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The symptoms of meningitis can vary quite widely in their severity, Sax said. Almost all people say they are tired, don’t feel right and can’t think straight, and some types of meningitis may cause a red rash on the body, he said.
The most common form of the disease in the United States is viral meningitis, which is usually less severe than meningitis caused by bacteria. Bacterial meningitis is very serious and can be deadly but is fairly rare in the U.S., Sax told Live Science, and is more common in a region known as the ‘meningitis belt’ in sub-Saharan Africa.
About 3,000 people in the U.S. are diagnosed with bacterial meningitis each year, and most of them are infants, children, college students and older adults, according to Boston Children’s Hospital. Between 10% to 15% of those who contract bacterial meningitis die from the infection.
- Causes and risk factors
- Symptoms of meningitis
- Diagnosis and treatment
- Meningitis in babies (0 to 12 months)
- What is meningitis?
- Which vaccines protect my baby against meningitis?
- How does meningitis spread?
- What are the signs and symptoms of meningitis?
- How will I know if my baby’s rash is the meningitis rash?
- How is meningitis diagnosed?
- What is the treatment for meningitis?
- Can newborn babies get meningitis?
- Neonatal Meningitis: Causes, Treatment, and Prevention
- Meningitis in Babies
Causes and risk factors
Bacterial meningitis can be spread by coming into contact with an infected person’s respiratory or throat secretions through coughing, sneezing, kissing or sharing food, drinks and eating utensils.
Teens and young adults, such as students in college dorms or military barracks, may be at higher risk for bacterial meningitis because of their social interactions and from living in close contact with one another.
Four of the most common bacteria species that cause meningitis include:
- Neisseria meningitidis, which is a specific type of bacteria normally found in people’s noses and throats. In rare cases, this bacteria can enter the bloodstream and travel to the fluid surrounding the brain and spinal cord, causing an illness known as meningococcal disease. This type is very contagious and can spread rapidly in large group settings, such as college campuses.
- Streptococcus pneumoniae bacteria can cause pneumococcal meningitis, which is the most serious form of bacterial meningitis.
- Haemophilus influenzae type b bacteria (Hib) typically affects children under age 5. It once was the leading cause of meningitis in young children in the U.S., but has nearly been eliminated since infant vaccination against Hib was recommended in 1989.
- Listeria monocytogenes is a type of bacteria that has become a more frequent cause of meningitis in newborns, pregnant women, adults over age 60 and people with weak immune systems in the past few decades, according to Massachusetts General Hospital.
The most common cause of viral meningitis in the U.S. is non-polio enteroviruses, according to the CDC. Other viruses, such as the ones that cause mumps, herpes and chickenpox, measles, flu and mosquito-transmitted arboviruses (like West Nile virus), can also cause the infection.
These viruses are found in the throat and feces of infected people. People can spread viral meningitis to others by coughing or sneezing, or by coming into contact with feces, such as when a person is changing a diaper or a soiled sheet.
People can develop fungal meningitis, which is rare in the U.S., when they breathe in fungal spores that live in soil or on decaying wood, or spores found in bird or bat droppings. The illness is almost always seen in those with weakened immune systems due to HIV or organ transplant, for example, Sax said.
Symptoms of meningitis
Some of the early signs of meningitis may come on suddenly and resemble the flu. Symptoms of bacterial meningitis usually show up three to seven days after a person is exposed to the infection, according to the CDC.
Bacterial meningitis symptoms may include:
- Sudden high fever
- Severe headache
- Stiff neck
- Eyes are more sensitive to light
- Lack of appetite
- Lack of energy
A red or purple skin rash may appear with meningococcal meningitis as the disease progresses.
Signs of bacterial meningitis in babies may include:
- Constant crying
- Excessive sleepiness or irritability
- Poor feeding
- Inactivity or sluggishness
- A bulge in the soft spot on a baby’s head (fontanelle)
- Stiffness in a baby’s body or neck
Other forms of meningitis have similar symptoms to those listed above.
Diagnosis and treatment
The key diagnostic test for evaluating meningitis is a spinal tap (lumbar puncture), Sax said. This test extracts a sample of fluid surrounding the spinal cord to analyze whether the cause of meningitis is bacterial, viral or fungal. Diagnostic tests have significantly improved over the years — they are better at detecting the cause of meningitis and can provide results in just a few hours, he said.
Brain imaging tests, such as a CT scan or an MRI, may also help doctors detect whether there is brain inflammation.
Bacterial meningitis is a serious illness that requires hospitalization, and its symptoms can quickly become life-threatening without prompt antibiotic treatment, according to the Mayo Clinic.
Fortunately, there are antibiotics that are very active against bacterial meningitis, Sax said. When a person is suspected of having meningitis, that individual is started on a broad-spectrum antibiotic, which can target many species of bacteria, and when the exact cause of the infection is determined, treatment is changed to a narrower, more specific antibiotic.
Most people recover from bacterial meningitis, but some individuals may develop permanent complications, such as brain damage, hearing loss, learning disabilities and memory problems as a result of the infection, according to the CDC.
There is no specific treatment for viral meningitis other than rest, fluids and over-the-counter pain relievers. Most people with the mild form of the viral infection recover within seven to 10 days, according to the CDC.
Fungal meningitis is treated with high doses of antifungal medications that are often given intravenously.
There are very good vaccines that can prevent some of the most common causes of bacterial meningitis, Sax said. One of the great advances in pediatric medicine has been the development of the H. influenzae type b vaccine (Hib), which has almost completely eliminated this form of bacterial meningitis in children in the U.S., he said.
According to Boston Children’s Hospital, the following vaccines can help prevent bacterial meningitis:
- The H. influenzae type b vaccine (Hib), which is typically given as a three- or four-part series of routine childhood vaccinations starting at 2 months of age.
- The pneumococcal conjugate vaccine, which is recommended for all children younger than age 2 and is given to infants as a four-part series of vaccinations.
- The meningococcal conjugate vaccine, which is typically given to kids ages 11 to 12 to prevent meningococcal meningitis, a highly contagious form of this bacterial infection. A second dose is recommended at age 16. College freshman living in dorms and military recruits who have not been previously vaccinated are also advised to get this shot.
Two other vaccines, serogroup B meningococcal vaccine and pneumococcal polysaccharide vaccine 23-valent, may be recommended for children or adults at high risk for developing meningitis.
Most of the viruses that cause viral meningitis are not preventable by vaccine. The best ways to prevent viral meningitis are keeping healthy and practicing good hygiene, according to the CDC.
- Find out why meningococcal disease is more common in teens and college students, from the American Academy of Pediatrics.
- Read more about bacterial meningitis from the Merck Manual.
- Test your knowledge with this meningitis quiz — from the Columbia University Department of Neurology.
Meningitis in babies (0 to 12 months)
What is meningitis?
Meningitis is an inflammation of the membrane covering the brain and spinal cord (meninges) (NHS 2016a, NICE 2016). Meningitis develops quickly and can be very serious.
Meningitis is caused by a bacterial infection, or by a viral infection:
- Bacterial meningitis. This is the most serious form of meningitis. It can be life-threatening and can lead to disabilities, such as deafness or brain damage (NHS 2016a). Untreated bacterial meningitis can also lead to a fast-spreading infection of the blood (septicaemia), which is very dangerous (NHS 2016a). Septicaemia causes red or purple spots that don’t fade under pressure (NHS 2016a).
- Viral meningitis. This is the most common type of meningitis, and compared with bacterial meningitis, can be relatively mild. Although the flu-like symptoms may be unpleasant for your baby, she’s likely to recover without any treatment, in about seven to 10 days (Wan 2017).
Which vaccines protect my baby against meningitis?
The early childhood vaccination programme protects against the main bacterial and viral infections that can lead to meningitis.
These are the infections, and the vaccines that protect your baby against them:
- Meningococcal bacteria type B. The MenB vaccine is offered at two months, four months and one year.
- Haemophilus influenzae type B (Hib) bacteria. The Hib vaccine is offered at two months, three months, and four months.
- Meningococcal bacteria type C. The MenC vaccine is offered at one year, combined with a booster vaccine against Hib.
- Pneumococcal bacteria. Pneumococcal conjugate vaccine (PCV) is offered at two months and four months.
- Measles, mumps and rubella. The combined MMR vaccine protects against all three infections and is offered at 13 months.
- (NHS 2016a, b, PHE 2017)
How does meningitis spread?
The bacteria and viruses that cause meningitis live in people’s noses, throats and intestines. By themselves, they may not cause any side-effects. Meningitis only develops when these bacteria or viruses infect the membrane round the brain and spinal cord.
It’s rare for someone who’s already developed meningitis to pass it on (NHS 2016a). However, people who share a house with someone with bacterial meningitis are usually offered antibiotics as a precaution, because it’s potentially such a dangerous infection (NHS 2016a).
Your baby can pick up bacteria and viruses from:
- being kissed or touched
- people sneezing and coughing close by
- sharing eating and drinking utensils and other personal items, such as toothbrushes
- (NHS 2016a)
You can help to protect your baby against infection by following good hygiene. Wash your hands after coughing, sneezing, or blowing your nose, or after going to the toilet or changing nappies (Meningitis Now 2017). Try to make sure anyone who comes into close contact with your baby does the same.
What are the signs and symptoms of meningitis?
The early signs of bacterial meningitis, the most dangerous type, can be hard to spot. Symptoms may seem similar to a cold, tummy bug or flu, such as having a fever, or going off feeds (NHS 2016a).
Also, the signs of meningitis can vary from person to person, and can appear in any order, so there’s often no fixed pattern to look out for (Meningitis Now 2017, MRF nd).
If it’s meningitis, your baby will become seriously ill, quickly. If it’s bacterial meningitis, your baby’s doctor will work quickly to diagnose and treat the illness (NICE 2016). Most children are admitted to hospital within about 24 hours of appearing ill (NICE 2016).
Call 999 for an ambulance, or take your baby to the nearest accident and emergency (A&E) if you see one or more of the following signs of meningitis:
- She’s developed a rash that doesn’t disappear when you press a glass onto it. The rash starts as a few small red pinpricks that increase in number and size and turn dark purple.
- She’s agitated and restless, and seems unhappy if you pick her up.
- She has a bulging soft spot on her head (fontanelle).
- She’s drowsy, floppy or unresponsive.
- Her crying is unusually high-pitched.
- She is vomiting, and refusing to feed
- She has cold hands and feet.
- Her neck and body are stiff.
- She appears to dislike bright lights.
- Her breathing has changed, either faster or slower than normal, and/or she’s making a grunting noise.
- She’s arching her back.
- Her tummy is swollen.
- She has a seizure. There is a particular type of seizure called convulsive status epilepticus that can be caused by meningitis.
- (Meningitis Now 2017, MRF nd, NHS 2016a, NICE 2013)
This is not a checklist of signs and symptoms. For example, some young babies with meningitis don’t have neck stiffness, bulging fontanelles or the distinctive, high-pitched cry (NICE 2013). The rash doesn’t always appear, either (MRF nd, NHS 2016a). Trust your instincts and seek medical help if your baby’s symptoms are worrying or unusual.
How will I know if my baby’s rash is the meningitis rash?
It may start out looking like a normal rash, but the spots may be tiny, like pinpricks. Spots can appear anywhere on your baby’s body, including the roof of her mouth or inside her eyelids (NHS 2016a, NICE 2016). The spots are easier to see on paler areas of your baby’s body, such as:
- on the soles of her feet
- on her palms
- on her tummy
- (NHS 2016a, NICE 2016)
Use the glass test. Press the side of a clear drinking glass on to the spots. A meningitis rash doesn’t fade. It’s called a non-blanching rash.
The meningitis rash happens because septicaemia damages blood vessels, causing little leaks of blood. These leaks cause pinprick red spots to appear on the skin. As the leaks of blood get bigger, the spots can change into larger red or purple blotches, like bruises, and blood blisters (MRF nd).
A rash is a sign that the illness is severe and your baby needs urgent medical help (MRF nd, NICE 2016). In some cases, babies also develop sepsis, when the immune system overreacts to an infection by inflaming the whole body (NHS 2016c). Call 999 for an ambulance or go to A&E if you suspect your baby has the meningitis rash, as it could turn to sepsis. Is your child’s rash serious? A paediatrician explains which rashes are minor and which need urgent medical help.More baby expert videos
How is meningitis diagnosed?
At the hospital, a paediatrician will quickly assess your baby, looking for signs of meningitis (NHS 2016). The doctor will need to take a sample of your baby’s blood or a sample of fluid from his spine to tell whether it’s viral or bacterial meningitis (NHS 2016a). The doctor will take a spinal fluid sample in a procedure called lumbar puncture.
To do the lumbar puncture, the doctor inserts a very fine, hollow needle into your baby’s lower spine to remove fluid from the tissues around the spinal cord. The fluid is sent to a lab for testing.
It can take up to 45 minutes for the doctor to complete the lumbar puncture. It can be distressing to watch your baby going through invasive medical procedures, however necessary they are. You may find it easier to step out of the room for a break, at times. Your baby will be in good hands while you’re outside.
Your doctor may have the lumbar puncture results within 48 hours, but he won’t wait to get the results if he suspects bacterial meningitis (NHS 2015a). He’ll give your baby antibiotics as soon as possible, just in case (NICE 2010, 2016).
Your doctor may also request that your baby has a CT scan of her brain to check for swelling (NHS 2016a). This will involve your baby being placed in a machine that captures an image of the internal structures of her brain. It’s called a CT scan because it uses computed tomography, a type of computerised x-ray (NHS 2015b).
What is the treatment for meningitis?
Your baby’s treatment will depend on what type of meningitis she has:
Bacterial meningitis requires immediate treatment with antibiotics in hospital. If your baby’s very ill, she may be cared for in an intensive care unit.
Your baby’s treatment will depend on how severely ill she is, and what symptoms she has. Treatments for bacterial meningitis include:
- Antibiotics given via a drip into your baby’s vein to make sure she has regular doses of medication.
- Fluids given via a drip to keep your baby hydrated.
- Oxygen through a face mask.
- Steroid medication to help reduce any swelling around the brain.
- (NHS 2016a)
Your baby may need to stay in hospital for several days, or even weeks, depending on how ill she is (NHS 2016a).
Viral meningitis doesn’t respond to antibiotics, so your baby will just need rest and care. Your baby may have headaches, be grizzly and tired, and reluctant to feed (Wan 2017). She should recover within a week to 10 days. In the meantime:
- Encourage her to take small, frequent feeds of milk.
- Relieve her headache with infant paracetamol or infant ibuprofen.
- Keep her surroundings calm and quiet.
In very rare cases, viral meningitis can cause inflammation of the brain (encephalitis). This is a serious condition that may start off with typical flu-like symptoms, but can lead to much more serious signs of illness. Call 999 for an ambulance or take your baby to A&E if:
- She becomes very agitated, and unlike her usual self.
- She has seizures (fits).
- She’s moving her eyes in an odd way, for example, rapid side-to-side eye movements.
- (NHS 2016d)
Encephalitis as a complication of viral meningitis is treated with antiviral medication in hospital (Wan 2017).
Can newborn babies get meningitis?
It’s rare for newborns to contract meningitis in the UK (Meningitis Now 2017). It’s called neonatal meningitis when babies develop it in the first 28 days of their life (Meningitis Now 2017). Out of the 775,000 babies born each year in the UK, only 300 will develop neonatal meningitis (Meningitis Now 2017).
Premature babies born before 33 weeks and babies born with a low birth weight are more likely to develop neonatal meningitis (Muller 2017).
Neonatal meningitis is usually caused by the bacteria E coli and group B streptococcus (Meningitis Now 2017, Muller 2017). Babies can come into contact with these bacteria during birth, if their mums have the bacteria in their bodies (Meningitis Now 2017).
Very rarely, if a mum is infected with the bacterium listeria during pregnancy, it can cross the placenta to her baby. A listeria infection raises the risk of a baby being born with neonatal meningitis, or developing it after birth. Very few women pick up listeria in the UK, thanks to widespread awareness of the risks that it poses and of ways to avoid it (Meningitis Now 2017, Muller 2017).
Neonatal meningitis can be difficult to diagnose. If you are at all worried about your newborn, and she doesn’t seem well, get immediate medical advice.
Use our guide to when to call the doctor and always trust your instincts.
To see which vaccinations your baby will be offered and when, go to our immunisations scheduler. Last reviewed: March 2018 Meningitis Now. nd. After effects of septicaemia. www.meningitisnow.org
Meningitis Now. 2017. Neonatal meningitis, the facts. www.meningitisnow.org
MRF. nd. Symptoms checker for babies. www.meningitis.org
Muller ML. 2017. Paediatric bacterial meningitis. MedScape. emedicine.medscape.com
NHS. 2015a. Lumbar puncture. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2015b. CT scan. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016a. Meningitis. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016b. Vaccinations. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016c. Sepsis. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2016d. Encephalitis. NHS Choices, Health A-Z. www.nhs.uk
NICE. 2010. Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management. National Institute for Health and Care Excellence, Clinical guideline 102. www.nice.org.uk
NICE. 2013. Fever in under 5s: assessment and initial management. National Institute for Health and Care Excellence, Clinical guideline 160. www.nice.org.uk
NICE. 2016. Meningitis – bacterial meningitis and meningococcal disease. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. cks.nice.org.uk
PHE. 2017. A guide to immunisations up to one year of age. Public Health England. www.gov.uk
Wan C. 2017. Viral meningitis. MedScape. emedicine.medscape.com
Neonatal Meningitis: Causes, Treatment, and Prevention
In the United States, there are roughly 300 to 400 cases of neonatal meningitis for every 100,000 live births. A rare type of meningitis, this often life-threatening condition affects newborns and is caused by various bacteria, including group B strep, E. coli, and listeria.
The most common cause of neonatal meningitis in the United States is group B beta-hemolytic streptococcus, or group B strep. According to the U.S. Centers for Disease Control and Prevention, 10 to 30 percent of pregnant women carry group B strep, which can potentially lead to meningitis at or near the time of birth.
Neonatal meningitis can also be caused by Escherichia coli (E. coli), and in rare cases, listeria monocytogenes (listeria). Pregnant women are among those at high risk for developing listeriosis, a food-borne illness that results from contaminated foods like soft cheeses, hot dogs, and luncheon meats. Listeria can be passed on through the birth canal during pregnancy.
Symptoms of Neonatal Meningitis
Because neonatal meningitis can be fatal, any infant showing symptoms should be taken to the emergency room immediately. Signs of neonatal meningitis may include:
- Feeding poorly or refusing to feed
- Trouble breathing
- Bulging fonatelle, the soft spot at the top of the head
- Feeling too warm or too cold
Neonatal Meningitis Diagnosis and Treatment
When doctors suspect neonatal meningitis, the newborn will have a lumbar puncture, or spinal tap, a procedure in which a needle is inserted in the back to withdraw spinal fluid for laboratory examination. Infants with neonatal meningitis are generally treated with:
- Antimicrobial agents (medications that work against bacteria causing meningitis)
Depending on the severity of the illness, the infant may require other therapies, such as:
- Anticonvulsant medicine, if the baby is having seizures
- Monitoring with an intracranial (inside the head) pressure monitoring device placed
- Evaluation for cerebral abscess, a mass in the brain resulting from a bacterial or fungal infection
- Evaluation for hydrocephalus, commonly referred to as water on the brain
How to Prevent Neonatal Meningitis
If a pregnant woman is given antibiotics during labor, her baby’s risk of having group B strep disease is greatly reduced. Doctors typically test a woman for group B strep in the third trimester. Group B strep cannot be prevented by the mother taking antibiotics before going into labor.
Women who should receive antibiotics during labor include those who:
- Have previously had a baby with a group-B strep infection
- Have a urinary tract infection caused by group B strep
- Have group-B strep bacteria, but are not infected
Neonatal Meningitis: Avoiding Listeriosis
There are numerous ways to reduce your risk of listeriosis. Here are some tips:
- Thoroughly cook any raw food from animal sources
- Wash vegetables thoroughly before eating
- Do not drink unpasteurized milk or eat products made with unpasteurized milk
Neonatal meningitis is a serious condition. Take steps to educate yourself about the condition before you have a baby so that you can be familiar with the warning signs and minimize your child’s risk of infection.
Meningitis in Babies
Vaccines can prevent many, but not all, kinds of meningitis if they’re given as recommended by the CDC. None are 100 percent effective, so even babies that are vaccinated can get meningitis.
Note that although there’s a “meningitis vaccine,” it’s for one specific type of bacterial meningitis called meningococcal meningitis. It’s generally recommended for older children and teens in the United States. It’s not used in babies.
In some countries such as the United Kingdom, babies often do receive a meningitis vaccine.
Vaccines against viruses that can lead to meningitis are:
- Influenza. This protects against meningitis caused by the flu virus. It’s given every year starting at 6 months of age. Although younger babies don’t get this vaccine, it does offer protection when family members and others who will be around your baby are vaccinated.
- Varicella. This vaccine protects against chickenpox. The first is given when your baby is 12 months old.
- Measles, mumps, rubella (MMR). If your baby gets the measles or mumps, it can lead to meningitis. This vaccine protects against those viruses. The first dose is given at 12 months of age.
Vaccines to prevent infections that can lead to bacterial meningitis in babies are:
- Haemophilus influenzae type b (Hib) vaccine. This protects against H. influenza bacteria. In developed countries, like the United States, this vaccine has nearly eliminated this type of meningitis. The vaccine protects a baby from getting meningitis and from becoming a carrier. Reducing the number of carriers leads to herd immunity. This means that even babies who aren’t vaccinated have some protection since they’re less likely to come in contact with a carrier. The first dose is given at 2 months of age.
- Pneumococcal (PCV13) vaccine. This protects against meningitis due to many strains of Streptococcus pneumoniae. The first dose is given at 2 months of age.
- Meningococcal vaccine. This vaccine protects against Neisseria meningitidis. It’s not routinely given until age 11, unless there’s an issue with a baby’s immune system or they’re traveling to countries where the bacterium is common. If that’s the case, then it’s given starting at 2 months of age.
For group B strep, antibiotics can be given to the mother during labor to help prevent the baby from getting it.
Pregnant women should avoid cheese made with unpasteurized milk because it’s a common source of Listeria. This helps prevent the mother from contracting Listeria and then transferring it to her baby.
Follow general precautions to avoid infections and help lower the risk of getting meningitis from any bacteria or viruses:
- Wash your hands often, especially before handling food and after:
- using the bathroom
- changing your baby’s diaper
- covering your mouth to sneeze or cough
- blowing your nose
- taking care of someone who might be contagious or has an infection
- Use proper hand-washing technique. This means washing with soap and warm water for at least 20 seconds. Make sure to wash your wrists and under your nails and rings.
- Cover your mouth with the inside of your elbow or a tissue every time you sneeze or cough. If you use your hand to cover, wash it right away.
- Don’t share things that may carry saliva, such as straws, cups, plates, and utensils. Avoid kissing a person who’s sick.
- Don’t touch your mouth or face if your hands aren’t washed.
- Frequently clean and disinfect objects you often touch, such as your phone, computer keyboard, remote controls, doorknobs, and toys.
There are no vaccines for fungal meningitis. Babies aren’t normally in the environments where most fungi live, so they’re unlikely to get fungal meningitis.
Since it’s usually picked up in the hospital, using routine infection precautions can help prevent a Candida infection, which can lead to meningitis, in low-weight premature babies.