How is meningitis diagnosed in its early stages. What tests are used to confirm meningitis. What treatments are available for bacterial and viral meningitis. How can the spread of meningitis infection be prevented.

Understanding Meningitis: Types and Causes

Meningitis is a serious inflammatory condition affecting the protective membranes surrounding the brain and spinal cord. There are five main types of meningitis, with viral and bacterial being the most common. While viral meningitis often resolves on its own, bacterial meningitis requires prompt medical intervention to prevent life-threatening complications.

The causative agents for the different types of meningitis include:

• Viral meningitis: Various viruses, including enteroviruses
• Bacterial meningitis: Bacteria such as Streptococcus pneumoniae or Neisseria meningitidis
• Fungal meningitis: Fungi like Cryptococcus or Candida
• Parasitic meningitis: Parasites such as Angiostrongylus cantonensis
• Non-infectious meningitis: Caused by certain medications, cancers, or autoimmune disorders

Recognizing Early Symptoms of Meningitis

Early detection of meningitis is crucial for effective treatment, especially in cases of bacterial meningitis. However, initial symptoms can be easily mistaken for the flu, making diagnosis challenging. Key early symptoms to watch for include:

• Sudden high fever
• Severe headache
• Stiff neck
• Sensitivity to light
• Nausea and vomiting
• Confusion or altered mental state

Can meningitis symptoms appear suddenly? Yes, the onset of meningitis can be very rapid, with symptoms progressing quickly. This is why it’s crucial to seek immediate medical attention if you experience these symptoms, particularly if they appear suddenly or in combination.

Diagnostic Procedures for Meningitis

When meningitis is suspected, healthcare providers employ several diagnostic tests to confirm the condition and determine its cause. These tests typically include:

1. Physical examination: Doctors check for signs like Brudzinski’s sign and Kernig’s sign, which indicate meningeal irritation.
2. Blood tests: These can detect signs of infection and inflammation.
3. Lumbar puncture (spinal tap): This procedure involves collecting a sample of cerebrospinal fluid for analysis.
4. Imaging tests: CT scans or MRI may be used to check for brain swelling or other complications.

What is the most definitive test for diagnosing meningitis? The lumbar puncture is considered the gold standard for diagnosing meningitis. It allows doctors to analyze the cerebrospinal fluid for the presence of bacteria, viruses, or other pathogens, as well as markers of inflammation.

Treatment Approaches for Meningitis

Treatment for meningitis varies depending on the underlying cause. Bacterial meningitis requires immediate hospitalization and aggressive treatment, while viral meningitis may be managed at home in milder cases.

Bacterial Meningitis Treatment

For suspected or confirmed bacterial meningitis, treatment typically involves:

• Intravenous antibiotics: Started immediately, even before the diagnosis is confirmed
• Corticosteroids: To reduce brain swelling and inflammation
• Intravenous fluids: To prevent dehydration and maintain electrolyte balance
• Oxygen therapy: If breathing difficulties are present
• Close monitoring: To manage potential complications

How long does treatment for bacterial meningitis usually last? The duration of treatment can vary, but patients typically need to stay in the hospital for several days to weeks, depending on the severity of the infection and any complications that arise.

Viral Meningitis Treatment

Viral meningitis often resolves on its own without specific treatment. However, supportive care is important and may include:

• Rest and hydration
• Over-the-counter pain relievers for headache and fever
• Anti-nausea medication
• In severe cases, hospitalization for monitoring and supportive care

Is antiviral medication used to treat viral meningitis? In most cases, antiviral medications are not necessary for viral meningitis. However, if the meningitis is caused by certain viruses like herpes simplex virus, specific antiviral drugs may be prescribed.

Preventing the Spread of Meningitis

While the risk of transmission is generally low, certain precautions can help prevent the spread of meningitis, especially in cases of bacterial meningitis:

• Vaccination: Immunizations are available for several types of bacterial meningitis
• Prophylactic antibiotics: For close contacts of individuals with certain types of bacterial meningitis
• Good hygiene practices: Regular handwashing and avoiding sharing personal items
• Isolation precautions: In hospital settings for patients with bacterial meningitis

Who should receive prophylactic antibiotics after exposure to meningitis? Close contacts of individuals diagnosed with certain types of bacterial meningitis, such as those caused by Neisseria meningitidis, may be advised to take preventive antibiotics. This typically includes household members, intimate partners, and individuals who have had prolonged close contact with the infected person.

Long-Term Outlook and Potential Complications

The prognosis for meningitis varies depending on the type, severity, and timeliness of treatment. While many people recover fully, some may experience long-term complications, including:

• Hearing loss
• Vision problems
• Memory and concentration issues
• Balance and coordination difficulties
• Seizures
• Learning disabilities (especially in children)

What factors influence the long-term prognosis of meningitis? The type of pathogen causing the infection, the patient’s age and overall health, the severity of the infection, and how quickly treatment was initiated all play crucial roles in determining the long-term outlook for meningitis patients.

Advancements in Meningitis Research and Treatment

Ongoing research in the field of meningitis is focused on improving diagnosis, treatment, and prevention strategies. Some areas of current interest include:

• Development of rapid diagnostic tests for faster identification of the causative agent
• New vaccine formulations to provide broader protection against various strains of meningitis-causing pathogens
• Investigation of novel antibiotic and antiviral therapies
• Research into the long-term effects of meningitis and potential interventions to mitigate these impacts

How might future advancements change the landscape of meningitis treatment? Emerging technologies like point-of-care diagnostic tools and personalized medicine approaches could potentially revolutionize meningitis management by enabling faster, more targeted treatments and improving overall outcomes for patients.

Living with the Aftermath: Support and Rehabilitation

For individuals who experience long-term effects from meningitis, comprehensive support and rehabilitation services are crucial. These may include:

• Physical therapy to address mobility and balance issues
• Occupational therapy to help with daily living activities
• Speech and language therapy for communication difficulties
• Cognitive rehabilitation for memory and concentration problems
• Psychological support to address emotional and mental health impacts
• Educational support for children with learning difficulties

What role does family support play in the recovery process? Family involvement is critical in the rehabilitation journey of meningitis survivors. Family members can provide emotional support, assist with daily care, and help coordinate various aspects of the recovery process, significantly improving the patient’s overall quality of life and rehabilitation outcomes.

Meningitis remains a serious health concern, but with increased awareness, prompt medical attention, and advances in treatment, outcomes continue to improve. Understanding the signs and symptoms, seeking immediate medical care when needed, and following preventive measures can significantly reduce the impact of this potentially life-threatening condition. As research progresses, we can hope for even better diagnostic tools, treatments, and preventive strategies in the future, further improving the outlook for those affected by meningitis.

Meningitis – Treatment – NHS

People with suspected meningitis will usually need to have tests in hospital and may need to stay in hospital for treatment.

Tests in hospital

Several tests may be carried out to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.

These tests may include:

• a physical examination to look for symptoms of meningitis
• a blood test to check for bacteria or viruses
• a lumbar puncture – where a sample of fluid is taken from the spine and checked for bacteria or viruses
• a CT scan to check for any problems with the brain, such as swelling

As bacterial meningitis can be very serious, treatment with antibiotics will usually start before the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused by a virus.

Treatment in hospital

Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can cause serious problems and requires close monitoring.

Severe viral meningitis may also be treated in hospital.

Treatments include:

• antibiotics given directly into a vein
• fluids given directly into a vein to prevent dehydration
• oxygen through a face mask if there are any breathing difficulties
• steroid medication to help reduce any swelling around the brain, in some cases

People with meningitis may need to stay in hospital for a few days, and in certain cases treatment may be needed for several weeks.

Even after going home, it may be a while before you feel completely back to normal.

Additional treatment and long-term support may also be required if any complications of meningitis occur, such as hearing loss.

Treatment at home

You’ll usually be able to go home from hospital if you or your child has mild meningitis and tests show it’s being caused by a viral infection.

This type of meningitis will usually get better on its own without causing any serious problems. Most people feel better within 7 to 10 days.

In the meantime, you may be advised to:

• get plenty of rest
• take painkillers for a headache or general aches
• take anti-sickness medicine for any nausea or vomiting

If you feel unable to manage your symptoms at home or you feel worse, get further medical help.

Preventing the spread of infection

The risk of someone with meningitis spreading the infection to others is generally low.

But if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure.

This may include anyone who’s been in prolonged close contact with someone who developed meningitis, such as:

• people living in the same house
• pupils sharing a dormitory
• university students sharing a hall of residence
• a boyfriend or girlfriend

People who have only had brief contact with someone who developed meningitis will not usually need to take antibiotics.

Page last reviewed: 25 October 2022
Next review due: 25 October 2025

How Meningitis Is Diagnosed in Its Early Stages

Symptoms of meningitis are often mistaken for the flu. But detecting and diagnosing the disease early can be lifesaving. Here’s what you should know.

By Mikel TheobaldMedically Reviewed by Pat F. Bass III, MD, MPH

Reviewed: July 18, 2014

Medically Reviewed

Meningitis is an extremely serious, often life-threatening disease — yet its early symptoms often resemble the flu, and that can make it difficult to diagnose.

There are five types of meningitis, each caused by different factors. The two most common forms of the disease are viral meningitis and bacterial meningitis. Viral meningitis often resolves on its own without treatment. But if you have bacterial meningitis, early diagnosis and treatment is vital. If treatment is delayed because symptoms are mistaken for the flu, there can be devastating consequences.

Symptoms such as sudden fever, severe headache, and a stiff neck are possible indications of meningitis. Anyone experiencing these symptoms should seek immediate medical attention — it’s definitely a case of better safe than sorry. “The onset may be very sudden, and the progression even faster,” says Malcolm Thaler, MD, an internist with One Medical Group in New York City.

Making a Meningitis Diagnosis

The first step of diagnosing meningitis is a physical exam, and there are specific indicators for which your doctor can check. Your doctor may look for Brudzinski’s sign, an indicator in which stiffness in your neck causes you to automatically flex your knees and hips when your doctor forces you to flex your neck. “The doctor may also look for Kernig’s sign,” says Dr. Thaler. This means you could feel severe pain in your thigh if you try to extend your leg,

If meningitis is suspected, may start you on antibiotics right away, even before determining the type of meningitis you have. “Since the culture for virus and bacterial growth often takes a few days to come back, it would be very dangerous to wait for that information,” says Cathy Clements, MD, a primary care physician and internist at Mercy Medical Center in Baltimore. “That’s why the most important thing a doctor can do when a patient comes in with suspected meningitis is to go ahead and initiate treatment. ” Antibiotics are prescribed based on the most common pathogens known to cause meningitis in certain age groups, Dr. Clements explains.

Additional Diagnostic Tests for Meningitis

When a meningitis diagnosis is suspected, there are several tests your doctor can run to confirm a diagnosis:

Blood tests. Standard blood tests to analyze antibodies and foreign proteins can alert your doctor to the presence of infection.

CT scan. A scan of the brain can reveal inflammation, internal bleeding, or other abnormalities. It can also detect conditions such as brain swelling, abscess, or hemorrhage, which could make a lumbar puncture unsafe.

Lumbar puncture. The inflammation associated with meningitis is most often caused by an infection of the cerebral spinal fluid, which surrounds the brain and spinal cord. A lumbar puncture, also known as a spinal tap, enables your doctor to collect a sample of this cerebrospinal fluid from a small area in your lower back. This fluid is sent to the lab and analyzed to determine if there is an infection. “We look for white blood cells, blood, protein, and glucose,” Clements says. “The results of these tests — and their ratios to each other — can give us an idea if the meningitis is bacterial, viral, or fungal.” She explains that bacterial meningitis tends to have more neutrophils (a certain type of white blood cell) and lower glucose levels. Viral meningitis tends to have more lymphocytes (another type of white blood cell) and more protein. “We also send it for culture for viruses and bacteria growth, which often takes a few days to come back,” she says.

Once all the results are in, the medical team should have the information needed for a more precise diagnosis and further treatment.

By subscribing you agree to the Terms of Use and Privacy Policy.

What Is Meningitis? Symptoms, Diagnosis, Treatment, and Prevention

Meningitis occurs when the protective membranes covering the brain and spinal cord become inflamed. Causes include viruses, bacteria, and fungi.

By Joseph Bennington-CastroFebruary 9, 2023

Fungal Meningitis: Types, Symptoms, and Treatment

Four different types of fungi are responsible for most cases of fungal meningitis, which is serious but rare and not contagious. Fungi usually enter the…

By Joseph Bennington-CastroJanuary 18, 2023

Viral Meningitis: Causes, Treatment, and Prevention

A number of different viruses can cause viral meningitis, the most common type of meningitis. Though viral meningitis is not as severe as bacterial meningitis…

By Joseph Bennington-CastroSeptember 8, 2022

Meningitis Treatment and Prevention

Bacterial meningitis is treated with antibiotics, but there’s no specific treatment for viral meningitis. Vaccines can protect you from the most common…

By Joseph Bennington-CastroSeptember 7, 2022

Meningitis Symptoms and Complications

A severe headache, fever, and the inability to lower your chin to your chest are all common symptoms of both bacterial and viral meningitis. Learn about…

By Joseph Bennington-CastroSeptember 7, 2022

Bacterial Meningitis: Types, Symptoms, Causes, and Treatment

Compared with other forms of meningitis, bacterial meningitis is often more severe and life-threatening. A stiff neck, headache, and fever are the main…

By Joseph Bennington-CastroApril 3, 2018

Understanding the 5 Types of Meningitis

There are five types of meningitis with different symptoms, causes, and levels of severity. Learn about each one and how you might prevent exposure to…

By Mikel TheobaldJuly 18, 2014

6 Ways to Prevent Meningitis

Meningitis is highly contagious and can be very serious. Learn what steps you can take to prevent meningitis from spreading and making you sick.

By Beth W. OrensteinJuly 18, 2014

The Warning Signs of Meningitis

Meningitis can be life-threatening. Learn about the telltale signs of meningitis and how to avoid mistaking meningitis symptoms for the flu.

By Kristen StewartJuly 18, 2014

How to recognize meningitis and diagnose the disease in the Optimum medical laboratory in Sochi (Adler)

1. Home
2. How to recognize the disease
3. Diseases of the nervous system
4. Meningitis

More about the doctor

Symptoms, diagnosis and prevention of meningitis

Meningitis is an inflammation of the membranes of the brain or spinal cord, which can be triggered by infections of viral and bacterial etiology. Pathology is accompanied by a severe headache, a typical body position in bed, hemorrhagic rashes on the skin and stiffness of the muscles of the occipital zone. Children and adolescents, as well as elderly people with weakened immune systems, are especially susceptible to this disease.

Causes of meningitis

The main cause of meningitis are infections of viral and bacterial etiology. The causative agent of the inflammatory process can be:

• pneumococci;
• Haemophilus influenzae;
• Escherichia coli;
• streptococci;
• amoeba.

In childhood, the main cause of the development of pathology is enteroviruses that enter the body by airborne droplets. Infection can occur during childbirth, through contaminated food, dirty water, and insect bites. The main causes of non-infectious meningitis are trauma and damage to the skull, as well as tumor processes occurring in the brain.

Mechanism of development

For the development of pathology, the pathogen must penetrate the cranial cavity and provoke an inflammatory process in the brain. In some cases, this is observed when foci of infection occur in tissues located near the meninges. Pathologies such as purulent otitis media or sinusitis can provoke meningitis.

In some cases, craniocerebral trauma becomes a provoking factor in the development of pathology, but the infection mainly penetrates into the cranial cavity along with the blood flow. The very process of entering the pathogen into the blood and its further spread to the meninges is associated with a poor state of immunity.

Symptoms

Meningitis causes the following clinical picture:

• rise in body temperature;
• photophobia;
• muscle tension in the occipital region;
• confusion;
• convulsive syndrome;
• strabismus;
• muscle pain syndrome;
• mental disorders;
• tachycardia;
• rashes on the skin.

If these symptoms develop, seek medical attention as soon as possible because meningitis has a high mortality rate.

Diagnostic methods

The main method for diagnosing meningitis is lumbar puncture with further examination of cerebrospinal fluid. This diagnostic method is used in all cases when there is a suspicion of a disease.

In addition, the doctor analyzes the patient’s complaints and collects an anamnesis, as well as conducts a neurological examination. With the help of a blood test, it is possible to diagnose signs of inflammation, and PCR of blood and cerebrospinal fluid helps to identify the pathogen.

Computed and magnetic resonance imaging allows to assess the structure of the brain and diagnose indirect manifestations of the pathological process in the meninges of the brain.

Prevention

Some forms of meningitis can be prevented by vaccination, which is effective for several years. As a preventive measure, it is recommended to treat chronic and acute pathologies of an infectious nature in a timely manner and take courses of immunostimulating drugs in the foci of meningococcal disease. In addition, you should harden the body, avoid visiting places with large crowds of people and severe hypothermia. In the autumn-winter period, you need to drink multivitamin complexes or vitamin C.

Tests for meningococcal infection

The causative agent of meningococcal infection is Neisseria meningitidis (meningococcus). Meningococcus colonizes the posterior wall of the human nasopharynx and, depending on the virulence of the strain and the resistance of the infected person, causes an infectious process with a wide range of clinical manifestations: asymptomatic carriage, nasopharyngitis and a generalized form – meningococcemia and / or meningitis. Meningococcal infection affects people of all ages, but more often (70%) children get sick. The lethality rate averages 10%, which determines the high social significance of the disease. Capsular strains of meningococcus, depending on the chemical structure of the capsular polysaccharide, are divided into a number of serological groups: A, B, C, X, Y, Z, W-135, 29-E, H, I, K, L. More than 90% of cases of generalized forms of meningococcal infection are caused by strains of serogroups A, B and C, much less often by strains of serogroups X, Y and W-135, the remaining serogroups are not of epidemiological interest. The determination of the serogroup is the most important procedure for the selection of an adequate vaccine product. All meningococci express on their surface one of the allelic variants of class 2 or 3 outer membrane proteins (PorB). Most meningococci express class 1 proteins (PorA). The antigenic structure of the PorB protein determines the serotype of the strain, while the PorA protein determines the serosubtype. Based on the chemical structure of the capsular lipopolysaccharide, the immunotype is determined. The antigenic characteristic may include some other AGs: Ora and Ors (class 5 outer membrane proteins), pili, FetA surface protein.

Indications for examination

• Diagnostic studies are carried out in a hospital with suspected purulent meningitis and / or a generalized form of meningococcal infection;
• studies according to epidemic indications are carried out in the focus of a generalized form of meningococcal infection among those who have been in contact with the patient and have clinical manifestations of nasopharyngitis.

Study material

• Blood – microscopic examination, culture;
• CSF – microscopic examination, culture, DNA detection, AH detection;
• swabs from the oropharynx and nose – culture;
• blood serum – detection of hypertension, determination of specific antibodies

Differential diagnosis

• Causative agents of purulent meningitis of other etiologies: Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, etc.;
• in the study of the nasopharynx – pigmenting Neisseria subflava, Neisseria flavescens, Neisseria mucosa, Neisseria sicca, Neisseria lactamica.

Laboratory diagnosis of a generalized form of meningococcal infection includes microscopy of biological material, inoculation of biological material with further cultural and biochemical identification of the pathogen, determination of antibiotic sensitivity; detection of specific genetic fragments of meningococcus and its AG, detection of specific antibodies.

Comparative characteristics of laboratory research methods and features of interpretation of their results. Microscopy of native cerebrospinal fluid or a “thick drop” blood product (stained with an aqueous-alcoholic solution of methylene blue) on a blue background reveals morphologically clear cocci, diplococci, stained in dark blue, resembling coffee beans or bean seeds, adjacent to each other with concave sides , sometimes the capsule comes to light. Microbial cells can be located both outside and inside leukocytes. The intensity of CSF contamination by microbial cells varies considerably and depends on the stage of development of the infectious process at the time of sampling. If antibiotic treatment has been carried out, the typical microbial cell morphology is lost. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital).

Inoculation of CSF and blood on nutrient media with further incubation for 24 hours at 37°C in an atmosphere with 5–10% CO2 and high humidity makes it possible to identify the characteristic tinctorial properties of the pathogen. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital) before the start of intensive antibiotic therapy.

When determining the saccharolytic activity, the results of sowing a pure culture on dense nutrient media with carbohydrates are taken into account. The method makes it possible to differentiate different types of Neisseria and some other types of microorganisms (Table 16). Sometimes there is variability in saccharolytic activity in different strains of the same species.

Clarification of the biochemical properties of meningococci is carried out using reagent kits for an extended study of their enzymatic and metabolic activity, which within 2 hours allows you to determine the species of the pathogen.

The determination of the serogroup of meningococci is carried out in the agglutination reaction on glass with a set of agglutinating serogroup antisera (serogroups A, B, C, X, Y, Z, W-135,29E). The reaction is carried out only with a pure culture of meningococci that has passed all stages of identification. Meningococci of serogroups A, B and C are most often the cause of generalized forms of meningococcal infection, the agglutination reaction is carried out primarily with antisera to meningococci of these serogroups. The absence of a reaction with one of the main serogroup antibodies indicates the need to continue similar studies with other specific antisera (X, Y, Z, W-135, 29e). Only if a strain of meningococcus confirmed by all tests did not show a positive result in the agglutination test with a full set of agglutinating antisera, it should be classified as a non-agglutinating strain (NA).

Latex agglutination reaction is used to detect AG in CSF and/or blood serum. The study of native cerebrospinal fluid (express method) is carried out if it contains signs of purulent inflammation and / or microscopic detection of pathogens. The use of the reaction allows in the shortest possible time (15-20 minutes) to identify specific AG of meningococci of the most common serogroups (A, B, C, Y, W-135). It is recommended to conduct a study in the active phase of the disease (the first two days after admission to the hospital).

CSF and/or a fresh pure culture of Neisseria meningitidis grown on Petri dishes is used to detect pathogen DNA. Detection of specific genetic fragments of the microorganism is performed using PCR. The method has high diagnostic sensitivity and specificity, allows to detect microorganisms contained in single quantities or in a non-viable state in a clinical sample, is characterized by high reproducibility and short deadlines for performing the study (within several hours).

Indications for conducting studies to detect DNA in the diagnosis of bacterial meningitis are:

• negative results of diagnosis by other methods, especially in the case of examination of CSF samples after massive antibiotic therapy or in the late stages of the disease;
• the need for an urgent response about the etiology of the pathogen;
• Examination of material samples delivered frozen or fixed in ethanol.

Detection of specific antibodies in the blood serum in the diagnosis of meningococcal infection is carried out using RNHA. It is recommended to conduct the study twice: in the active phase of the disease (the first two days after admission to the hospital) and on the 12-14th day of the disease. The diagnosis is considered confirmed when the increase in titers of antibodies by four or more times within the specified period.

The use of RNHA for research in “paired sera” reveals the dynamics of the increase in titers of specific antibodies to meningococcus in the blood and allows you to determine whether the pathogen belongs to the most common serogroups of meningococci (A and C). The detection of AT makes it possible to conduct a retrospective laboratory diagnosis of generalized forms of meningococcal infection, since the final answer is obtained only 12-14 days after the onset of the disease. The primary research opportunities are laboratory confirmation of meningococcemia, in which the use of other methods of laboratory diagnostics, as a rule, is not very effective.