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Meningitis

Meningitis is an infection of the meninges (protective membranes) that surround the brain and spinal cord. It can be bacterial or viral.

Meningitis is an infection of the protective membranes that surround the brain and spinal cord.

This infection causes these membranes (the meninges) to become inflamed, which in some cases can damage the nerves and brain.

Signs and symptoms of meningitis

Anyone can get meningitis, but babies and young children under five years of age are most at risk. A baby or young child with meningitis may:

  • have a high fever, with cold hands and feet
  • vomit and refuse to feed 
  • feel agitated and not want to be picked up
  • become drowsy, floppy and unresponsive
  • grunt or breathe rapidly
  • have an unusual high-pitched or moaning cry
  • have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it
  • have a tense, bulging soft spot on their head (fontanelle)
  • have a stiff neck and dislike bright lights
  • have convulsions or seizures

The above symptoms can appear in any order, and some may not appear at all.

Don't wait for a rash to develop. If your child is unwell and getting worse, seek medical help immediately.

In older children, teenagers and adults, the symptoms of meningitis can include:

  • a fever, with cold hands and feet
  • vomiting
  • drowsiness and difficulty waking up
  • confusion and irritability
  • severe muscle pain
  • pale, blotchy skin, and a distinctive rash (although not everyone will have this)   
  • a severe headache
  • stiff neck
  • sensitivity to light (photophobia)
  • convulsion or seizures

Again, these symptoms can appear in any order, and not everyone will get all of them.

Don't wait for a rash to develop. Seek immediate medical help if someone is unwell and displays the symptoms of meningitis.

The glass test

If you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of meningococcal septicaemia.

A person with septicaemia may have a rash of tiny "pin pricks" that later develops into purple bruising.

A fever with a rash that doesn't fade under pressure is a medical emergency, and you should seek immediate medical help.

Types of meningitis

There are two types of meningitis. They are:

  • bacterial meningitis  caused by bacteria such as Neisseria meningitidis or Streptococcus pneumoniae and through close contact
  • viral meningitis  caused by viruses that can be spread through coughing, sneezing and poor hygiene 

Bacterial meningitis

Bacterial meningitis is very serious and should be treated as a medical emergency. If the bacterial infection is left untreated, it can cause severe brain damage and infect the blood (septicaemia).

In 2011-12, there were around 2,350 cases of bacterial meningitis and septicaemia in the UK. The number of cases has dropped since the introduction of vaccines that protect against many of the bacteria that can cause meningitis, including the meningitis C vaccineMMR vaccine and pneumococcal vaccine.

It's essential to know the signs and symptoms, and to get medical help if you're worried.

Bacterial meningitis most commonly affects children under five years of age, particularly babies under the age of one. It's also common among teenagers aged 15 to 19. 

Viral meningitis

Viral meningitis is the most common, and less serious, type of meningitis. It's difficult to estimate the number of viral meningitis cases, because symptoms are often so mild that they're mistaken for flu.

Viral meningitis is most common in children and more widespread during the summer.

Read more about the causes of meningitis.

Diagnosing meningitis

Diagnosing meningitis can be difficult because it often comes on quickly and can be easily mistaken for flu, as many of the symptoms are the same.

However, it's very important to seek immediate medical help if you notice any of the symptoms of meningitis, particularly in a young child.

This may mean going to the accident and emergency (A&E) department of your local hospital in the middle of the night. 

Don't wait for a purple rash to appear, because not everyone with meningitis gets one.

If meningitis is suspected, treatment will usually be started before the diagnosis is confirmed. This is because some of the tests can take several hours to complete, and it could be dangerous to delay treatment.

The doctors will carry out a physical examination to look for signs of meningitis (see above) or signs of septicaemia, such as a rash. They will also carry out a number of other tests to confirm the diagnosis.

Read more about how meningitis is diagnosed.

Treating meningitis

Viral meningitis usually gets better within a couple of weeks, with plenty of rest, painkillers for the headache and anti-sickness medication for the vomiting.

Bacterial meningitis is treated with intravenous antibiotics (delivered through a vein in the arm). Admission to hospital will be needed, with severe cases treated in intensive care, so the body's vital functions can be monitored and supported.

If antibiotics don't work, you will need to be in hospital for a week or less. If the infection is more severe, you may need to stay in for longer. 

Read more about how meningitis is treated.

Outlook

Several decades ago, the outlook for bacterial meningitis wasn't good, and almost everyone who had the condition would die.

Nowadays, most deaths are caused by septicaemia (blood poisoning) rather than meningitis. Meningococcal disease, meningitis or septicaemia caused by Neisseria meningitidis bacteria results in about 1 death in every 10 cases.

Up to a quarter of people may experience complications of meningitis, such as hearing loss, after having bacterial meningitis.

Vaccination

The best way to prevent meningitis is by ensuring vaccinations are up-to-date. Children in the UK should receive the available vaccines as part of the childhood vaccination programme.

It's also important to check your travel vaccinations are up-to-date before travelling in certain parts of the world.

Read more about meningitis vaccination.



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Meningitis

Meningitis can be caused by bacteria or a virus. This is known as either bacterial meningitis or viral meningitis.

Meningitis can be caused by bacteria or a virus.

Bacterial meningitis

Vaccination programmes have helped reduce the number of different types of bacteria that can cause meningitis.

However, there are currently a number of bacteria for which there currently aren't effective vaccines. Some bacterial causes are described below.

Neisseria meningitidis bacteria

Neisseria meningitidis bacteria are often referred to as meningococcal bacteria. There are several different types of meningococcal bacteria, called groups A, B, C, W, X, Y and Z.

There's a vaccination that protects against group C meningococcal bacteria. Read more about the Men C vaccination. There's also a quadruple vaccine that provides protection against group A, C, W and Y meningococcal bacteria.

In the UK, most cases of meningococcal meningitis are caused by the group B bacteria. A vaccine for group B bacteria has recently been developed and approved for use, but it isn't currently available on the NHS.

Read more about the new meningitis B vaccine

Streptococcus pneumoniae bacteria

Streptococcus pneumoniae bacteria are often referred to as pneumococcal bacteria.

Pneumococcal bacteria tend to affect babies and young children because their immune systems (the body's natural defence) haven't built up immunity (protection) to these bacteria.

Spreading the bacteria

The meningococcal bacteria that cause meningitis can't survive for long outside the body, so they're usually only spread through prolonged, close contact. Possible ways the bacteria are spread include:

  • sneezing
  • coughing 
  • kissing
  • sharing utensils, such as cutlery
  • sharing personal possessions, such as a toothbrush or cigarette

As most people, particularly adults aged over 25, have a natural immunity to the meningococcal bacteria, most cases of bacterial meningitis are isolated, single incidents.

However, there's a chance of a small outbreak of cases occurring in environments where many young people live in close proximity. For example:

  • boarding schools
  • university campuses
  • military bases
  • student housing

Pneumococcal bacteria are more easily spread than meningococcal bacteria, and are passed on through coughing and sneezing. However, in most cases, they only cause mild infections, such as a middle ear infection (otitis media).

Read more about pneumococcal infections.

Viral meningitis

As in the case of bacterial meningitis, vaccination programmes have successfully eliminated the threat from many viruses that used to cause viral meningitis.

For example, the measles, mumps and rubella (MMR) vaccine provides children with immunity against mumps, which was once a leading cause of viral meningitis in children.

However, there are still a number of viruses that can cause viral meningitis. These include:

  • enteroviruses  a group of viruses that usually only cause a mild stomach infection, and can be spread through coughing, sneezing or not washing your hands after touching a contaminated surface
  • herpes simplex virus  which can cause genital herpes and cold sores 

During a meningitis infection

In most meningitis infections, bacteria or viruses spread through the blood. An infection can begin in one part of the body, such as your throat or lungs, before moving through the tissue and into the blood.

The brain is usually protected from infection by the blood-brain barrier, which is a thick membrane that filters out impurities from the blood before allowing it into the brain. However, in some people, the infection is able to pass through the blood-brain barrier and infect the meninges (brain membrane).

The immune system responds to the infection by causing the meninges to swell in an attempt to stop the spread of infection. The swollen meninges may then damage the brain and the rest of the nervous system (nerves and spinal cord).

Bacteria or viruses can also infect the cerebrospinal fluid (CSF) that surrounds and supports the brain and spinal cord. If the CSF becomes infected, it can cause the meninges to become more swollen, leading to increased pressure in the skull and pressing on the brain. This is known as intracranial pressure.

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Meningitis

Mary Baron and her family were enjoying a holiday in Tenerife when tragedy struck – her three-year-old grandson, Kyle, caught bacterial meningitis.

Mary Baron and her family were enjoying a holiday in Tenerife when tragedy struck  her three-year-old grandson, Kyle, caught bacterial meningitis.

"We'd been out for our evening meal when Kyle seemed to become unwell. We decided to return to our apartment so that we could put him to bed. 

"During the night Kyle was moaning. He had a high temperature and he'd been sick. I was worried he might have meningitis, so I checked his body for a rash. He didn't have one. I gave him some Calpol and put him back to bed.

"By the morning, Kyle was delirious. We called a doctor, who immediately suspected meningitis and ordered an ambulance. It wasn't until Kyle arrived at the hospital that the rash  which I knew was one of the signs of meningitis  began to appear.

"In hospital, we were deeply distressed when we were told that Kyle had as little as a 1% chance of surviving. They told us to prepare for the worst. Unless you've been in that situation yourself, you just can't understand how desperate it feels to be told your child or grandchild is probably going to die.

"Thankfully, Kyle proved the doctors wrong, and against all the odds he carried on fighting the disease, which raged through his body. Six weeks later, Kyle flew back from Tenerife to Sheffield Children's Hospital in an air ambulance. There, the doctors decided that to save Kyle's life, all four of his limbs needed to be amputated.

"The operation was a success and Kyle's condition began to improve. A few months later, he was allowed to go home to begin the long recuperation.

"Kyle now attends a special school in Sheffield. People are amazed by him and how positive he is. He's a normal young boy who likes doing things that all other young boys do, such as watching football, playing video games and spending time with his friends.

"Kyle is an upbeat, positive and loving lad. He's got a great personality, and he wants to be a comedian when he grows up. I hope he'll succeed in that, because he's already an inspiration to me and to everyone who meets him."

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