The most common causes of meningitis are viral infections that usually get better without treatment. However, bacterial meningitis infections are extremely serious, and may result in death or brain damage, even if treated.
Acute bacterial meningitis is a medical emergency, and requires immediate treatment in a hospital.
Viral meningitis is milder and occurs more often than bacterial meningitis. It usually develops in the late summer and early fall, and often affects children and adults under age 30. Most infections occur in children under age 5. Most viral meningitis is due to enteroviruses, which are viruses that also can cause intestinal illness.
Many other types of viruses can cause meningitis. For example, viral meningitis can be caused by herpes viruses, the same virus that can cause cold sores and genital herpes (although people with cold sores or genital herpes are not at a greater risk of developing herpes meningitis).
Recently, West Nile virus, spread by mosquito bites, has become a cause of viral meningitis in most of the United States.
Symptoms usually come on quickly, and may include:
Unusual posture, with the head and neck arched backwards (opisthotonos)
Meningitis is an important cause of fever in children and newborns.
People cannot tell if they have bacterial or viral meningitis by how they feel, so they should seek prompt medical attention.
Signs and tests
Physical examination will usually show:
Fast heart rate
Mental status changes
For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing.
Doctors prescribe antibiotics for bacterial meningitis. The type will vary depending on the bacteria causing the infection. Antibiotics are not effective in viral meningitis.
Other medications and intravenous fluids will be used to treat symptoms such as brain swelling, shock, and seizures. Some people may need to stay in the hospital, depending on the severity of the illness and the treatment needed.
Early diagnosis and treatment of bacterial meningitis is essential to prevent permanent neurological damage. Viral meningitis is usually not serious, and symptoms should disappear within 2 weeks with no lasting complications.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.