Meningitis

Issue

Vol. 2 No. 2 (2025)

Date Log

Submitted
March 5, 2025
Accepted
May 11, 2025
Published
May 11, 2025

Understanding Meningitis: Causes, Symptoms, and Lifesaving Insights

https://doi.org/10.69512/ajphi.v2i2.93
Rochana Acharya, MD
Department of Internal Medicine, Cleveland Clinic Foundation, OH, USA
https://orcid.org/0000-0001-7293-8207
Gauri Adhikari, MD
Department of Internal Medicine, Washington University/Consortium at Missouri Baptist Medical Center, MO, USA
https://orcid.org/0000-0002-4250-9839

Corresponding Author(s) : Rochana Acharya, MD

rochanaacharya2054@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 2 (2025)

Abstract


  1. Meningitis is a life-threatening inflammation of the meninges, which is the protective membranes covering the brain and spinal cord.

  2. Bacterial meningitis is the most dangerous form, as it can progress rapidly, causing brain damage or even death if not treated in time.

  3. Meningitis can affect anyone, but certain groups, such as infants, young children, the elderly, and people with weakened immune systems, are at higher risk.

  4. Vaccines like meningococcal, Hemophilus Influenza B, and pneumococcal vaccines have reduced the incidence of bacterial meningitis in many parts of the world.

Keywords

meningitis symptoms causes of meningitis viral meningitis bacterial meningitis meningitis treatment meningitis vaccine meningitis prevention
Acharya, MD, R., & Adhikari, MD, G. (2025). Understanding Meningitis: Causes, Symptoms, and Lifesaving Insights. The American Journal of Patient Health Info, 2(2). https://doi.org/10.69512/ajphi.v2i2.93
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References
  1. World Health Organization. Meningitis. [Internet]. 2023 [cited 2024 Jul 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis
  2. Hersi K, Gonzalez FJ, Kondamudi NP. Meningitis. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459360/
  3. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.Available from: https://pubmed.ncbi.nlm.nih.gov/21612470/
  4. Oordt-Speets AM, Bolijn R, van Hoorn RC, Bhavsar A, Kyaw MH. Global etiology of bacterial meningitis: A systematic review and meta-analysis. PLOS ONE. 2018 Jun 11;13(6): e0198772.Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198772
  5. Mount HR, Boyle SD. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. American Family Physician [Internet]. 2017 Sep 1;96(5):314–22. Available from: https://pubmed.ncbi.nlm.nih.gov/28925647/
  6. Hall AD, Kumar JE, Golba CE, Luckett KM, Bryant WK. Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases. Parasitology Research. 2024 Jan 1;123(1). Available from: https://link.springer.com/article/10.1007/s00436-023-08094-w
  7. Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. N Engl J Med. 2004 Oct 28;351(18):1849-59. Available from: https://pubmed.ncbi.nlm.nih.gov/15509818/
  8. Sín R;Struncova D;Cechurova L. Clinical picture, diagnostics and treatment of bacterial meningitis. Neuro endocrinology letters [Internet]. 2022 [cited 2024 Dec 6];43(7-8). Available from: https://pubmed.ncbi.nlm.nih.gov/36720125
  9. Sanaei Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis. Medicine. 2017 Sep;96(35):e7637. Available from: https://pubmed.ncbi.nlm.nih.gov/28858084
  10. Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJA. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgraduate Medical Journal [Internet]. 2010 Aug 1 [cited 2019 Oct 21];86(1018):478–85. Available from: https://pmj.bmj.com/content/86/1018/478
  11. Wagner K, Springer B, Pires VP, Keller PM. Pathogen Identification by Multiplex LightMix Real-Time PCR Assay in Patients with Meningitis and Culture-Negative Cerebrospinal Fluid Specimens. Ledeboer NA, editor. Journal of Clinical Microbiology. 2017 Dec 13;56(2). Available from: https://pubmed.ncbi.nlm.nih.gov/29237781
  12. Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010 May;10(5):317-28. Available from: https://pubmed.ncbi.nlm.nih.gov/20417414/
  13. Centers for Disease Control and Prevention. Selection of antibiotics as prophylaxis for close contacts of patients with meningococcal disease in areas with ciprofloxacin resistance. MMWR Morb Mortal Wkly Rep. 2024 [cited 2024 Jul 25]. Available from: https://www.cdc.gov
  14. Centers for Disease Control and Prevention (CDC). Haemophilus influenzae Disease. [Internet]. 2024 [cited 2024 Jul 25]. Available from: https://www.cdc.gov
  15. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020;69(No. RR-9):1-41. Available from: http://dx.doi.org/10.15585/mmwr.rr6909a1
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Rochana Acharyaa, Gauri Adhikarib

a Department of Internal Medicine, Cleveland Clinic Foundation, OH, USA

b Department of Internal Medicine, Washington University/Consortium at Missouri Baptist Medical Center, MO, USA

Background

The human brain and spinal cord are surrounded by a protective layer of tissue called the meninges. Meningitis is a serious health condition in which the covering layers, which are closely attached to the brain and spinal cord, become irritated and inflamed. While it is usually due to infections from bacteria or viruses, it can happen without any infection.

Meningitis can affect individuals of all ages, but it occurs more frequently in children. [1] Epidemics have been reported worldwide, with sub-Saharan Africa being especially affected. Although bacterial meningitis is uncommon in the United States, it is still a major health concern. Each year, around 1 to 2 people per 100,000 are diagnosed with it in the U.S. Without fast and proper treatment, it can be life-threatening, and about 1 in 7 people who develop the disease may die. [2, 3]

Types of Meningitis

Figure 1.

  • Bacterial Meningitis: This is the most severe form of meningitis and is caused by bacteria such as Neisseria meningitidis and Streptococcus pneumoniae. Bacterial meningitis can develop rapidly, and without immediate antibiotic treatment, it can lead to brain damage, hearing loss, or even death. [2, 4]
  • Viral Meningitis: This is caused by viruses like enteroviruses, herpes simplex virus, or HIV. Viral meningitis is more common than bacterial meningitis and is usually less severe, with most people recovering fully within a few weeks without specific antiviral treatment. [2, 5]
  • Fungal Meningitis: It is rare but more serious. It generally affects people with weakened immune systems, such as those with HIV/AIDS or those undergoing chemotherapy. [2]
  • Parasitic Meningitis: It is a rare but deadly brain infection caused by Naegleria fowleri, a parasite found in warm freshwater like lakes and hot springs. It mainly affects children and young people who swim or dive in these waters. The risk is higher in tropical and subtropical regions. [6]
  • Non-Infectious Meningitis: It occurs due to conditions like cancer, certain medicines, or immune system disorders. [1,2]

Risk Factors of Meningitis

Figure 2.

  • Close Contact in Crowded Environments: Bacteria and viruses that cause meningitis can spread through respiratory droplets when an infected person coughs, sneezes, or has close contact with others. The risk is higher in crowded places like schools, dormitories, and military camps. [1,2]
  • Age: Newborns, infants, and young children are particularly vulnerable to meningitis, as their immune systems are not fully developed. Adults over 60 are also at higher risk, as the immune system weakens with age. [1,2]
  • Weakened Immune System: Conditions like HIV/AIDS, cancer, or treatments suppressing the immune system (e.g., chemotherapy or steroids) can increase the risk of developing meningitis. [1,2]
  • Travel to Endemic Areas: Traveling to regions where bacterial meningitis is common, such as parts of sub-Saharan Africa, increases the risk, especially in unvaccinated individuals. [1,2]
  • Head Injuries and Surgery: Head trauma, like skull fracture or surgery that involves the brain and nearby structures, can increase the risk of developing meningitis by providing an artificial pathway for bacteria or viruses to enter the meninges. [1, 2]

How Meningitis Spreads in The Body?

Meningitis, especially bacterial meningitis, can spread through tiny droplets from coughing or sneezing. You can catch it from someone sick or even someone who feels fine but carries the bacteria. The bacteria usually enter the nose or throat, grow there, and travel into the bloodstream. They reach the brain and spinal cord from the blood, crossing a protective layer called the blood-brain barrier. This can lead to serious infection and swelling of the brain’s protective layers.

Sometimes, the infection spreads from nearby areas, like the ears (ear infections) or sinuses. The infection can even enter the brain’s protective fluid during head injuries or surgeries. [2]

Symptoms of Meningitis

The symptoms of meningitis can come on quickly and feel like a bad flu at first. In adult cases of meningitis, headache, fever, neck stiffness, and confusion are the most common symptoms. Up to 95% of patients present with at least two of these four symptoms. [6] Here’s what you should look out for:

Figure 3.

  • Severe Headache: You might feel a pounding headache that doesn’t go away and feels worse than anything you’ve experienced. [6]
  • Stiff Neck: Turning or moving your neck could feel difficult or painful. Your neck muscles may be unusually tight. [6]
  • High Fever: A sudden spike in your body temperature could be one of the first warning signs. You may also feel chills or sweats. [6]
  • Sensitivity to Light (Photophobia): Bright lights might hurt your eyes or worsen your headache, causing you to avoid well-lit places. [2]
  • Confusion or Difficulty Concentrating: You may feel foggy, confused, or unable to think clearly. It might be hard to stay focused or remember things. [2]
  • Skin Rash: If you have bacterial meningitis caused by Neisseria meningitidis, you might notice small purplish spots or blotches on your skin that don’t fade when pressed. [7]

For babies and young children, the symptoms can be harder to spot. If your baby has meningitis, they may: [8]

  • The baby appears irritable or cries constantly in a high-pitched voice that is hard to soothe.
  • Have trouble feeding or refuse to eat.
  • Look very sleepy, floppy, or unresponsive.

Diagnosis of Meningitis

Diagnosing meningitis involves carefully reviewing the patient's symptoms, performing a physical examination of the nervous system, and using specific tests to confirm the condition.

Figure 4.

  • Blood Tests: Blood tests are essential to check for signs of infection and inflammation in the body. A complete blood count (CBC) can show an increase in white blood cells, which signals that the body is fighting an infection. Blood cultures are also taken to determine if bacteria or fungi exist in the bloodstream. Cultures also tell us what antibiotic best targets the bug causing your meningitis. Additional blood tests, like C-reactive protein (CRP) and procalcitonin levels, can help doctors tell whether the infection is bacterial or viral. [9]
  • Imaging: A computed tomography (CT) scan is typically the first test to rule out other conditions like brain swelling or bleeding quickly. While it can't directly diagnose meningitis, it helps assess immediate risks. An MRI of the brain provides more detailed images and examines the brain for inflammation or complications, such as fluid buildup or swelling. These imaging techniques complement a lumbar puncture. [10]
  • Lumbar Puncture: The lumbar puncture is the most important and accurate test for diagnosing meningitis. During this procedure, the patient lies on their side or sits up while the lower back is cleaned and numbed. A thin needle is then inserted between the bones of the lower spine to collect a small sample of cerebrospinal fluid (CSF). This fluid surrounds the brain and spinal cord. While you may feel pressure during the procedure, it is usually not painful. The entire process typically takes about 15–30 minutes. The sample is tested to confirm whether meningitis is present and whether bacteria, viruses, or fungi cause it. The results from the lumbar puncture help doctors choose the right treatment quickly. [7]
  • Polymerase Chain Reaction (PCR) Testing: It’s a special test that looks for tiny pieces of genetic material (DNA or RNA) from germs like bacteria, viruses, or fungi. Even if there is only a small amount of these germs, PCR can find them quickly.This test is very helpful when regular tests take too long or don’t show clear results, and if the patient is already on antibiotics, it can be harder to find bacteria with other tests. [11]

Treatment of Meningitis

Figure 5.

  • Antibiotics: If your doctor suspects bacterial meningitis, they will start antibiotics right away. This is very important because early treatment can save lives. At first, broad antibiotics are used to fight many types of bacteria. Once tests show exactly which bacteria are causing the infection, the treatment is adjusted to target them more directly.Doctors often use a combination of antibiotics, such as Ampicillin and Cefotaxime, along with an antiviral medicine called Acyclovir, for newborn babies. Older babies and children usually receive Ampicillin and Ceftriaxone. Adults between 18 and 49 are often treated with Ceftriaxone and Vancomycin. Adults over 50 or those with weak immune systems may need Ceftriaxone, Vancomycin, and Ampicillin together. Starting antibiotics quickly gives the best chance of recovery and lowers the risk of serious complications. [2,7]
  • Antiviral Medication: For viral meningitis caused by the herpes virus or certain other viruses, doctors may give antiviral medicines to help ease symptoms and speed up recovery. For most other types of viral meningitis, treatment mainly focuses on relieving symptoms and providing supportive care. [2]
  • Antifungal and Tuberculosis Medications for Meningitis: If meningitis is caused by a fungus, especially in people with weak immune systems, medicines like Amphotericin B, flucytosine, and fluconazole are used to fight the infection. Treatment for meningitis caused by tuberculosis (TB) includes a combination of four medications: isoniazid, rifampin, pyrazinamide, and ethambutol. Doctors may also add steroids to reduce swelling and protect the brain. These treatments usually must be taken for several months to clear the infection fully. [2]
  • Corticosteroids: Steroids like dexamethasone are often given before or with the first dose of antibiotics in bacterial meningitis. They help lower inflammation in the brain, which can reduce the risk of serious complications like hearing loss or brain damage. Timing is important, giving steroids early offers the best chance to prevent long-term problems. [2]
  • Supportive Care: In severe cases, hospitalization is needed to provide intravenous fluids, manage complications, and monitor your condition closely. Rest, pain management, and hydration are essential parts of recovery. [2]

Complications of Meningitis

Meningitis is a serious illness, especially if not treated quickly. Even with medical care, bacterial meningitis can still lead to severe problems. A low level of consciousness, such as being very drowsy or unresponsive, indicates a poor prognosis. [2]

Figure 6.

  • Brain Damage: Meningitis can cause lasting problems with memory, concentration, and thinking. [2]
  • Hearing Loss: The infection can damage the nerves responsible for hearing, leading to partial or complete hearing loss. [2]
  • Seizures: Swelling in the brain can cause seizures during or after the illness. [2]
  • Fluid buildup in the brain (Hydrocephalus): In some cases, fluid builds up, causing dangerous pressure and requiring further treatment. [12]
  • Blood Poisoning: The infection in the meninges can spread to the blood, affecting multiple other organs and causing organ failure. [12]
  • Learning and Development Problems: In children, meningitis can lead to learning difficulties or delays in development. [12]
  • Death: Meningitis can be life-threatening. Without prompt treatment, there is a risk of death. [2]

Prevention of Meningitis

Meningitis can spread through droplets when an infected person coughs or sneezes, putting people in close contact at risk. To protect exposed ones, preventive antibiotics, called chemoprophylaxis, are recommended. This works best if started within 24 hours of exposure, but can still help if given within 14 days.

People who may need chemoprophylaxis include:

  • Family members living in the same house.
  • Close friends or partners.
  • Roommates or people sharing a sleeping space (like dorms or military barracks).
  • Healthcare workers exposed to the patient’s mouth or breathing tubes.
  • Anyone who traveled with the patient for more than eight hours.

You usually don’t need preventive treatment for casual contact, like sharing a drink or cigarettes, unless you were also in close contact. [13]

Recommended antibiotics for preventing meningococcal meningitis include rifampicin, ciprofloxacin, and ceftriaxone, which eliminate the bacteria from the body and reduce transmission risk. Additionally, the CDC advises chemoprophylaxis with rifampin for household contacts of patients with Haemophilus influenzae meningitis, particularly children under four who are not fully vaccinated or are immunocompromised. [14]

But remember, not all meningitis can be prevented. Some types, like those caused by certain viruses, fungi, or other medical conditions, don’t have vaccines or specific prevention. That’s why early detection and treatment are just as important. [14]

Vaccination for Meningitis

Vaccination is one of the most effective ways to prevent meningitis and protect against severe complications. Several vaccines target the most common causes of meningitis, including bacterial forms. The meningococcal vaccine helps protect against Neisseria meningitidis, a leading cause of bacterial meningitis. It is typically recommended for adolescents, young adults, and individuals at higher risk, such as those living in close quarters like dormitories or military barracks. A booster dose is often advised for continued protection. [15]

The Haemophilus influenzae type b (Hib) vaccine is given to infants as part of routine childhood immunizations and has significantly reduced cases of meningitis caused by this bacterium.

The Pneumococcal vaccine protects against Streptococcus pneumoniae, another major cause of bacterial meningitis. It is recommended for young children, older adults, and individuals with weakened immune systems or certain chronic conditions. [2,15]

Questions To Ask Your Doctor

  1. How long does it typically take to recover from meningitis?
  2. Does meningitis affect mental health during or after the illness?
  3. How many months before shifting into a college dorm should I get vaccinated against meningitis?
  4. What dietary changes should I consider during recovery from meningitis?
  5. If I’ve had meningitis before, does that increase my risk of getting it again, or am I now protected from it?

Peer Reviewed By

Dr. Sumit Saurav Karna, MD

​​Charleston Area Medical Center, WV, USA

Conflict of Interest

RA has no conflict of interest to declare. GA worked as a paid research assistant for ehealthyinfo from 6/2023 till 5/2025. There is no other conflict of interest to declare.

References

  1. World Health Organization. Meningitis. [Internet]. 2023 [cited 2024 Jul 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis
  2. Hersi K, Gonzalez FJ, Kondamudi NP. Meningitis. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459360/
  3. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.Available from: https://pubmed.ncbi.nlm.nih.gov/21612470/
  4. Oordt-Speets AM, Bolijn R, van Hoorn RC, Bhavsar A, Kyaw MH. Global etiology of bacterial meningitis: A systematic review and meta-analysis. PLOS ONE. 2018 Jun 11;13(6): e0198772.Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198772
  5. Mount HR, Boyle SD. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. American Family Physician [Internet]. 2017 Sep 1;96(5):314–22. Available from: https://pubmed.ncbi.nlm.nih.gov/28925647/
  6. Hall AD, Kumar JE, Golba CE, Luckett KM, Bryant WK. Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases. Parasitology Research. 2024 Jan 1;123(1). Available from: https://link.springer.com/article/10.1007/s00436-023-08094-w
  7. Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. N Engl J Med. 2004 Oct 28;351(18):1849-59. Available from: https://pubmed.ncbi.nlm.nih.gov/15509818/
  8. Sín R;Struncova D;Cechurova L. Clinical picture, diagnostics and treatment of bacterial meningitis. Neuro endocrinology letters [Internet]. 2022 [cited 2024 Dec 6];43(7-8). Available from: https://pubmed.ncbi.nlm.nih.gov/36720125
  9. Sanaei Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis. Medicine. 2017 Sep;96(35):e7637. Available from: https://pubmed.ncbi.nlm.nih.gov/28858084
  10. Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJA. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgraduate Medical Journal [Internet]. 2010 Aug 1 [cited 2019 Oct 21];86(1018):478–85. Available from: https://pmj.bmj.com/content/86/1018/478
  11. Wagner K, Springer B, Pires VP, Keller PM. Pathogen Identification by Multiplex LightMix Real-Time PCR Assay in Patients with Meningitis and Culture-Negative Cerebrospinal Fluid Specimens. Ledeboer NA, editor. Journal of Clinical Microbiology. 2017 Dec 13;56(2). Available from: https://pubmed.ncbi.nlm.nih.gov/29237781
  12. Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010 May;10(5):317-28. Available from: https://pubmed.ncbi.nlm.nih.gov/20417414/
  13. Centers for Disease Control and Prevention. Selection of antibiotics as prophylaxis for close contacts of patients with meningococcal disease in areas with ciprofloxacin resistance. MMWR Morb Mortal Wkly Rep. 2024 [cited 2024 Jul 25]. Available from: https://www.cdc.gov
  14. Centers for Disease Control and Prevention (CDC). Haemophilus influenzae Disease. [Internet]. 2024 [cited 2024 Jul 25]. Available from: https://www.cdc.gov
  15. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020;69(No. RR-9):1-41. Available from: http://dx.doi.org/10.15585/mmwr.rr6909a1

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