Bacterial 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

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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:

• Systemic infection— sepsis
• Shock—very low blood pressure
• Seizures
• Brain swelling
• Fluid build up in the brain— hydrocephalus
• Hearing loss
• Vision problems
• Paralysis
• Coma
• Death

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:

• MRI scan
• CT scan

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.