What are the common causes of viral meningitis. How does viral meningitis differ from bacterial meningitis. What are the typical symptoms of viral meningitis. How is viral meningitis diagnosed and treated. Can viral meningitis be prevented.

Understanding Viral Meningitis: An Overview

Viral meningitis is a condition characterized by inflammation of the meninges, the protective layers of tissue covering the brain and spinal cord. It also affects the subarachnoid space, a fluid-filled area between these layers. Unlike its bacterial counterpart, viral meningitis is generally less severe and often resolves on its own. However, it remains a significant health concern due to its potential complications and impact on quality of life.

Common Causes of Viral Meningitis

Viral meningitis can be caused by various viruses, with some being more prevalent than others. The most common culprits include:

• Enteroviruses (e.g., echovirus and coxsackievirus)
• Herpes simplex virus (HSV), particularly type 2 (HSV-2)
• Varicella-zoster virus
• Arboviruses (transmitted by mosquitoes)
• Lymphocytic choriomeningitis virus
• Human immunodeficiency virus (HIV)

Enteroviruses, which reside in the digestive tract, are the most frequent cause of viral meningitis. These infections are highly contagious and can spread rapidly through communities.

Recognizing the Symptoms of Viral Meningitis

The onset of viral meningitis typically begins with symptoms resembling a common viral infection. These initial signs may include:

• Fever
• General feeling of illness (malaise)
• Headache
• Muscle aches

As the condition progresses, more specific symptoms emerge:

• Severe headache
• Stiff neck (making it difficult or impossible to lower the chin to the chest)
• Sensitivity to light (photophobia)
• Nausea and vomiting
• Confusion or altered mental state (in severe cases)

Is fever always present in viral meningitis?

While fever is a common symptom of viral meningitis, it is not always present. Some individuals may experience mild or no fever, especially in the early stages of the infection. However, the absence of fever does not rule out meningitis, and other symptoms should be carefully evaluated.

Diagnosing Viral Meningitis: The Importance of Prompt Evaluation

Accurate diagnosis of viral meningitis is crucial for appropriate treatment and management. The diagnostic process typically involves:

1. Medical history and physical examination
2. Spinal tap (lumbar puncture) to analyze cerebrospinal fluid
3. Blood tests to check for signs of infection and inflammation
4. Imaging studies (e.g., CT scan or MRI) to rule out other conditions

The spinal tap is a key diagnostic tool, allowing doctors to differentiate between viral and bacterial meningitis based on the characteristics of the cerebrospinal fluid.

Why is rapid diagnosis important in suspected meningitis cases?

Rapid diagnosis is critical because bacterial meningitis, which can be life-threatening, requires immediate antibiotic treatment. In cases where the cause is uncertain, patients are often treated for bacterial meningitis until it can be ruled out, ensuring that potentially serious infections are not missed.

Treatment Approaches for Viral Meningitis

The treatment of viral meningitis varies depending on the causative agent and the severity of symptoms. In most cases, viral meningitis resolves on its own within a few weeks. However, supportive care is essential to manage symptoms and prevent complications.

What are the primary treatment strategies for viral meningitis?

Treatment approaches may include:

• Rest and hydration
• Over-the-counter pain relievers and fever reducers
• Antiviral medications for specific viral causes (e.g., acyclovir for herpes simplex virus)
• Antiretroviral therapy for HIV-associated meningitis
• Monitoring and management of intracranial pressure
• Supportive care to address symptoms like nausea and headache

For most viral causes, there are no specific antiviral drugs available. However, if the meningitis is caused by HIV or a herpesvirus, targeted antiviral therapy can be beneficial.

Distinguishing Viral Meningitis from Bacterial Meningitis

While viral and bacterial meningitis can present with similar symptoms, there are key differences that healthcare providers consider:

How do doctors differentiate between viral and bacterial meningitis?

The distinction is primarily made through analysis of the cerebrospinal fluid obtained during a lumbar puncture. Characteristics such as white blood cell count, glucose levels, and protein concentrations help determine the likely cause. Additionally, PCR testing and cultures can identify specific pathogens.

Potential Complications and Long-Term Effects of Viral Meningitis

While viral meningitis is generally less severe than its bacterial counterpart, it can still lead to complications in some cases. Potential long-term effects may include:

• Persistent headaches
• Memory problems
• Balance issues
• Fatigue
• Mood changes
• Hearing loss (rare)

Most people recover fully from viral meningitis without significant long-term effects. However, the recovery process can take weeks or even months in some cases.

Are certain populations at higher risk for complications from viral meningitis?

Yes, some groups are more vulnerable to severe outcomes:

• Infants and young children
• Elderly individuals
• People with weakened immune systems
• Those with certain underlying medical conditions

These high-risk groups may require closer monitoring and more aggressive supportive care during the course of the illness.

Prevention Strategies for Viral Meningitis

While not all cases of viral meningitis can be prevented, certain measures can reduce the risk of infection:

1. Practicing good hygiene, including regular handwashing
2. Avoiding close contact with individuals who have viral infections
3. Keeping vaccinations up to date, particularly for diseases that can lead to meningitis
4. Using insect repellent and taking precautions against mosquito bites in areas where arbovirus infections are common
5. Practicing safe sex to reduce the risk of sexually transmitted infections that can cause meningitis

Are there vaccines available to prevent viral meningitis?

While there are no vaccines specifically for viral meningitis, some vaccinations can prevent infections that may lead to meningitis. These include:

• Measles, mumps, and rubella (MMR) vaccine
• Varicella (chickenpox) vaccine
• Influenza vaccine

Additionally, maintaining overall health and a strong immune system can help reduce the risk of viral infections that may progress to meningitis.

Emerging Research and Future Directions in Viral Meningitis Management

The field of viral meningitis research is continuously evolving, with ongoing efforts to improve diagnosis, treatment, and prevention strategies. Some areas of current focus include:

• Development of rapid diagnostic tests to quickly differentiate between viral and bacterial meningitis
• Investigation of novel antiviral therapies for a broader range of causative agents
• Research into the long-term effects of viral meningitis and potential interventions to mitigate these impacts
• Exploration of genetic factors that may influence susceptibility to viral meningitis
• Studies on the role of the immune system in viral meningitis progression and recovery

How might future advancements change the landscape of viral meningitis management?

Potential future developments could include:

• More targeted and effective antiviral treatments
• Improved preventive strategies, including new vaccines
• Enhanced diagnostic tools for faster and more accurate identification of causative agents
• Personalized treatment approaches based on genetic and immunological factors
• Better understanding and management of long-term complications

These advancements could significantly improve outcomes for patients with viral meningitis and reduce the overall burden of the disease.

The Role of Public Health in Controlling Viral Meningitis Outbreaks

Public health agencies play a crucial role in monitoring, preventing, and controlling outbreaks of viral meningitis. Their responsibilities include:

1. Surveillance and data collection to track the incidence and patterns of viral meningitis
2. Implementing and promoting vaccination programs
3. Educating the public about prevention strategies and recognizing symptoms
4. Coordinating responses to outbreaks, including contact tracing and targeted interventions
5. Collaborating with healthcare providers and researchers to improve management strategies

How do public health measures contribute to reducing the impact of viral meningitis?

Effective public health initiatives can:

• Reduce the overall incidence of viral meningitis through prevention efforts
• Facilitate early detection and treatment of cases
• Limit the spread of infections within communities
• Improve public awareness and understanding of the disease
• Support research efforts by providing valuable epidemiological data

By addressing viral meningitis at a population level, public health measures complement clinical care in managing the overall burden of the disease.

Living with Viral Meningitis: Patient Experiences and Support

While most cases of viral meningitis resolve without long-term effects, the experience can be challenging for patients and their families. Understanding the patient perspective is crucial for comprehensive care and support.

What are common challenges faced by individuals recovering from viral meningitis?

Patients may encounter various difficulties during and after their illness, including:

• Persistent fatigue and weakness
• Cognitive difficulties, such as problems with concentration and memory
• Emotional impacts, including anxiety and depression
• Disruptions to work, education, or daily activities
• Concerns about potential recurrence or long-term effects

Support systems, including medical follow-up, psychological support, and patient support groups, can play a vital role in the recovery process. Healthcare providers should be attentive to these aspects of patient care and provide appropriate resources and referrals as needed.

As research continues to advance our understanding of viral meningitis, it is crucial to maintain a patient-centered approach, addressing both the immediate medical needs and the broader impact of the disease on individuals’ lives. By combining scientific advancements with compassionate care, we can continue to improve outcomes and quality of life for those affected by viral meningitis.

Viral Meningitis – Brain, Spinal Cord, and Nerve Disorders

By

John E. Greenlee

, MD, University of Utah Health

Reviewed/Revised Nov 2022

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Viral meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused by viruses.

• Viral meningitis usually begins with symptoms of a viral infection such as fever, a general feeling of illness, headache, and muscle aches.

• Later, people develop a headache and a stiff neck that makes lowering the chin to the chest difficult or impossible.

• Doctors suspect viral meningitis based on symptoms and do a spinal tap (lumbar puncture) to confirm the diagnosis.

• If people appear very ill, they are treated for bacterial meningitis until that diagnosis is ruled out.

• If the cause is human immunodeficiency virus (HIV) or a herpesvirus, drugs effective against those viruses are used.

• For other viruses, no effective drugs are available, but most people recover on their own within weeks.

(See also Introduction to Meningitis Introduction to Meningitis Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space). Meningitis can be… read more .)

The brain and spinal cord are covered by three layers of tissue called meninges. The subarachnoid space is located between the middle layer and the inner layer of the meninges, which cover the brain and spinal cord. It contains the cerebrospinal fluid, which flows through the meninges, fills the spaces within the brain, and helps cushion the brain and spinal cord.

Viral meningitis is the most common cause of aseptic meningitis. Aseptic meningitis refers to meningitis that is caused by anything other than the bacteria that typically cause meningitis. Thus, aseptic meningitis can include meningitis caused by drugs, disorders that are not infections, or other organisms (such as the bacteria that cause Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These… read more or syphilis Tertiary (third, or late) syphilis ).

Tissues Covering the Brain

The most common cause of viral meningitis is

• Enteroviruses Overview of Enterovirus Infections Enterovirus infections affect many parts of the body and may be caused by any of several different strains of enterovirus. Enterovirus infections are caused by many different viruses. Symptoms… read more , such as echovirus and coxsackievirus

Enteroviruses tend to reside in the digestive tract. Infections are very contagious.

Other common causes include

• Herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection… read more (HSV), usually type 2 (HSV-2)

• Varicella-zoster virus

• Viruses spread by mosquitoes (called arboviruses Epidemic encephalitis ), such as West Nile virus West Nile Virus Infection West Nile virus infection is a viral disease spread primarily from mosquitoes to people. Most people have mild or no symptoms, but some people develop a severe infection that affects the central… read more , St. Louis encephalitis virus, and California encephalitis virus

• Lymphocytic choriomeningitis virus

• Human immunodeficiency virus Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause… read more (HIV)

HSV-2 causes genital herpes Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection… read more , a sexually transmitted infection that causes painful blisters in the genital area. HSV-2 can also cause symptoms of meningitis. HSV-2 meningitis usually occurs when the virus first infects the body. Genital and meningitis symptoms can occur at the same time. Symptoms of meningitis may appear before the genital symptoms, and some people have meningitis but do not have any genital symptoms. After symptoms disappear, HSV-2 remains in the body in a nonactive (dormant) state. That is, it does not cause symptoms. However, it can become active again (reactivate) periodically and cause symptoms. Thus, meningitis due to HSV-2 Viruses Recurrent meningitis is meningitis that occurs more than once. Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space… read more can recur.

The varicella-zoster virus causes chickenpox Chickenpox Chickenpox is a highly contagious viral infection with the varicella-zoster virus that causes a characteristic itchy rash, consisting of small, raised, blistered, or crusted spots. Chickenpox… read more . Like HSV-2, the varicella-zoster virus remains in the body in a nonactive state. The virus may never cause symptoms again, or it may reactivate many years later. When it reactivates, it causes shingles Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. What causes the virus to reactive… read more (herpes zoster) and may cause meningitis. Unlike HSV infections, which can recur many times, shingles usually occurs only once in a person’s lifetime. However, people with a weakened immune system Overview of Immunodeficiency Disorders Immunodeficiency disorders involve malfunction of the immune system, resulting in infections that develop and recur more frequently, are more severe, and last longer than usual. Immunodeficiency… read more (such as people with HIV infection) may have shingles more than once.

Zika virus Zika Virus Infection Zika virus infection is a mosquito-borne viral infection that typically causes no symptoms but can cause fever, rash, joint pain, or infection of the membrane that covers the white of the eye. .. read more and Chikungunya virus Arboviruses sometimes cause meningitis. Both viruses were once present in only a few parts of the world but now have spread.

Occasionally, meningitis develops in people with COVID-19 COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose… read more . Rarely, this meningitis is caused by simultaneous infection with another virus (such as varicella-zoster virus).

Viral meningitis can be spread in several ways, depending on the virus:

• Spread through the bloodstream from an infection in another part of the body (the most common way)

• Contact with contaminated stool, which may occur when infected people do not wash their hands after a bowel movement or when they swim in a public swimming pool (for enteroviruses)

• Sexual intercourse or other genital contact with an infected person (for HSV-2 and HIV)

• A bite of an insect, such as a mosquito (for West Nile virus, St. Louis virus, Zika virus, or Chikungunya virus)

• Spread through the air by inhaling the virus (for varicella-zoster virus)

• Contact with dust or food contaminated by the urine or stool of infected mice or pet hamsters (for lymphocytic choriomeningitis virus)

• Use of infected needles to inject drugs (for HIV)

Because of the way they are spread, some viruses (such as those spread by mosquitoes) cause meningitis only during certain seasons.

Viral meningitis usually begins with symptoms of a viral infection, such as fever, a general feeling of illness (malaise), cough, muscle aches, vomiting, loss of appetite, and headache. However, occasionally, people have no symptoms at first.

Later, people have symptoms that suggest meningitis. That is, they typically have fever, headache, and a stiff neck. Trying to lower the chin to the chest causes pain and may be impossible. Moving the head in other directions is not as difficult.

Symptoms may resemble those of bacterial meningitis but are usually less severe and develop and progress more slowly.

• Spinal tap and analysis of cerebrospinal fluid

• Sometimes culture and testing of blood, other body fluids, or stool

Doctors suspect meningitis when people have a headache, fever, and stiff neck. They then try to determine whether meningitis is present and whether it is caused by bacteria (requiring immediate treatment) or a virus. Viral meningitis is more likely when the symptoms are less severe.

A spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which… read more (lumbar puncture) is done to obtain a sample of cerebrospinal fluid. However, if doctors suspect that pressure within the skull is increased, computed tomography (CT) or magnetic resonance imaging (MRI) may be done first to check for causes of the increased pressure (such as a tumor or another mass in the brain). Doing a spinal tap when pressure within the skull is increased may cause a life-threatening disorder called brain herniation Herniation: The Brain Under Pressure . After pressure within the skull is lowered or if no mass is detected, the spinal tap is done.

The sample of cerebrospinal fluid is sent to a laboratory to be examined and analyzed. Sugar and protein levels and the number and type of white blood cells in the fluid are determined. The fluid is cultured to check for bacteria and thus rule out or confirm bacterial meningitis. The fluid is not usually cultured for viruses because doing so is technically difficult.

The polymerase chain reaction (PCR) technique, which produces many copies of a gene, is used to identify enteroviruses, herpesviruses (such as HSV and varicella-zoster virus), and some other viruses. Doctors also test cerebrospinal fluid for the presence of antibodies to certain viruses. For example, detecting antibodies to West Nile virus in cerebrospinal fluid indicates infection with that virus.

Doctors sometimes also take a sample of blood, nasal or throat secretions, or stool for culture, examination, and/or, if available, PCR testing. HIV can be diagnosed based on the results of antibody tests and PCR. Levels of antibodies to other viruses are measured and sometimes remeasured a few weeks later. An increase in the level of antibodies to a particular virus indicates that the virus caused a recent infection and so probably was the cause of recent meningitis.

Most people who have viral meningitis recover within a few weeks. Occasionally, recovery can take months, as sometimes occurs when meningitis is caused by West Nile virus or lymphocytic choriomeningitis virus.

• Acyclovir (an antiviral drug) for herpes simplex virus (HSV) or varicella-zoster infection

• Antiretroviral drugs for HIV infection

• Treatment of symptoms

If people appear very ill, doctors start treatment right away without waiting for test results to identify the cause. These people are given antibiotics until doctors are sure that they do not have bacterial meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid… read more , which, if untreated, can rapidly cause permanent brain or nerve damage or death. They are also given acyclovir (an antiviral drug) in case the meningitis is due to HSV or varicella-zoster infection.

After the cause is identified, doctors change drugs as needed.

HIV infection is treated with antiretroviral drugs Antiretroviral Treatment of Human Immunodeficiency Virus (HIV) Infection Antiretroviral medications used to treat human immunodeficiency virus (HIV) infection aim to do the following: Reduce the amount of HIV RNA (viral load) in the blood to an undetectable amount… read more . These drugs prevent HIV (a retrovirus) from reproducing and multiplying inside human cells. Almost always, people need to take a combination of several antiretroviral drugs. People must take these drugs for the rest of their life.

If the cause is HSV or varicella-zoster infection, acyclovir is continued.

For most of the other viruses that commonly cause meningitis, there are no effective drugs. However, if people have a normal immune system, they almost always recover from these infections on their own.

Symptoms are also treated. For example, acetaminophen, taken by mouth or suppository (inserted into the rectum), can reduce fever. Pain relievers (analgesics), taken as needed, can help control headache.

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22 effects of meningitis

Meningitis is inflammation of the meninges, which are the membranes that protect the brain and the spinal cord. It can cause various symptoms, including headaches, a rash, and a fever.

Meningitis can cause serious complications and can quickly become life threatening. Anyone can develop meningitis, but young children, older adults, and people with weakened immune systems are most at risk.

The different types of meningitis depend on the cause and include:

• bacterial
• aseptic
• herpes meningitis, which is a type of viral meningitis

How symptoms affect a person may depend on the type.

Viral meningitis is more common and usually less severe than bacterial meningitis. While both types are serious, bacterial meningitis is more likely to be life threatening.

The Centers for Disease Control and Prevention (CDC) also note that bacterial meningitis has a higher likelihood of leading to long-term complications, such as hearing and vision loss.

Around 10–15% of cases of bacterial meningitis are fatal. Being able to recognize the signs and symptoms is essential, as prompt medical attention can save lives and reduce the risk of complications.

In this article, find out about how to recognize the signs of meningitis.

One of the most common symptoms of meningitis is a severe headache. This is due to inflammation in the meninges, which are the membranes surrounding the brain and the spinal cord. The inflammation can result in significant pain.

The headache tends to start quickly and affect the whole head, rather than focusing on one location.

This headache can resemble a migraine headache. However, a migraine headache is more likely to affect one side of the head.

Some types of meningitis may cause a rash. This is not a skin rash, as it results from bleeding under the skin. If bacteria enter the bloodstream, small blood vessels can break, leading to marks under the skin that healthcare professionals call petechiae.

Not everyone with meningitis will have a rash. It is most likely to occur with meningococcal meningitis, a type of bacterial meningitis.

On pale skin, petechiae may appear as reddish or purple bruise-like patches or as blotchy or mottled skin.

It may also appear as small pink, brown, or purple pinprick marks under the skin that may resemble fleabites. At first, they are likely to be 1–2 millimeters in diameter and appear where the skin is under pressure, for example, under elastic in clothing.

On dark skin, petechiae can be harder to see but may be visible inside the eyelids and on the palms of the hands, the soles of the feet, the abdomen, and the roof of the mouth.

Skin symptoms that evolve quickly can be a sign of severe and rapidly developing disease.

At first, if a person presses a glass tumbler on the rash, the rash may disappear. In time, however, it will remain visible with the same test.

As the infection develops, it can affect blood clotting, making it harder for oxygen to reach the extremities, usually the hands and feet, but likely also the nose and lips.

These areas, and possibly the arms and legs, may develop large dark bruises, which can eventually become blackened, as tissues die due to a lack of oxygen.

Anyone who has skin changes with a headache and fever should seek immediate medical advice.

Here, learn what a meningitis rash looks like and how to test it.

A fever is part of the body’s immune response. It can happen when the body notices an unwanted invader, such as a virus or bacterium.

A person with meningitis may suddenly develop a high fever of over 99.5°F (37.5°C).

The CDC lists fever as a symptom of all types of meningitis except parasitic meningitis, which is rare in humans.

Swelling and inflammation around the brain can causeconfusion and behavioral changes. For people with severe symptoms, confusion may be an early sign.

In some cases, long-term problems can occur after bacterial meningitis, such as:

• difficulty thinking and focusing
• problems with memory
• learning difficulties

These effects are due to long-term neurological damage.

Babies have areas on the head known as a fontanel. This is a gap 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. It could indicate bacterial meningitis.

A 2021 study notes that there are many reasons for a bulging fontanel and that it does not necessarily mean an infant has bacterial meningitis.

However, if an infant’s fontanel starts to bulge, someone should seek medical advice as soon as possible, especially if the infant has other symptoms.

Learn what else a bulging fontanel can mean in a baby here.

Pain and stiffness in the neck, which healthcare professionals call Brudzinski sign, are a common indication of meningitis. They result from inflammation in the spinal cord. Moreover, the pain may worsen when a person bends their neck forward.

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.

However, experts say that Brudzinki sign may not be a reliable sign of meningitis for everyone. Infants aged under 6 months, older adults, people with a weakened immune system, and those in a coma are less likely to have this symptom.

Learn more about the link between a stiff neck and meningitis here.

A person with meningitis may become sensitive to light. Babies or children may cry or turn away from light.

The CDC lists sensitivity to light, or photophobia, as a symptom of all types of meningitis except amebic meningitis. This is a rare type of meningitis that can result from exposure to water where the ameba Naegleria fowleri is present.

Other possible causes of photophobia include:

• migraine
• traumatic brain injury
• tumors
• stroke
• various eye conditions

Find out more about photophobia here.

If a person cannot be woken or seems 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.

Some older research has found links between long-term sleep problems and both viral and bacterial meningitis. People have reported reduced sleep quality and feeling less rested after sleep 1 year after first having symptoms of meningitis. Experts believe this may be due to long-term neurological changes in the brain.

Learn about other causes of excessive sleepiness here.

Lethargy is a common symptom of bacterial and viral meningitis in both adults and children. An infant with bacterial meningitis may appear slow or inactive and may not wake for feeds.

A person with parasitic meningitis may experienceweakness or paralysis.

If the bacteria that cause meningococcal meningitis enter the bloodstream, a person may develop flu-like symptoms, including fatigue.

They may also notice:

• rapid breathing
• fever and chills
• vomiting, diarrhea, or both
• cold hands and feet
• aches and pains in the abdomen, chest, joints, and muscles
• petechiae

People who have recovered from meningitis may also experience long-term fatigue, including:

• difficulty focusing and remembering things
• sensitivity to noise and light
• emotional changes
• irritability
• sensitivity to stress
• sleep disturbances
• headache

These symptoms may make it difficult to return to work.

Learn about other causes of fatigue here.

A reduced appetite can be a symptom of viral or bacterial meningitis in both adults and children. Infants may not be interested in feeding.

What are some other causes of a low appetite?

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

Learn about some other causes of nausea and vomiting here.

Meningitis can lead to changes in mental status and a loss of consciousness. In some cases, coma can occur.

The authors of a 2014 study note that doctors do not always know exactly why this happens. Contributing factors may include:

• severe inflammation
• increased pressure on the brain
• other complications, such as a seizure
• the use of sedative medication

The researchers conclude that people with reduced levels of consciousness due to bacterial meningitis may have a poorer outlook than those whose consciousness levels are not affected.

However, they note that a score of 3 — the lowest score on the Glasgow Coma Scale — is rare with bacterial meningitis.

When meningitis causes brain swelling or pressure, it can disrupt the brain’s normal function, resulting in 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, individuals occasionally develop epilepsy after recovering from meningitis.

Some people experience a seizure when they have a fever. Learn more about febrile seizures here.

In severe cases of meningitis, a person may experience enough brain damage to cause a coma. This is rare with bacterial or viral meningitis.

In one study, 30 out of 1,083 people with bacterial meningitis, or 3%, scored 3 on the Glasgow Coma Scale, which indicates a coma.

According to the CDC, parasitic meningitis can lead to the following symptoms and complications:

• a loss of coordination and muscle control
• weakness or paralysis
• coma
• death

What is a coma, and why does it happen?

A person with meningitis may find it hard to think, focus, and remember things.

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

According to the Meningitis Research Foundation, both meningitis and sepsis resulting from meningitis can lead to memory loss and difficulty retaining information.

Confusion and altered mental status are symptoms of various types of meningitis.

Neurological damage that occurs during the illness can also affect thinking and concentration in the long term.

Depending on the area of the brain affected, children who have had meningitis may find it harder to carry out various functions, including:

• focusing
• thinking
• remembering things
• learning
• making decisions and solving problems

The brain takes over 20 years to develop, which means the risk is higher among younger children. Older children and adults, who have already developed certain thinking and reasoning skills before having meningitis, may retain those skills.

Younger children, however, may need additional help at school with tasks such as planning and working independently.

Around 32% adults who have experienced bacterial meningitis may also find they have difficulty thinking. For instance, they may have a hard time focusing or feel their thinking is slower, according to one older study.

Hearing changes can be a complication of meningitis. Bacterial meningitis can affect the inner ear or the auditory nerve, which carries sound to the brain. This can result in hearing loss, which may be permanent.

Damage can happen if the infection spreads to the hair cells in the cochlea, a bone that plays a crucial role in hearing. It may also occur if inflammation puts pressure on the auditory nerve.

Hearing loss can affect both children and adults. After recovering from meningitis, people should have a hearing test to check for potential hearing problems.

Ringing in the ears, or tinnitus, can also develop after meningitis.

Symptoms of a meningitis infection can includedouble vision. If there is swelling in the optic nerve, temporary vision changes may occur.

Various types of meningitis can also have a long-term impact on vision if the infection affects the optic nerve.

After recovery, a person may experience:

• double vision
• partial vision loss
• total vision loss

Vision changes can develop in one or both eyes. In some cases, they can be permanent.

The risk of long-term vision loss may be higher if a person has vision changes in the early stages, according to a small study that looked at people with HIV-related cryptococcal meningitis.

A person who has meningitis may face problems with speech after they recover.

Speech loss or changes in speech can occur if meningitis causes damage in a part of the brain that affects speech. It can affect the muscles involved in speech and the way the brain coordinates between thinking and the words a person uses.

If a child has meningitis before they learn to talk, damage may occur that affects their ability to learn to speak and to use speech and language.

A speech and language therapist can sometimes help a child learn to speak, or help people regain their ability to speak after recovering from the illness.

The brain and the ears interact to help a person keep their balance and their awareness of space around them. Meningitis can cause problems with the inner ear, leading to:

• loss of coordination
• dizziness
• falls

This may occur while a person has meningitis, but it often resolves after they recover. If damage has affected the inner ear, however, it may persist.

A child who was previously walking or sitting up, for example, may appear to lose that ability. Up to 10% of children who have bacterial meningitis may have ongoing dizziness or balance problems.

Individuals who continue to experience dizziness should seek medical advice, as they may have a longer-term problem that needs addressing.

In rare cases, some types of bacterial meningitis can result in kidney, or renal, failure or long-term kidney damage, such as:

• kidney injury
• oliguria, or low urine output
• rhabdomyolysis, which involves a breakdown of muscle tissue

Some medications for meningitis can also damage the kidneys.

A rare but severe complication of bacterial meningitis — usually meningococcal meningitis — is known as Waterhouse-Friderichsen syndrome (WFS). This involves a hemorrhage in the adrenal glands, which causes them to stop working. If this happens, shock can result. It can be life threatening.

Symptoms include:

• headache
• a petechial rash
• weakness and fatigue
• pain in the side or abdomen
• nausea and vomiting
• lack of appetite
• confusion and disorientation
• low blood pressure in around 50% of cases

Experts note that it can be difficult to diagnose adrenal gland failure if a person may have sepsis, because the two produce similar symptoms.

If a person has a diagnosis of suspected sepsis, and their symptoms are not responding to fluids, a doctor may suspect WFS, or adrenal gland failure.

Common symptoms of meningitis to look out for are:

• fever
• headache
• stiff neck
• cold hands and feet
• vomiting
• confusion
• rapid breathing
• muscle and joint pain
• pale, mottled, or blotchy skin
• spots or a rash
• sensitivity to bright lights
• sleepiness or difficulty waking
• seizures

Other symptoms may be less common or develop as a long-term complication.

Learn more about meningitis in adults here.

In addition to other symptoms, an infant or a newborn may:

• refuse to feed
• be irritable
• give a high-pitched cry
• have a stiff body or be floppy or unresponsive
• have a bulging, soft spot on the top of their head

Learn more about meningitis in babies here.

Anyone who shows signs and symptoms of meningitis needs urgent medical attention, as the condition can progress rapidly and lead to severe and potentially fatal complications.

If a person recovers from meningitis and continues to experience problems, they should seek guidance from a doctor, as they may need additional help.

Although the outlook for meningitis partly depends on the cause and type, all types of meningitis are serious and need immediate medical attention.

Without treatment, bacterial meningitis can continue to worsen and cause damage throughout the body. It is fatal in around 10–15% of cases, and a person may experience long-term complications.

Viral meningitis, while serious, is usually self-limiting and goes away with supportive treatment. It can have long-term implications, but most people who experience viral meningitis make a full recovery.

Treatment for bacterial meningitis is with antibiotics. A doctor may not wait for the results of blood tests to start this treatment, as delaying increases the risk of severe illness.

Having a meningitis vaccine can help reduce the risk of meningitis. Find out more here.

Meningitis is a severe and potentially life threatening condition that involves inflammation of the meninges, which are tissues that surround the brain.

Common symptoms include a headache, fever, stiff neck, and purple rash that healthcare professionals refer to as petechiae. Without prompt treatment, a person with bacterial meningitis may develop sepsis.

Those particularly susceptible to severe illness include young children and people with a weakened immune system.

Anyone with symptoms of meningitis needs prompt medical attention to prevent severe illness and complications.

Meningococcal infection. Diseases.

Infectious diseases

Meningococcal infection has been known since ancient times. Descriptions of the infection are given by Celsus (I century BC), Aretheus (II century BC), etc. The causative agent – meningococcus (Neisseriameningitidis) was isolated in 1887 by A. Weikselbaum.

Meningococcal infection is characterized by fever, intoxication, hemorrhagic rash and purulent inflammation of the meninges. Infection manifests as a carrier state, nasopharyngitis, and generalized forms (meningococcal meningitis, meningococcemia), which are potentially fatal and should always be considered a medical emergency. The risk group includes children under 5 years of age. The peculiarity of the infection is that due to the presence of a protective capsule in meningococcus (as well as in Haemophilus influenzae and pneumococci), small children (1-5 years old) are unable to effectively develop immunity against a natural infection. Therefore, the peak of meningitis occurs in younger children. Meningitis is caused by a variety of bacteria. Twelve serogroups of N.meningitidis have been identified, six of which (A, D, C, W135 and X) can cause epidemics.

Meningococcus is not resistant to environmental factors, outside the body quickly dies when dried, cooled below 22 ^o C, at 55 ^o C dies after 5 minutes. Under the action of 0.01% chloramine solution, 1% phenol solution and 0. 1% hydrogen peroxide solution, it is inactivated after 2-3 minutes. The average survival rate on environmental objects is 7.5-8.5 hours at a microbial load density of 106 per 1 cm ² .

Meningococcal infection has been known since ancient times. Descriptions of the infection are given by Celsus (I century BC), Aretheus (II century BC), etc. The causative agent – meningococcus (Neisseriameningitidis) was isolated in 1887 by A. Weikselbaum.

Meningococcal infection is characterized by fever, intoxication, hemorrhagic rash and purulent inflammation of the meninges. Infection manifests as a carrier state, nasopharyngitis, and generalized forms (meningococcal meningitis, meningococcemia), which are potentially fatal and should always be considered a medical emergency. The risk group includes children under 5 years of age. The peculiarity of the infection is that due to the presence of a protective capsule in meningococcus (as well as in Haemophilus influenzae and pneumococci), small children (1-5 years old) are unable to effectively develop immunity against a natural infection. Therefore, the peak of meningitis occurs in younger children. Meningitis is caused by a variety of bacteria. Twelve serogroups of N.meningitidis have been identified, six of which (A, D, C, W135 and X) can cause epidemics.

Meningococcus is not resistant to environmental factors, outside the body quickly dies when dried, cooled below 22 ^o C, at 55 ^o C dies after 5 minutes. Under the action of 0.01% chloramine solution, 1% phenol solution and 0.1% hydrogen peroxide solution, it is inactivated after 2-3 minutes. The average survival rate on environmental objects is 7.5-8.5 hours at a microbial load density of 106 per 1 cm ² .

Infection possible:

Through close contact with a patient or carrier

when talking, coughing, sneezing

The patient is contagious in the prodromal (asymptomatic) period and 24 hours from the start of treatment. The level of carriage of meningococcus in the human population with active detection is 4-10%. The duration of carriage lasts 2-3, sometimes up to 6 weeks or more.

Due to the instability of meningococcus in the external environment and its localization on the mucous membrane of the posterior wall of the nasopharynx, it is transmitted through fairly close (at a distance of up to 1 meter) and prolonged communication. 70% of infections occur at a distance of 0.5 meters. Especially dangerous are long-term close contacts in a closed, warm room with high humidity.

Symptoms

The incubation period is 1-10 days, but more often 2-4 days.

Runny nose

severe headaches

intoxication

stiffness of the neck and other muscles

loss of consciousness

sensitivity to light

vomiting

9 0002 fever

hemorrhagic rash

Complications

• meningococcal sepsis
• meningitis
• pneumonia
• inflammation of the lining of the heart (endocarditis)
• inflammation of the joints (arthritis)
• inflammation of the iris (iridocyclitis)
• internal hemorrhage

Important and with meningococcal infection: it appears at the end of 1- th, or the beginning of the 2nd day of the disease – first roseolous or roseolous-papular, of various diameters, disappearing with pressure, located throughout the body.

Within a few hours, the first hemorrhagic elements appear: purple-red in color with a bluish tint, which do not disappear when pressed, of various shapes and sizes, rising above the skin. Localized on the lower body: heels, shins, hips, buttocks. Roseolous-papular elements fade away without a trace after 1-2 days, and hemorrhagic pigmentation. In the center of hemorrhagic elements, necrosis occurs, and where there are extensive hemorrhagic rashes, necrosis is rejected with the formation of ulcers and scars. Rashes in the first hours of the disease on the face, upper body are a prognostically unfavorable sign. Also, a meningococcal infection may be characterized by a special posture in which the patient is located – the “pointing dog” position – the patient’s head is thrown back, the hips are pressed to the stomach, the shins to the hips.

If left untreated, meningococcal infection is fatal in 50% of cases. But even when diagnosed early and treated appropriately, up to 16% of patients die, usually within 24 to 48 hours of symptom onset.

Vaccine

The first meningitis vaccine was developed in 1972.

In Russia, vaccination against meningococcal infection is included in the calendar according to epidemic indications: children and adults in foci of meningococcal infection caused by meningococcal serogroups A or C, in endemic regions, in case of an epidemic caused by meningococcal serogroups A or C, as well as persons eligible for military service.

In a number of regions of the country, children are routinely vaccinated before entering preschool educational organizations.

View the vaccination schedule

The incidence of meningococcal infection in Russia in 2019 was 0.75 per 100,000 population. Generalized forms of meningococcal infection (GFMI) in 2019 accounted for 79.8% of cases, including 80.1% in children under 17 years of age. Mortality from GFMI remains at a high level in 2019: 21%. There is a significant contribution to the formation of mortality in the age group of 45–64 years and the group of people aged 65 and older (27% and 31%, respectively). The mortality rate for children under 4 years of age was 25%, and for adolescents aged 15–19years – 20%. Children who do not attend preschool institutions (unorganized children) died from GFMI more often (21.1%) than organized ones (12.9%).

In 2020, 380 cases of HFMI were registered, of which 44 were fatal, i.e. in 11.5% of patients, the disease ended in death. Among the sick, 231 cases are between the ages of 0 and 17 years.

Good to know

Interesting facts

Recommended materials

The level and structure of mortality in meningococcal infection in the Russian Federation

Meningococcal vaccines: polysaccharide and polysaccharide conjugate vaccines

Meningococcal infection – controllable

Effectiveness of vaccination

If vaccinated

Possible post-vaccination complications

9 0063 rash, urticaria headache, joint pain, nausea or vomiting <10%.
• fever up to 38 ⁰ C – 0. 6-4%
• soreness and redness at the injection site – 25-30%

  If not vaccinated

  Complications in the course of the disease

  • Infectious-toxic shock,
  • syndrome of acute edema and swelling of the brain,
  • acute renal failure,
  • cardio -vascular insufficiency,
  • acute adrenal insufficiency (Waterhouse-Friderichsen syndrome).

  Mortality in the disease

  • up to 20% -30% among children under one year old, and people over 60 years old
  • up to 10% die within 24-48 hours after the onset of symptoms

  Meningitis – vaccination in Kazan

  In meningitis, inflammation affects the meninges. It is possible that meningitis can be the result of any disease or injury. However, most often, the disease has a viral, bacterial or fungal nature.

  The type of meningitis determines the type of pathogen that caused the disease:

  – Meningococci, streptococci and other types of bacteria cause bacterial meningitis.
  – Mumps, influenza, herpes and other viruses can cause viral meningitis.

  – Candida, for example, can cause fungal meningitis.
  – Protozoa, such as Toxoplasma, are also on the list of pathogens.

  – If more than one potential pathogen is found in the body, they speak of a mixed form.

  Other differences defining types and forms:

  – The rate of development of symptoms can be lightning fast up to two days, in which case they speak of acute meningitis. Subacute is said to be when the development of symptoms is prolonged (up to several weeks). After 4 weeks they talk about chronic. In case of repetition – about recurrent.
  – Type of inflammation.
  Serous (viral) and, considered more severe, purulent (bacterial).

  – Origin.

  There is a primary (main disease), there is a secondary (complication after another disease).
  – The disease also spreads throughout the body in different ways. The spinal cord (spinal meningitis), the upper part of the brain (convexital), the lower – basal. Cerebrospinal extends both to the back and to the brain.

  Symptoms vary from case to case, but there are common symptoms:
  – Headache of a different nature, as a result of vomiting, which does not alleviate the condition.
  – Convulsions.
  – Change in the state of consciousness (confusion, cloudiness).
  – Tics (the above changes are called cerebral and are the result of increased intracranial pressure).
  – Typical meningeal symptoms are, for example, neck stiffness.
  In addition, there are distinctive features for each type of disease:
  – In viral meningitis, the first signs develop 6-14 days after the pathogen enters (these can be enteroviruses, parainfluenza, mumps, and others) and it begins with complaints common to infectious diseases, such as fever, malaise and weakness, later they are joined by specific symptoms. For example, in an infant, a diagnosis can be suspected by taking his armpits and finding that he pulls his legs up to his stomach when he is in weight.

  Symptoms may vary depending on the virus. Some viruses give a blurry picture, some create conditions for the development of inflammation of the ovaries and testicles, as well as signs similar to pancreatitis. Some (for example, the herpes virus) do not always give meningeal symptoms. Tick-borne encephalitis can give a wave-like picture of the course of the disease, that is, after the first wave with an increase in temperature, the symptoms subside, and after a while the second wave occurs.

  Only laboratory tests can detect meningitis, and only a doctor can decide on the appointment.

  Treatment again depends on the pathogen, in the case of most viruses, it will be symptomatic. If the herpes virus is the culprit, acyclovir may be given intravenously with a drip.
  If measures are taken promptly and correctly, then the likelihood of recovery without dangerous consequences is high.
  Vaccination is a good preventive measure. It is also in the power of doctors to prevent the infection from spreading. Namely, to organize quarantine in time and promote measures to maintain personal hygiene and strengthen immunity.

  Bacterial meningitis poses the greatest danger to children under 5 years of age, they also constitute the most numerous of the risk groups.
  Meningococcal meningitis is characterized by a high rate of spread, and symptoms, including both acute intoxication symptoms and specific symptoms, are exacerbated when the infection begins to move through the bloodstream, sepsis and other adverse effects, up to coma and death, may occur.

  An ambulance, at the slightest suspicion of not meningitis, should be called immediately. Based on the examination, the doctor will prescribe an examination plan and, further, a treatment regimen that includes antibiotics and symptom-relieving therapy.

  Severe consequences, according to some reports, occur in 20% of cases, namely, irreversible brain damage, gangrene, and others.
  In order to prevent severely tolerated with a risk to life and subsequent quality of life, forms of the disease are vaccinated (in Russia against groups A, C, W, Y).

  The least likely to cope with pneumococcal meningitis in children under the age of 2 years.
  The disease can be either primary (independent disease) or secondary (complication of another disease).
  Primary characterizes the sharp development of symptoms of intoxication, which are joined by meningeal symptoms on the third day or so.
  Convulsions, chaotic movements, confusion and other symptoms indicate that the medulla is affected. The final stage may be coma. The secondary is characterized by a slow development of symptoms, the temperature does not always rise at the beginning of the disease, it takes several days before the symptoms become similar to the acute form of the disease.

  Diagnostics includes not only blood sampling, but also cerebrospinal fluid sampling. Treatment includes the appointment of an antibiotic, to which the microorganisms that caused the disease are sensitive, and measures to maintain the affected organs and systems.
  Pneumococcal meningitis is more likely to cause severe consequences than other bacterial meningitis.
  Experts believe that vaccination is a way to reduce the prevalence of cases by 80%.
  Vaccines used in Russia (PKV10 and PKV13) are approved for use from two months. From the age of two, PPV23, also common in the country, can be used.

  Hib or Haemophilus influenzae meningitis causes the so-called Haemophilus influenzae (type b) is more common in children (up to 5, sometimes up to 8 years). However, recently the prevalence among the adult population has increased.
  Children are characterized by the rapid development of symptoms (fever, headache, vomiting, and others), in small children, you can notice a bulging of the fontanel, pronounced anxiety. For children under one year old, the addition of a symptom of neck stiffness is considered typical. Experts also note the possibility of developing seizures, signs of impaired consciousness, and even coma.

  The disease can also be the result of other infections, in which case its development is less rapid.