This article was medically reviewed by Dr. Ira Gurland.
Meningitis is a complex disease that can take many forms, some being very serious or even deadly. As a result, it’s important to recognize the symptoms of different meningitis types and to understand how they are diagnosed and treated — as Dr. Ira Gurland of ID Care explains in this blog.
Meningitis is an inflammation, or swelling, of the meninges, the protective membranes that line the brain and spinal cord. It is most commonly caused by an infection of the fluid around the meninges.
Some quick facts about meningitis fall into the following categories:
- Types: Viral is the most common type of meningitis in the United States and bacterial is the second most common type. Much less common are the fungal, parasitic, and amebic types, as well as non-infectious cases of meningitis associated with medication use, other health conditions, or injuries.
- Severity: Bacterial meningitis can be extremely serious, leading to brain damage, or even death. Viral meningitis tends to be milder.
- Risk: Anyone can get meningitis, but certain people face a higher risk, including those who are immunocompromised or live in crowded conditions.
- Prevention: There are vaccines that can prevent meningitis, but only a certain bacterial type.
- Symptoms: The signs of meningitis are similar across all types and can mimic a cold or flu, including headache, fever and stomach upset.
- Diagnosis: A spinal tap, also referred to as a lumbar puncture, is the go-to test used to diagnose meningitis.
- Treatments: Bacterial meningitis is treated with antibiotics, viral disease with hydration and rest, and the rare fungal, parasitic, and amebic forms with other kinds of medicines.
“The best overall advice I can offer is to prevent meningitis when possible, urgently seek a diagnosis if you have symptoms, and, once diagnosed, follow the care plans given to you by infectious disease doctors like those at ID Care,” Dr. Gurland said.
Assessing Meningitis Risk
Anyone can get meningitis, but certain groups of people are more at risk:
- Those with compromised immune systems: This includes people with immune-compromising illnesses such as HIV; pregnant women, who are susceptible to the bacteria Listeria; and infants and young children, whose immune systems are immature.
- People who live in crowded conditions: This includes college students who live in dorms and can contract meningitis through respiratory secretions, such as people coughing nearby.
- People in certain professions, particularly laboratory scientists who work with the germs that cause bacterial meningitis.
Recognizing the Symptoms of Meningitis
The symptoms of meningitis are similar across all types of the disease but may vary in severity. They can include:
- stiff neck
- sensitivity to light
- nausea and vomiting
The list may be broader for some disease types; for instance, bacterial meningitis symptoms may also include seizures and/or a rash.
Is Meningitis Preventable?
Some types are preventable.
A key way to prevent meningitis is through vaccines, which can help prevent some bacterial forms of the disease. One vaccine prevents meningococcus by targeting four bacterial types. Another meningitis vaccine protects strictly against S. pneumoniae, while a third type protects against disease caused by Haemophilus influenzae type B. There are no other types of meningitis vaccination.
“It is fortunate that we have a vaccine against meningococcal meningitis, a rare but very contagious and devastating form of meningitis that can leave people with significant damage to their brains and bodies,” Dr. Gurland said. “Generally, this vaccine is given to younger people, who face a higher risk of contracting the disease. Most pediatricians give it to patients from age 11 to 16 in preparation for college, where there have been many outbreaks due to students living and gathering in small spaces and spreading bacteria through respiratory secretions. At ID Care, we offer these vaccines in our offices.”
Other Preventive Strategies
There are also several other strategies for preventing meningitis:
- Avoiding exposure can include keeping your distance from people who have a respiratory infection and taking care of your health and hygiene.
- Requesting an antibiotic is wise after coming into contact with someone diagnosed with meningococcus type meningitis.
- Using only previously boiled, distilled, or filtered water for nasal irrigation is essential, as inhaled tap water can very rarely lead to amebic meningitis.
The Best Way to Diagnose Meningitis
All forms of meningitis are diagnosed by sampling the fluid around the brain using a lumbar puncture, also known as a spinal tap, ideally in the emergency room.
“As soon as you suspect that you may have meningitis, it’s time to go the emergency room,” Dr. Gurland emphasized. “This disease is often an emergency, and that certainly includes all of the bacterial forms, which require urgent diagnosis and treatment.”
A Look at Types of Meningitis
Meningitis is divided into types based on the kinds of germs that cause it.
The two most common in the United States are:
- Viral meningitis, the most common, which is caused by certain viruses in the community.
- Bacterial meningitis, the second most common type, which is caused by specific kinds of bacteria.
Together, the viral and bacterial forms comprise 99% of all the meningitis cases in the United States. The viral type alone causes more than half of those, with an incidence ranging from 0.26 to 17 cases per 100,000 people. The most common type of viral meningitis, caused by enterovirus infections, account for up to 75,000 cases each year in the U.S. Meanwhile, for every 100,000 people in the U.S., there are 1.3 cases of bacterial meningitis, which translates to about 4,200 cases per year, approximately 500 of them fatal.
Other types of meningitis are even more rare. They include:
- fungal meningitis, which is caused by fungi.
- parasitic meningitis, which is caused by parasites.
- amebic meningitis, a very rare type of parasitic meningitis that is caused by amoeba typically found in water.
All those types are considered infectious because they are caused by germs that can spread between people. There are also non-infectious types of meningitis:
- medication-stimulated meningitis can develop as a side effect of the antibiotic Bactrim or of non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen.
- meningitis associated with another illness can occur if a cancer spreads to the covering of the brain or as a complication of lupus, sarcoidosis, a head injury, or brain surgery.
Treating Meningitis Types
Treatment is different for each type of meningitis.
- Bacterial meningitis is treated with antibiotics.
- Viral meningitis is treated with rest and hydration.
- Fungal meningitis is treated with antifungal medications.
- Parasitic meningitis is treated with antiparasitic medications.
- Amebic meningitis may rarely be treatable with antibiotics.
- Non-infectious meningitis is addressed by treating the medical problem that caused it, stopping the drug that contributed to it, and providing supportive care — although antibiotics and steroids may be given until bacterial meningitis has been ruled out.
Understanding Viral Meningitis
Viral meningitis occurs when a virus causes an infection of the meninges. The most common causes are non-polio enteroviruses, including coxsackie virus A and B and echoviruses, which are inhaled or acquired through the gastrointestinal tract. In addition, the genital herpes virus HSV-2, often having been reactivated after an earlier infection, can cause meningitis. Viral meningitis runs its course in 1-2 weeks, with little risk of complications.
In rare cases, viral meningitis can occur frequently in specific individuals. This syndrome is known as Mollaret meningitis. “Although some research shows a connection between this syndrome and the presence of HSV-2, as infectious disease doctors, we don’t yet fully understand why these individuals so often experience viral meningitis symptoms,” Dr. Gurland said.
Viral Meningitis Treatment
Viral meningitis is treated mainly with supportive care consisting of rest, pain medications and, when necessary, IV fluids. This is because not many antiviral medications work well against the common causes of this disease type.
Understanding Bacterial Meningitis
Bacterial meningitis occurs due to an infection by bacteria that are inhaled and then travel through the bloodstream and into the meninges; others are acquired from food. Once severe symptoms have emerged, bacterial meningitis is likely to last at least 10 to 14 days with treatment with antibiotics.
This type of meningitis can be quite severe and quickly deadly. In some survivors, it can cause long-term health issues. Brain problems, such as infections, can arise, causing speech and sight difficulties that could become permanent. “Some are surprised to learn that pneumococcal meningitis can also be associated with difficulty hearing that can linger after the illness is over,” Dr. Gurland said. “However, if the cause is recognized and treatments such as steroids are given, the severity of the hearing loss may be reduced.”
Bacterial Meningitis Treatment
Antibiotics are the key to treatment for bacterial meningitis. Initially, when the cause of this meningitis type is unknown, patients are treated with antibiotics that target all the bacteria that might have sparked the disease. Once the cause has been identified, bacterial meningitis treatment consists of an antibiotic that targets only the relevant bacteria.
Your Environment and Fungal Meningitis
Fungal meningitis is extremely rare in the United States. Here are 3 top facts about this type of meningitis:
- It comes from the earth: Fungus from airborne soil, decaying wood, or leaves can cause meningitis if it enters the body, typically through the respiratory tract. Then, the fungus spreads from the lungs to the brain.
- It’s location dependent: Those who live in certain areas of the United States, such as the southwest and upper Midwest, are more likely to get fungal meningitis due to the germs in their environments.
- It can be associated with medications. Taking steroids or other specialized medications can make fungal meningitis more likely.
- It can be associated with certain medical conditions. HIV infection when severe can lead to certain types of fungal meningitis.
Food, Water — and Parasitic Meningitis
Parasitic, or eosinophilic, meningitis arises when a parasite contracted from eating contaminated food inflames the meninges. “This type of meningitis is very unusual in the United States and more often occurs in Southeast Asia when people contract Angiostrongyliasis cantonensis from eating raw snails,” Dr. Gurland said.
An especially rare and usually fatal type of parasitic meningitis called amebic meningitis is typically caused by the pathogen Naegleria fowleri. Three top facts about this type of meningitis are that:
- It affects swimmers: Amebic meningitis is contracted by swimming in stagnant lake water, hot springs, or unmaintained pools, where individuals can pick up amoeba that burrow into their nasal cavities and then into the meninges and brain.
- It’s difficult to diagnose: To identify this type of meningitis, a doctor must first suspect the presence of amoeba.
- It’s difficult to treat: The only known treatments for amebic meningitis are ineffective, resulting in a fatality rate of nearly 90%.
“Less than 350 cases of amebic meningitis, also known as amebic encephalitis, have been reported worldwide, but it’s worthwhile to note that there has been a higher incidence of this kind of infection in people who irrigate their noses using neti pots,” Dr. Gurland said. “The recommendation with nasal irrigation is to use filtered or sterilized water, because if you use tap water or water that is stagnant, it’s possible for free-floating amoeba to enter the nose and burrow into the nasal cavity to the brain.”
Do You Need to be Hospitalized for Meningitis?
“If a spinal tap suggests viral meningitis and the patient can eat and function with pain medications, he or she can go home for rest and hydration. But patients who can’t control their pain and can’t keep food down should go to the hospital for supportive treatment, even if their meningitis is viral,” Dr. Gurland said.
When a spinal tap suggests bacterial meningitis, the patient must be hospitalized to receive antibiotics and await a definitive diagnosis, which can take a few days. Infectious disease doctors like those at ID Care send these patients home once their condition has stabilized and a treatment plan has been put in place. Other types of meningitis usually require hospitalization, too.
What is ID CARE’s Role in Treating Patients with Meningitis?
The infectious disease doctors at ID Care play a central role in the management of meningitis across New Jersey.
“Our first goal is to prevent meningitis, so we strongly encourage and provide vaccination,” Dr. Gurland said. “We can also make recommendations about how to test for meningitis and how to diagnose meningitis. Finally, when patients do receive a diagnosis, ID Care doctors have the expertise to provide effective therapies rapidly, which is crucial in the management of what can be a devastating and even deadly disease. Our team of more than 50 doctors is available to provide that care 24/7.”