Carl R. Darnall Army Medical Center - Health Library

Bacterial Meningitis

(Spinal Meningitis)

Definition

The brain and spinal cord are covered by layers of tissue. These layers are called the meninges. Bacterial meningitis is an infection of the meninges.

It is an urgent issue that will need immediate treatment. Severe infections can lead to death within hours.

Bacterial Meningitis
Meningitis

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Causes  ^

The infection is caused by bacteria. There are many different types. Some are more likely to cause a severe infection than others.

Bacteria is most often passed from an infected person through:

  • Coughing, sneezing, or kissing—most common
  • Fluid contact during birth (bacteria passes from mother to child)
  • Food made by an infected preparer

Risk Factors  ^

Bacterial meningitis is more common in:

  • Infancy and childhood
  • Older adults compared to middle-aged adults

Other factors that may increase your chance of getting bacterial meningitis include:

  • Missing recommended vaccinations
  • Community living, such as a college dormitory or military base
  • Close and prolonged contact with people with meningitis
  • Suppressed immune system caused by certain health conditions or medicines
  • Head trauma that includes something breaking through skull and into meninges or brain
  • Previous brain surgery, or cerebrospinal fluid shunts
  • Birth defects, such as dermal sinus or myelomeningocele, a type of spina bifida
  • A history of epidural steroid injections or other invasive spinal procedures
  • Cochlear implants
  • Alcohol use disorder
  • Smoking, or exposure to second-hand smoke

Symptoms  ^

Classic symptoms can develop over several hours or may take 1-2 days:

  • High fever
  • Headache
  • Very stiff, sore neck

Other symptoms may include:

  • Red or purple skin rash
  • Bluish skin color
  • Nausea
  • Vomiting
  • Sensitivity to bright lights
  • Sleepiness
  • Mental confusion
  • Seizures

Symptoms can be hard to spot in newborns and infants. Infants under 3 months old with a fever are often checked for meningitis. Symptoms in newborns and infants may include:

  • Inactivity
  • Unexplained high fever or any form of temperature instability, including a low body temperature
  • Irritability
  • Vomiting
  • Yellowing of the skin or eyes
  • Feeding poorly or refusing to eat
  • Tightness or bulging of soft spots between skull bones
  • Difficulty awakening

Complications of bacterial meningitis include:

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Blood cultures—to look for bacteria
  • Urine tests
  • Tests of mucous and pus from your skin
  • Lumbar puncture—test fluid that surrounds your spine and brain called cerebrospinal fluid (CSF)

Imaging tests of the brain and spinal cord may be done with:

Treatment  ^

Immediate care will include:

  • Antibiotics—to fight bacteria
  • Corticosteroids—to reduce swelling
  • Fluids

Most will survive with immediate care.

People usually stay in the hospital until the fever has fallen. The fluid around the spine and the brain will also need to be clear of infection. This may mean several days in the hospital.

Antibiotics

Antibiotics are given through an IV. It will be started as soon as the infection is suspected. Tests will be done to find the exact type of bacteria. The type of antibiotics may be changed after the test results are in.

Corticosteroids

Corticosteroids help to control brain pressure and swelling. It can help to prevent further damage to the brain. This may decrease risk of complications after, like hearing loss.

Fluid Replacement

Fluids can be lost due to fever, sweating, or vomiting. IV fluids will help you until you are feeling better.

Other Medications

Your doctor may also advise:

  • Pain relievers
  • Sedatives
  • Anticonvulsants—to control or avoid seizures
  • Medications to help reduce brain swelling
  • Glycerol to reduce the risk of hearing loss and neurological complications

Prevention  ^

Steps that may help you reduce your chance of getting bacterial meningitis include:

  • Antibiotics if you have been in contact with an infected person. It may be given if you have one or both of the following:
    • Extended contact with someone who is infected
    • Had contact with secretions from mouth of infected person
  • Make sure your vaccinations are up to date.
  • Choose pasteurized milk and milk products.
  • Prenatal care is important. It may help to find an infection before it passes to the baby.
RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov

Meningitis Foundation of American
http://www.musa.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Meningitis Research Foundation of Canada
http://www.meningitis.ca

REFERENCES:

Bacterial meningitis in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115577/Bacterial-meningitis-in-adults. Updated September 26, 2017. Accessed October 2, 2017.

Bacterial meningitis in infants and children. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T566506/Bacterial-meningitis-in-infants-and-children. Updated September 26, 2017. Accessed October 2, 2017.

Bamberger D. Diagnosis, initial management, and prevention of meningitis. Am Fam Physician. 2010;82(12):1491-1498.

Lumbar puncture (LP). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T168500/Lumbar-puncture-LP. Updated September 11, 2017. Accessed October 2, 2017.

Meningitis and encephalitis information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm. Accessed October 2, 2017.

Meningococcal disease. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/meningococcal/about/index.html. Updated March 28, 2017. Accessed October 2, 2017.

Weisfelt M, de Gans J, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in alcoholic patients. PLoS One. 2010;5(2):e9102.

10/2/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T115577/Bacterial-meningitis-in-adults: Centers for Disease Control and Prevention. Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. MMWR. 2009;58(37):1042-1043.

4/22/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T115577/Bacterial-meningitis-in-adults: Lee CC, Middaugh NA, Howie SR, Ezzati M. Association of secondhand smoke exposure with pediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLoS Med. 2010;7(12).

1/2/2014 DynaMed Plus Systematic Literature Surveillance httphttp://www.dynamed.com/topics/dmp~AN~T115577/Bacterial-meningitis-in-adults: Zalmanovici T, Fraser A, et al. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev. 2013;10:CD004785.

Last reviewed January 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 7/17/2018