2 and adults with a weakened immune system. People who have had pneumococcal meningitis often suffer neurological damage ranging from deafness to severe brain damage. Immunizations are available for certain strains of the pneumococcal bacteria.
  • Meningococcal meningitis is caused by the bacterium Neisseria meningitides. Each year in the United States about 2,600 people get this highly contagious disease. High-risk groups include infants under the age of 1 year, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and college students (freshmen in particular), military recruits, and others who reside in dormitories. Between 10 and 15 percent of cases are fatal, with another 10-15 percent causing brain damage and other serious side effects. If meningococcal meningitis is diagnosed, people in close contact with an infected individual should be given preventative antibiotics.
  • Haemophilus influenzae meningitis was at one time the most common form of bacterial meningitis. Fortunately, the Haemophilus influenzae b vaccine has greatly reduced the number of cases in the United States. Those most at risk of getting this disease are children in child-care settings and children who do not have access to the vaccine.

Other forms of bacterial meningitis include Listeria monocytogenes meningitis (in which certain foods such as unpasteurized dairy or deli meats are sometimes implicated); Escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal; and Mycobacterium tuberculosis meningitis, a rare disease that occurs when the bacterium that causes tuberculosis attacks the meninges.

Viral, or aseptic, meningitis is usually caused by enteroviruses—common viruses that enter the body through the mouth and travel to the brain and surrounding tissues where they multiply. Enteroviruses are present in mucus, saliva, and feces, and can be transmitted through direct contact with an infected person or an infected object or surface. Other viruses that cause meningitis include varicella zoster (the virus that causes chicken pox and can appear decades later as shingles), influenza, mumps, HIV, and herpes simplex type 2 (genital herpes).

Fungal infections can affect the brain. The most common form of fungal meningitis is caused by the fungus cryptococcus neoformans (found mainly in dirt and bird droppings). Cryptococcal meningitis mostly occurs in immunocompromised individuals such as those with AIDS but can also occur in healthy people. Some of these cases can be slow to develop and smolder for weeks. Although treatable, fungal meningitis often recurs in nearly half of affected persons.

Parasitic causes include cysticercosis (a tapeworm infection in the brain), which is common in other parts of the world, as well as cerebral malaria.

There are rare cases of amoebic meningitis, sometimes related to fresh water swimming, which can be rapidly fatal.

Encephalitis

Encephalitis, usually viral, can be caused by some of the same infections listed above. However, up to 60 percent of cases remain undiagnosed. Several thousand cases of encephalitis are reported each year, but many more may occur since the symptoms may be mild to non-existent in most individuals.

Most diagnosed cases of encephalitis in the United States are caused by herpes simplex virus types 1 and 2, arboviruses (such as West Nile Virus), which are transmitted from infected animals to humans through the bite of an infected tick, mosquito, or other blood-sucking insect, or enteroviruses. Lyme disease, a bacterial infection spread by tick bite, occasionally causes meningitis, and very rarely encephalitis. Rabies virus, which is transmitted by bites of rabid animals, is an extremely rare cause of human encephalitis.

Herpes simplex encephalitis (HSE) is responsible for about 10 percent of all encephalitis cases, with a frequency of about 2 cases per million persons per year. More than half of untreated cases are fatal. About 30 percent of cases result from the initial infection with the herpes simplex virus; the majority of cases are caused by reactivation of an earlier infection. Most people acquire herpes simplex virus type 1 (the cause of cold sores or fever blisters) in childhood.

HSE due to herpes simplex virus type 1 can affect any age group but is most often seen in persons under age 20 or over age 40. This rapidly progressing disease is the single most important cause of fatal sporadic encephalitis in the United States. Symptoms can include headache and fever for up to 5 days, followed by personality and behavioral changes, seizures, hallucinations, and altered levels of consciousness. Brain damage in adults and in children beyond the first month of life is usually seen in the frontal lobes (leading to behavioral and personality changes) and temporal lobes (leading to memory and speech problems) and can be severe.

Type 2 virus (genital herpes) is most often transmitted through sexual contact. Many people do not know they are infected and may not have active genital lesions. An infected mother can transmit the disease to her child at birth, through contact with genital secretions. In newborns, symptoms such as lethargy, irritability, tremors, seizures, and poor feeding generally develop between 4 and 11 days after delivery.

Four common forms of mosquito-transmitted viral encephalitis are seen in the United States:

  • Equine encephalitis affects horses and humans.
    • Eastern equine encephalitis also infects birds that live in freshwater swamps of the eastern U.S. seaboard and along the Gulf Coast. In humans, symptoms are seen 4-10 days following transmission and include sudden fever, general flu-like muscle pains, and headache of increasing severity, followed by coma and death in severe cases. About half of infected individuals die from the disorder. Fewer than 10 human cases are seen annually in the United States.
    • Western equine encephalitis is seen in farming areas in the western and central plains states. Symptoms begin 5-10 days following infection. Children, particularly those under 12 months of age, are affected more severely than adults and may have permanent neurologic damage. Death occurs in about 3 percent of cases.
    • Venezuelan equine encephalitis is very rare in this country. Children are at greatest risk of developing severe complications, while adults generally develop flu-like symptoms. Epidemics in South and Central America have killed thousands of persons and left others with permanent, severe neurologic damage.
  • LaCrosse encephalitis occurs most often in the upper midwestern states (Illinois, Wisconsin, Indiana, Ohio, Minnesota, and Iowa) but also has been reported in the southeastern and mid-Atlantic regions of the country. Most cases are seen in children under age 16. Symptoms such as vomiting, headache, fever, and lethargy appear 5-10 days following infection. Severe complications include seizures, coma, and permanent neurologic damage. About 100 cases of LaCrosse encephalitis are reported each year.
  • St. Louis encephalitis is most prevalent in temperate regions of the United States but can occur throughout most of the country. The disease is generally milder in children than in adults, with elderly adults at highest risk of severe disease or death. Symptoms typically appear 7-10 days following infection and include headache and fever. In more severe cases, confusion and disorientation, tremors, convulsions (especially in the very young), and coma may occur.
  • West Nile encephalitis is usually transmitted by a bite from an infected mosquito, but can also occur after transplantation of an infected organ or transfusions of infected blood or blood products. Symptoms are flu-like and include fever, headache, and joint pain. Some individuals may develop a skin rash and swollen lymph glands, while others may not show any symptoms. At highest risk are older adults and people with weakened immune systems.

Outside the United States, Japanese encephalitis is one of the most common causes of encephalitis worldwide. It is widespread in Asia and is transmitted by a mosquito. A vaccine is available so travelers to at-risk areas should discuss this with their healthcare provider.

Powassan encephalitis is rare but is the only well-documented tick-borne arbovirus in the United States and Canada. Symptoms are noticed 7-10 days following the bite (most people do not notice tick bites) and may include headache, fever, nausea, confusion, partial paralysis, coma, and seizures.

It is also possible to develop encephalitis that has non-infectious or autoimmune causes. Some cases of encephalitis are caused by an autoimmune disorder that may in some instances be triggered by an infection (“post infectious”) or by a cancer – even one that is microscopic and cannot be found (so-called paraneoplastic neurological syndromes). NMDA-Receptor encephalitis is a type of autoantibody-mediated encephalitis and is being increasingly recognized; it was the most documented form of non-bacterial meningitis reported in the long-term study and follow-up of participants in the California Encephalitis project. Treatment involves immunosuppression and/or tumor removal if such a cause is found.

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Who is at risk for encephalitis and meningitis?

Anyone—from infants to older adults—can get encephalitis or meningitis. People with weakened immune systems, including those persons with HIV or those taking immunosuppressant drugs, are at increased risk.

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How are these disorders transmitted?

Some forms of bacterial meningitis and encephalitis are contagious and can be spread through contact with saliva, nasal discharge, feces, or respiratory and throat secretions (often spread through kissing, coughing, or sharing drinking glasses, eating utensils, or such personal items as toothbrushes, lipstick, or cigarettes). For example, people sharing a household, at a day care center, or in a classroom with an infected person can become infected. College students living in dormitories—in particular, college freshmen—have a higher risk of contracting meningococcal meningitis than college students overall. Children who have not been given routine vaccines are at increased risk of developing certain types of bacterial meningitis.

Because these diseases can occur suddenly and progress rapidly, anyone who is suspected of having either meningitis or encephalitis should immediately contact a doctor or go to the hospital.

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What are the signs and symptoms?

The hallmark signs of meningitis include some or all of the following: sudden fever, severe headache, nausea or vomiting, double vision, drowsiness, sensitivity to bright light, and a stiff neck. Encephalitis can be characterized by fever, seizures, change in behavior, and confusion and disorientation. Related neurological signs depend on which part of the brain is affected by the encephalitic process as some of these are quite localized while others are more widespread.

Meningitis often appears with flu-like symptoms that develop over 1-2 days. Distinctive rashes are typically seen in some forms of the disease. Meningococcal meningitis may be associated with kidney and adrenal gland failure and shock.

Individuals with encephalitis often show mild flu-like symptoms. In more severe cases, people may experience problems with speech or hearing, double vision, hallucinations, personality changes, and loss of consciousness. Other severe complications include loss of sensation in some parts of the body, muscle weakness, partial paralysis in the arms and legs, impaired judgment, seizures, and memory loss.

Important signs of meningitis or encephalitis to watch for in an infant include fever, lethargy, not waking for feedings, vomiting, body stiffness, unexplained/unusual irritability, and a full or bulging fontanel (the soft spot on the top of the head).

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How are meningitis and encephalitis diagnosed?

Following a physical exam and medical history to review activities of the past several days or weeks (such as recent exposure to insects, ticks or animals, any contact with ill persons, or recent travel; preexisting medical conditions and medications), the doctor may order various diagnostic tests to confirm the presence of infection or inflammation. Early diagnosis is vital, as symptoms can appear suddenly and escalate to brain damage, hearing and/or speech loss, blindness, or even death.

Diagnostic tests include:

  • A neurological examination involves a series of physical examination tests designed to assess motor and sensory function, nerve function, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior.
  • Laboratory screening of blood, urine, and body secretions can help detect and identify brain and/or spinal cord infection and determine the presence of antibodies and foreign proteins. Such tests can also rule out metabolic conditions that may have similar symptoms.
  • Analysis of the cerebrospinal fluid that surrounds and protects the brain and spinal cord can detect infections in the brain and/or spinal cord, acute and chronic inflammation, and other diseases. A small amount of cerebrospinal fluid is removed by a special needle that is inserted into the lower back and the fluid is tested to detect the presence of bacteria, blood, and viruses. The testing can also measure glucose levels (a low glucose level can be seen in bacterial or fungal meningitis) and white blood cells (elevated white blood cell counts are a sign of inflammation), as well as protein and antibody levels.

Brain imaging can reveal signs of brain inflammation, internal bleeding or hemorrhage, or other brain abnormalities. Two painless, noninvasive imaging procedures are routinely used to diagnose meningitis and encephalitis.

  • Computed tomography, also known as a CT scan, combines x-rays and computer technology to produce rapid, clear, two-dimensional images of organs, bones, and tissues. Occasionally a contrast dye is injected into the bloodstream to highlight the different tissues in the brain and to detect signs of encephalitis or inflammation of the meninges.
  • Magnetic resonance imaging (MRI) uses computer-generated radio waves and a strong magnet to produce detailed images of body structures, including tissues, organs, bones, and nerves. An MRI can help identify brain and spinal cord inflammation, infection, tumors, and other conditions. A contrast dye may be injected prior to the test to reveal more detail.

Additionally, electroencephalography, or EEG, can identify abnormal brain waves by monitoring electrical activity in the brain noninvasively through the skull. Among its many functions, EEG is used to help diagnose patterns that may suggest specific viral infections such as herpes virus and to detect seizures that don’t show any clinical symptoms but may contribute to an altered level of consciousness in critically ill individuals.

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How are these infections treated?

People who are suspected of having meningitis or encephalitis should receive immediate, aggressive medical treatment. Both diseases can progress quickly and have the potential to cause severe, irreversible neurological damage.

Meningitis

Early treatment of bacterial meningitis involves antibiotics that can cross the blood-brain barrier (a lining of cells that keeps harmful micro-organisms and chemicals from entering the brain). Appropriate antibiotic treatment for most types of meningitis can greatly reduce the risk of dying from the disease. Anticonvulsants to prevent seizures and corticosteroids to reduce brain inflammation may be prescribed.

Infected sinuses may need to be drained. Corticosteroids such as prednisone may be ordered to relieve brain pressure and swelling and to prevent hearing loss that is common in Haemophilus influenza meningitis. Lyme disease is treated with antibiotics.

Antibiotics, developed to kill bacteria, are not effective against viruses. Fortunately, viral meningitis is rarely life threatening and no specific treatment is needed. Fungal meningitis is treated with intravenous antifungal medications.

Encephalitis

Antiviral drugs used to treat viral encephalitis include acyclovir and ganciclovir. For most encephalitis-causing viruses, no specific treatment is available.

Autoimmune causes of encephalitis are treated with additional immunosuppressant drugs and screening for underlying tumors when appropriate. Acute disseminated encephalomyelitis, a non-infectious inflammatory brain disease mostly seen in children, is treated with steroids.

Anticonvulsants may be prescribed to stop or prevent seizures. Corticosteroids can reduce brain swelling. Affected individuals with breathing difficulties may require artificial respiration.

Once the acute illness is under control, comprehensive rehabilitation should include cognitive rehabilitation and physical, speech, and occupational therapy.

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Can meningitis and encephalitis be prevented?

People should avoid sharing food, utensils, glasses, and other objects with someone who may be exposed to or have the infection. People should wash their hands often with soap and rinse under running water.

Effective vaccines are available to prevent Haemophilus influenza, pneumococcal and meningococcal meningitis.

People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure.

To lessen the risk of being bitten by an infected mosquito or other arthropod, people should limit outdoor activities at night, wear long-sleeved clothing when outdoors, use insect repellents that are most effective for that particular region of the country, and rid lawn and outdoor areas of free-standing pools of water, in which mosquitoes breed. Repellants should not be over-applied, particularly on young children and especially infants, as chemicals such as DEET may be absorbed through the skin.

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What is the prognosis for these infections?

Outcome generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild encephalitis or meningitis can make a full recovery, although the process may be slow.

Individuals who experience only headache, fever, and stiff neck may recover in 2-4 weeks. Individuals with bacterial meningitis typically show some relief 48-72 hours following initial treatment but are more likely to experience complications caused by the disease. In more serious cases, these diseases can cause hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. These individuals may need long-term therapy, medication, and supportive care.

The recovery from encephalitis is variable depending on the cause of the disease and extent of brain inflammation.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

Current research efforts include basic studies of host immune responses, gaining a better understanding of how the central nervous system responds to inflammation, and the role of T cells (blood cells involved in immune system response) in suppressing infection in the brain. Scientists hope to better understand the molecular mechanisms involved in the protection and disruption of the blood-brain barrier, which could lead to the development of new treatments for several neuroinflammatory diseases such as meningitis and encephalitis. Other scientists hope to define, at a molecular level, how certain viruses overcome the body’s defense mechanisms and interact with target host cells. A possible therapeutic approach under investigation involves testing neuroprotective compounds that block the damage that may follow infection and inflammation of meningitis and encephalitis and potentially lead to complications, including loss of cognitive function and dementia. Additional research focuses on autoimmune causes of encephalitis and the optimal treatments for them.

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

Meningitis Foundation of America, Inc.
P.O. Box 1818
El Mirage, AZ 85335

Tel: 480-270-2652

HHV-6 Foundation
1482 East Valley Road, Suite 619
Santa Barbara, CA 93108
888-530-6726

NIAID Office of Communications and Government Relations
National Institutes of Health, DHHS
5601 Fishers Lane, MSC 9806
Bethesda, MD 20892

Tel: 301-496-5717

U.S. Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
800-232-4636

National Library of Medicine/MedlinePlus
National Institutes of Health

“Meningitis and Encephalitis Fact Sheet”, NINDS, Publication date June 2018.

NIH Publication No. 18-NS-4840

Back to Meningitis and Enchephalitis Information Page

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Meningitis y Encefalitis

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

Meningitis is an inflammation of the meninges, the tissues that surround and protect the spinal cord and brain. Meningitis is a serious condition that is most commonly caused by viral or bacterial infections, and requires urgent medical attention. If you think you, or somebody else, is displaying symptoms of meningitis then you should seek medical help immediately. The symptoms of meningitis differ between ages, so it is important to know which symptoms to look out for.

What are the symptoms of meningitis?

The symptoms of meningitis in babies include:

  • Crying, which is sometimes described as an unusual cry
  • Cold hands and feet, even with a fever
  • Pale or blotchy skin, which may turn blue
  • Refusing to feed
  • Fast or unusual breathing
  • A bulging fontanelle (the soft spot on the head)
  • Drowsiness and difficult to wake up
  • Jerky movements or convulsions
  • Stiff or floppy body

The symptoms of meningitis in older children and adults include:

  • Severe headache
  • Fever
  • Stiff neck
  • Nausea and vomiting
  • Sensitivity to light
  • Tiredness and lack of energy
  • Confusion
  • Seizures

The first signs of the meningitis can be hard to spot – the early symptoms of meningitis are very similar to those of the flu and other milder illnesses, so meningitis can be very difficult to identify at first. As meningitis can be potentially life-threatening, it is important to learn how to identify the early symptoms that distinguish meningitis from other illnesses.

A bad headache and a stiff neck are telltale signs of meningitis – while a number of the early symptoms of meningitis have similarities to other illnesses, a severe headache and a stiff neck are signs that the meninges in the head and neck may be becoming inflamed as a result of meningitis. These two symptoms are key to look out for to help differentiate meningitis from the flu. Sensitivity to light is also another symptom that is not commonly seen in illnesses such as the flu, which can also be indicative of meningitis.

The “tumbler test” cannot be relied on to identify meningitis – a well known symptom of meningitis is the distinctive red rash that does not fade when a glass is pressed against it (this is called the glass test or tumbler test). This rash is actually a sign of blood poisoning (septicaemia) caused by bacterial meningitis, which means that the infection has already spread and urgent medical attention is required. As the red rash is a symptom of sepsis secondary to only one type of meningitis (bacterial meningitis), lots of cases of meningitis may not display this symptom.

How long do the symptoms of meningitis take to appear?

The first symptoms of meningitis typically happen very quickly – much like the flu, the symptoms of meningitis can come on quite suddenly and progress in a short amount of time. This is especially true for bacterial meningitis, the second most common type of meningitis in the UK, which can progress to causing serious health complications or even death in a matter of hours.

Symptoms of viral meningitis appear within a week – viral meningitis is usually milder and less aggressive than bacterial meningitis, and the symptoms come on slower. The first symptoms of viral meningitis typically appear between 3 to 7 days after being exposed to the infection.

Symptoms of bacterial meningitis appear and progress quickly – bacterial meningitis is the most dangerous type of meningitis, and the infection progresses the fastest. Symptoms of bacterial meningitis can appear just a few hours, though in some cases may appear 1 to 2 days afterwards. Because of this, it is vital to seek treatment immediately if symptoms appear.

Fungal meningitis comes on gradually – fungal meningitis is a very rare type of meningitis in the UK, but is more common in regions of Africa. Fungal meningitis is caused by the inhalation of fungal spores in dirt and soil, which then infect the spinal cord and brain. Fungal meningitis has a very gradual onset, typically over the course of weeks or even months, which can make it even harder to detect than other forms of meningitis.

How long do the symptoms of meningitis last?

The length of time depends on the type and treatment – as there different types of meningitis that are caused by different triggers, the length of time you will be symptomatic depends on the type of meningitis that you have been affected by. Getting early treatment, particularly for bacterial meningitis, will improve the chances that you will fully recover without suffering long term after-effects. Treatment will depend on what type of infection caused the symptoms of meningitis, but typically antibiotics will be administered directly into the vein before the diagnosis has been confirmed. This is a precaution taken in case of bacterial meningitis, which can progress rapidly without treatment. If the diagnosis confirms that you do not have bacterial meningitis, then antibiotic treatment will stop.

Viral meningitis – the symptoms of viral meningitis are typically quite mild, and will usually go away in 7-10 days without requiring extensive treatment. Once diagnosed by a medical professional, most cases of viral meningitis can be recovered from at home with rest and painkillers.

Bacterial meningitis – bacterial meningitis has a sudden onset, and can cause serious health problems, or even death, within 24 hours if left untreated. If treated early, the symptoms of bacterial meningitis can improve in as little as 2-3 days.

Fungal meningitis – fungal meningitis has a gradual onset, but also takes a long time to recover from. Depending on the type of fungus that has caused this infection, symptoms can last for weeks to months even with treatment.

Parasitic meningitis – meningitis caused by a parasitic infection can progress rapidly, usually over the course of 1 to 12 days, and is fatal in almost all cases. Between 1962 and 2008, 97% of confirmed cases of meningitis caused by the parasite Naegleria fowleri the US were fatal.

Non-infectious meningitis – non-infectious meningitis, as an umbrella term for meningitis caused by a variety of non-infectious triggers, is dependant on what has lead to the inflammation. Symptoms can be expected to be relieved after the underlying cause has been diagnosed and treated.

The after-effects of meningitis can be lifelong – some survivors of meningitis will suffer lifelong health complications that may have a significant impact on their lives. For those who do experience long-term after-effects of meningitis, there are a number of organisations that can offer support and advice, for example Meningitis Now and the NHS’s counselling services, which you can talk to your GP about. Some after-effects of meningitis may be managed with the assistance of medical technology, such as cochlear implants for those who have experienced hearing loss, or prosthetic limbs for amputees.

What happens as meningitis progresses?

Meningitis can be life-threatening – all types of meningitis can cause serious health complications if they are left untreated, especially bacterial meningitis. Bacterial meningitis is fatal in up to 70% of cases when it is not treated, and is estimated to be fatal in 10% of cases where it is treated.

Meningitis can cause life-changing after-effects – meningitis, as an inflammation of the tissues around the brain and spine, can lead to long-term health complications in survivors. It is estimated that 20% of survivors of bacterial meningitis will suffer after-effects as a result.

Possible complications of meningitis include:

  • Partial or total hearing loss
  • Partial or total vision loss
  • Neurological damage, such as memory loss and behavioural changes
  • Epilepsy
  • Difficulty with movement and coordination
  • Loss of limbs
  • Septicaemia (bacterial meningitis only)

What should I do if I think I’m having symptoms of meningitis?

Meningitis is a medical emergency – left untreated, all types of meningitis have the potential to cause death or life-altering after-effects. If you are seriously ill and suspect that it is as a result of meningitis, call 999 or go to the nearest A&E immediately for emergency care.

Do not wait to see if your symptoms improve – it’s better to be safe than sorry with meningitis, as the infection can progress rapidly and could potentially have a serious impact on your health if not treated in a timely manner. If your symptoms are mild, or even if you’re not completely sure that you’re displaying symptoms of meningitis at all, you can still call NHS 111 for advice. You’ll be put in contact with a trained adviser who will be able to offer assistance, and let you know whether or not you need to see a doctor.

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Patient Education

Viral Meningitis

Meningitis is an infection in the fluid (cerebrospinal fluid) that covers your brain and spinal cord. It may cause headache, stiff neck, irritability, fever, drowsiness, nausea, and vomiting.

Most cases of meningitis are caused by bacteria or viruses. Bacterial meningitis is more serious. It may cause permanent complications. You would need to be treated in the hospital with antibiotics. But your tests show that you have viral meningitis. This is much less serious. It rarely causes any complications. You can take care of a mild case at home.

Most cases of viral meningitis are passed from person to person through coughing, sneezing, and close contact. West Nile virus is a rare cause of viral meningitis. It is passed by mosquito bites.

Antibiotics are not used to treat viral meningitis. You may be given other medicines to treat your symptoms. It will take 2 to 7 days to recover from viral meningitis. You may have headaches that come and go for up to 2 weeks.

In rare cases, what looks like viral meningitis may turn out to be early bacterial meningitis. That’s why it’s important to be rechecked. Call your healthcare provider or come back to this facility if your symptoms get worse or new symptoms appear.

Home care

Follow these tips when taking care of yourself at home:

  • Rest in bed until you are feeling better. Stay home from school or work for at least 7 days, or until all symptoms are gone.

  • Use acetaminophen or ibuprofen for fever and to relieve pain, unless another pain medicine was prescribed. Note: If you have chronic liver or kidney disease, talk with your healthcare provider before taking these medicines. Also talk with your provider if you’ve had a stomach ulcer or gastrointestinal bleeding. Don’t give aspirin to anyone younger than 18 years old who is ill with a fever. It may cause severe liver damage.

  • If you have a fever, drink extra water, sports drinks, or other fluids. This will keep you from getting dehydrated.

  • Wash your hands often with soap and water to prevent spreading the infection.

Follow-up care

Follow up with your healthcare provider, or as advised. This is to make sure you are getting better as expected.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Headache or stiff neck that gets worse

  • Drowsiness, confusion, or bizarre behavior

  • You can’t keep fluids down because of vomiting

  • Fever of 100.4°F (38°C) or higher that doesn’t get better after you take fever medicine. or as advised

  • Weakness or numbness in an arm or leg

  • Difficulty speaking, swallowing, or walking

  • Seizure

Meningitis in Children

What is meningitis in children?

The two types of meningitis in children are viral meningitis (which is more common and usually goes away on its own) and bacterial meningitis (which is rare, but it can be life threatening and cause serious complications if not treated quickly).

Any child can get meningitis, but the following groups are more at risk:

  • Students living together in close quarters, such as in boarding school or college dormitories
  • Children who are not properly vaccinated (routine vaccinations lower your child’s risk of getting both bacterial and viral meningitis)
  • Children with cochlear implants

Symptoms of meningitis in children

Symptoms of meningitis in children vary depending on the type of meningitis. Viral meningitis often causes mild, flu-like symptoms (fever and headache) that go away on their own. Bacterial meningitis can have more serious symptoms and requires medical care right away.

Contact your pediatrician if your child has the following symptoms:

  • Sudden high fever
  • Severe headache
  • Stiff neck
  • Nausea or vomiting
  • Sensitivity to light

Contact your pediatrician right away if your child has meningitis symptoms. If symptoms come on suddenly, immediately call 911 or take your child to the emergency room. Quick treatment can prevent serious complications, such as brain damage or death.

If your child has a cochlear implant, contact your pediatrician if your child has any infection, such as an ear or sinus infection. Receiving proper medical care for a bacterial infection lowers the chance that the infection may spread and cause meningitis.

Symptoms of meningitis in babies

Babies with meningitis may have different symptoms than older children. Contact your pediatrician if your baby has any of the following symptoms:

  • Fever
  • Poor feeding
  • Body or neck stiffness
  • Irritability (difficult to comfort)
  • Sleepiness, lack of energy
  • Bulging soft spot on the head

Vaccines that prevent bacterial meningitis in children

Meningitis can be caused by many different types of bacteria. Vaccines can prevent your child from getting certain bacterial infections that cause meningitis.

Haemophilus influenzae type b (Hib) vaccine

Before the vaccine, H. influenzae was the leading cause of bacterial meningitis in children younger than 5 years old. On a routine vaccination schedule, your child will receive three to four doses of the vaccine, the first one at 2 months of age and the last one at about a year old.

Meningococcal vaccines

Meningococcus is the most common cause of bacterial meningitis in children and teenagers. It is very contagious and can cause outbreaks in college dormitories and military bases.

There are two types of the meningococcal vaccine:

  • Meningococcal conjugate vaccine is recommended for all children. Your child will receive the first shot at age 11 or 12, and then a booster at age 16.
  • Meningococcal B vaccine is not yet part of routine vaccination. It is recommended in certain cases, such as during an outbreak, in preparation for foreign travel, or before living in a dormitory.

Pneumococcal conjugate vaccine

Pneumococcus can cause bacterial meningitis and may lead to long-term brain damage. The pneumococcal conjugate vaccine protects against 13 strains of this type of bacteria. As part of a routine vaccination program, your child will receive doses of the vaccine between 2 and 15 months of age.

Vaccines that prevent viral meningitis

By following your pediatrician’s routine vaccination schedule, your child will be protected against some viral infections that can lead to meningitis, such as the following:

  • Measles
  • Mumps
  • Chickenpox
  • Influenza

Care for children with meningitis at Rush

Diagnosis

Your pediatrician will test your child’s blood and spinal fluid to determine what type of meningitis your child has. Your pediatrician may also order imaging tests to look for signs of inflammation in your child’s brain or spinal cord.

Treatment

A child with viral meningitis can usually recover at home. Your child will need to drink plenty of fluids to prevent dehydration. You can use over-the-counter pain relievers to control your child’s pain.

For bacterial meningitis, your child will be hospitalized and begin receiving intravenous antibiotics right away. Your child may also receive corticosteroids to control inflammation.

After recovery, your child’s care team may evaluate your child to check for neurological damage caused by the infection. This may include a hearing test or other tests to check brain function. Your child may be referred to a pediatric neurologist to address any neurological side effects from the illness.

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