Travel Medicine

Emerging Infectious Diseases and Other Conditions

Meningitis

What is meningitis?

Meningitis is an inflammation of the meninges, the membranes that cover the brain. There are three meninges:

dura mater - the outside membrane that adheres to the inside of the skull
arachnoid - the middle membrane
pia mater - the innermost membrane, which adheres to the brain

What are the causes of meningitis?

There are two distinct types of meningitis:

viral -- caused by a virus

Viral meningitis is more common than bacterial, although rarely life-threatening.Viral meningitis can be caused by different viruses, and is spread between people by coughing or sneezing, or through poor hygiene. Other germs can be found in sewage polluted water.

Viral meningitis cannot be helped by antibiotics. Treatment is based on good nursing care. Recovery is normally complete, but headaches, tiredness, and depression may persist.

bacterial -- caused by a bacterium

Bacterial meningitis, although comparatively rare, is by far the most dangerous and may be fatal.

Bacteria may be spread between people by coughing, sneezing, and kissing, but they cannot live outside the body for long. They cannot be picked up from water supplies, swimming pools, buildings, etc.

Many species of bacteria can cause meningitis, but three types account for about 80 percent of cases:

neisseria meningitidis (meningococcus) Meningococcus is found in the nasopharynx of about 5 percent of the population and is spread by respiratory droplets and close contact. For unknown reasons, only a small fraction of carriers develop meningitis. Meningococcal meningitis occurs most often in the first year of life, but may also occur in closed populations, such as schools. Meningococcal meningitis occurs commonly overseas, particularly in sub-sahara Africa and the Middle East. A vaccine is partly protective, and is often given to travelers.

hemophilus influenzae type b
Hemophilus influenzae type b accounts for most meningitis in children more than one month old, but usually not in adults unless there is a predisposing factor such as head trauma or a compromised immune system. A vaccine is available, but it is not customarily given to travelers because the risk of infection is low.

streptococcus pneumoniae (pneumococcus)
Pneumococcus is the most common cause of adult meningitis. Those at high risk are alcoholics and people with chronic ear infections, sinus infections, closed head injury, recurrent meningitis, pneumococcal pneumonia, sickle cell disease, or those without a spleen. A vaccine is available but like H. influenza b, it is not customarily given to travelers unless they are in one of the high risk groups.

How does the infection reach the brain?

There are several ways that the infection can reach the brain, including:

through the bloodstream from another infected part of the body
through the bones of the skull from infected sinuses or inner ears
from a head injury, such as a fractured skull or penetrating wound
after surgery or extended hospitalization
a weakened immune system
as a result of chronic kidney failure

What are symptoms of meningitis?

It is important to note that these symptoms may not occur all at once nor in everyone who contracts meningitis.

Symptoms of meningitis may include:

fever
headache
nausea and vomiting
stiff neck
photophobia (low tolerance to bright light)
occasionally, deep red or purplish skin rash that does not turn white when pressed
joint aches or pains
if untreated, drowsiness may develop followed by loss of consciousness
occasionally, seizures

Symptoms for children may also include:

fever -- possibly with the hands and feet feeling cold
refusing foods or vomiting
high pitched moaning cry or whimpering
dislike of being handled -- fretful
neck retraction with arching back
blank and staring expression
child difficult to wake -- lethargic
pale, blotchy skin color

How may meningitis be treated?

There are many forms and degrees of meningitis. Treating it depends on the type of bacterium or virus that causes the infection.

Specific treatment will be determined by your physician(s) based on:

your overall health and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Generally, antibiotics are used to treat bacterial meningitis, and may also prescribed for immediate family members or others who are in very close contact with the patient . Antibiotics are not used for viral meningitis. Vaccines are available for several forms of bacterial meningitis, as discussed above.

This page was last updated on: February 14, 2008.

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