Meningitis: Symptoms, Causes and Treatment

Meningitis is an inflammation of the membranes that surround the brain and spinal cord. It is most often caused by a virus, in which case the illness is usually mild and resolves on its own, but bacterial meningitis is serious and requires immediate hospital treatment. Typical symptoms include fever, headache and a stiff neck. This article explains how to recognise the symptoms, how the viral and bacterial forms differ, how the disease is treated and when help must be sought straight away.

Inflammation of the meninges in brief

The brain and spinal cord are protected by a three-layered system of membranes, the meninges, inside which cerebrospinal fluid circulates. When a microbe enters this space, the membranes become inflamed and swollen, which causes the typical severe headache and neck stiffness. Meningitis is not the same as encephalitis, in which the inflammation is in the brain tissue itself. In everyday language the two are sometimes lumped together, which easily causes confusion.

The great majority of cases are caused by viruses or bacteria, and these two forms of the disease differ from each other decisively. Viral meningitis is usually mild and not life-threatening. Bacterial disease, by contrast, is a serious systemic infection that can progress within hours and carries significant mortality without rapid treatment. Rarer causes of meningitis include fungi and certain parasites.

Fortunately meningitis is rare, particularly the bacterial form. Vaccinations have reduced severe cases considerably over recent decades. It is still important to be able to recognise the illness, because acting quickly makes a great difference.

Viral and bacterial causes

Among viruses, the most common causes of viral meningitis are enteroviruses, which otherwise mainly cause respiratory and gastrointestinal infections. They occur especially in late summer and early autumn. Other possible causes include herpes simplex virus, the varicella (chickenpox) and mumps viruses, and tick-borne encephalitis virus. A mild viral meningitis can sometimes be part of an ordinary viral infection, and it then shows up only as a headache that is more severe or longer-lasting than usual.

Among bacteria, the most common causes of bacterial meningitis in adults are pneumococcus, meningococcus and listeria. Infections caused by pneumococcus and listeria are more common in older people, whereas meningococcus is more typical in children and young adults. Listeria is rare but poses a particular risk to older people, pregnant women and those with weakened immunity. Rarer bacterial causes include borrelia and the tuberculosis bacterium.

In newborns and babies a few weeks old, the causative agents are partly different, for example group B streptococcus. For this reason a baby under three months old who has a fever should always be taken promptly for a medical assessment, even if there are no other symptoms. At this age, fever alone is reason enough to act quickly.

Risk groups and predisposing factors

Anyone can develop meningitis, but certain groups are more susceptible to severe bacterial disease. These include older people, babies and young children, pregnant women and those whose immunity is weakened by illness or medication. Removal of the spleen also increases susceptibility to certain bacterial infections, which is why vaccinations are recommended for these individuals.

Meningococcus spreads by droplet transmission through respiratory secretions, and it is more common in young adults and in groups living closely together. Listeria, on the other hand, can be transmitted through food, for example certain cold-smoked or unpasteurised products, and is a particular risk for pregnant women and older people. After brain or spinal surgery, staphylococci can rarely cause the infection.

Being unvaccinated is one of the most significant risk factors that you can influence yourself. Spending long periods in regions where meningococcal disease is common also increases the risk. For this reason, vaccination is recommended for travellers before such trips.

Meningitis symptoms in adults

Meningitis symptoms often develop rapidly. The most typical are fever, severe headache and a stiff neck, and nausea, vomiting and sensitivity to light are often present as well. Neck stiffness means that bending the chin towards the chest is difficult or painful, and it is not caused by ordinary neck pain. Sitting on a flat surface with the legs straight may also feel impossible.

In bacterial disease the fever is usually high and the general condition collapses within a day or two, sometimes even within hours. Symptoms may include confusion, a lowered level of consciousness, unusual drowsiness and seizures. In meningococcal infection, small or larger red or bluish-purple spots caused by bleeding under the skin may appear. In very old people the disease may even occur without fever, and the only sign may be a rapid decline in general condition.

In viral disease the symptoms are similar in type but milder. The fever is rarely as high as in bacterial disease, and there is no impaired consciousness or other neurological symptoms. General condition usually remains reasonably good, and the illness typically resolves within a couple of weeks, although a tendency to headaches can continue for several weeks.

The way the symptoms develop can give a clue as to which form is involved. In viral disease the symptoms usually stay the same or begin to ease during the first three days, whereas in bacterial disease they worsen day by day. The two forms cannot, however, be reliably distinguished on the basis of symptoms alone, and so any suspicion always requires examination by a doctor.

Differences from ordinary headache, flu and migraine

Fever and headache are part of almost every cold or flu, and the vast majority of feverish headaches are caused by a perfectly ordinary viral infection. With a cold or flu, the headache is usually accompanied by a runny nose, sore throat or cough, and you feel better with rest and a painkiller. You may feel tired, but your thinking is normal and your neck bends, even if the muscles are sore.

In migraine the headache can be very severe and may be accompanied by nausea and sensitivity to light, which are the same symptoms as in meningitis. Migraine is usually not accompanied by fever, however, and many people recognise an attack from previous episodes. If a headache is the worst of your life, begins suddenly like a thunderclap or differs clearly from previous attacks, you should seek assessment immediately, whatever its eventual cause turns out to be.

Alarming combinations include fever together with a stiff neck, confusion or spots caused by bleeding under the skin, as well as a rapidly worsening general condition. An ordinary cold rarely causes a collapse in condition within a few hours. If something feels different now from your usual experience of being ill, trust your instinct and seek help.

Meningitis in children and babies

In children, the symptoms of meningitis are largely the same as in adults: high fever, headache, vomiting, tiredness, sensitivity to light and a stiff neck. In young children and babies, however, neck stiffness is often absent. In them, signs may include distress when handled, an unusual or high-pitched cry, floppiness and not responding to their surroundings in the usual way.

A seizure may also be the first symptom. A rapid deterioration in the general condition of a feverish child, cold hands and feet, changes in skin colour and spots from bleeding under the skin are signs that mean you must go to the emergency department immediately. In children the disease can progress within a few hours.

Viral meningitis is considerably more common in children than the bacterial form. The children are then usually in good condition and recover within a few days. Because the two forms cannot be distinguished on the basis of symptoms alone, a suspicion is always investigated in hospital. Once bacterial disease has been ruled out, a child recovering from the viral form can usually get better at home, with symptoms eased by anti-inflammatory painkillers.

It is useful for parents to know that most fever in children is caused by ordinary viral infections, and a child can be playful and alert despite a fever while a fever medicine is working. What is worrying is specifically a child who remains floppy, hard to wake or unresponsive despite fever medicine. In that case there is no point in hesitating; set off immediately.

When to see a doctor or go to the emergency department

An ordinary feverish cold with a mild headache can be monitored at home as long as your general condition stays reasonable and the symptoms start to ease within a few days. Fever and headache are very common in viral infections, and on their own they do not raise suspicion of bacterial meningitis. Rest, adequate fluids and, if needed, a fever-reducing painkiller are usually enough in this situation.

It is worth seeing a doctor if fever and headache continue without easing for more than three days, even if there are no other symptoms. Likewise, get in touch if the headache is more severe than usual, if you are vomiting repeatedly or if you have been in close contact with someone diagnosed with meningococcal disease. A baby under three months old with a fever should also always be assessed by a doctor promptly.

Go to the emergency department or call the emergency number immediately if fever is accompanied by a clear and rapid decline in general condition, a stiff neck, confusion, hallucinations, unusual drowsiness, a lowered level of consciousness, a seizure, numbness or paralysis in the face or limbs, or spots from bleeding under the skin. In these situations you must not wait but act at once. Suspected meningitis is not a matter for a remote consultation; it always requires examination in hospital.

What to do if you suspect a serious illness

If someone close to you is confused, unusually drowsy or deteriorating rapidly, call the emergency number rather than driving them yourself. The emergency service will assess the situation and give instructions, and in an ambulance treatment can begin on the way. If the person's condition is still reasonable and they can be transported safely, you can go straight to the emergency department.

Do not wait for a rash, because not everyone who falls ill develops one, and it may appear only late. At the emergency department, explain when the symptoms started, how they have developed, whether the patient has been vaccinated and whether they have been in close contact with someone who is ill. This information speeds up the assessment and helps the doctor choose the right tests.

Diagnosis: lumbar puncture and other tests

At the emergency department the doctor examines the patient, paying particular attention to neck stiffness, level of consciousness and nervous system function. Blood tests, such as inflammatory markers, can help distinguish bacterial from viral disease, but they are not sufficient on their own for a reliable distinction. The most important test is a lumbar puncture, in which a sample of cerebrospinal fluid is taken from the lower back with a thin needle.

The cerebrospinal fluid sample can show whether meningitis is present and often also identify the causative agent and which antibiotic the bacterium is sensitive to. A brain imaging scan is often performed as well, for example to look for raised intracranial pressure, an abscess or concurrent encephalitis. If the symptoms and course of the illness are very typical of viral disease, not all tests are always needed.

A lumbar puncture sounds frightening to many people, but it is a routine procedure performed under local anaesthetic. Knowing whether the cause is a bacterium or a virus determines the treatment. For this reason the test is often essential.

Treatment of the bacterial and viral forms

Bacterial meningitis is always treated in hospital with intravenous antibiotics, and treatment is started immediately once the disease is suspected. A corticosteroid is often used to reduce pressure in the brain. In the most severe cases the patient spends the first days in intensive care, and thanks to treatment the majority recover well.

Bacterial disease can, however, leave some patients with after-effects, such as hearing or vision problems or other neurological symptoms. Recovery is therefore followed up after hospital treatment, and hearing, for example, is often tested separately. Starting treatment quickly is the best way to reduce the risk of long-term consequences.

Viral meningitis usually resolves on its own with rest once bacterial disease has been ruled out. Symptoms can be relieved with anti-inflammatory painkillers, and recovery often takes place at home. For some viruses, such as herpes and varicella viruses and influenza, an antiviral medicine exists and is used when needed.

Recovery and follow-up after the illness

After viral meningitis, many people return to normal daily life within a couple of weeks, but tiredness and a tendency to headaches can last longer. Gentle activity during recovery does not slow healing, and it is best to build up your strength gradually according to how you feel. If the headache worsens again or is accompanied by fever, it is a good idea to contact a doctor.

After bacterial meningitis, recovery usually takes longer, and follow-up visits check whether any after-effects remain. Reduced hearing, difficulty concentrating, memory problems or changes in mood are things worth telling your doctor about. Many of these ease over time, and support is available.

A return to work or study is best planned according to how you feel. After a long hospital stay it can be helpful to start with reduced hours, if that is possible. Adequate sleep, regular meals and light exercise support recovery, whereas returning too quickly to a full workload can prolong fatigue. If necessary, let your employer or teacher know that your concentration may be weaker than usual for a while.

A serious illness is also hard on those close to the patient, and fear that the disease will return is a common reaction. If worry, fears or sleep problems continue for weeks after recovery, it is worth talking about them with a doctor. Support is available both for the person who was ill and for the family.

Meningitis prevention and vaccines

Vaccines exist against pneumococcus and meningococcus, and routine vaccinations for young children have significantly reduced severe bacterial meningitis. There are several subgroups of meningococcal bacteria, the most important being A, B, C, W, X and Y. Vaccines are available against groups A, C, W and Y, and separately against group B. Vaccination is recommended, for example, for travellers who will stay for long periods in regions where the disease is common, and for certain risk groups, such as people whose spleen has been removed.

Meningitis does not usually spread through close contact with another person, and getting cold or going out in winter without a hat does not increase the risk. The exception is meningococcal disease, although even there the risk is small. When someone falls ill with meningococcal disease, their close contacts, such as family members, are protected with a short course of antibiotics, and health authorities usually take care of contact tracing.

There is no specific vaccine to prevent viral meningitis. Good hand hygiene, however, reduces the spread of viral infections in general. Vaccinations against chickenpox, mumps and tick-borne encephalitis also reduce the complications caused by these viruses.

Listeria infection can be prevented through food choices, which is especially important during pregnancy and for older people. Risk products include unpasteurised dairy products, vacuum-packed cold-smoked and cured fish products, and ready meals stored for a long time that are not heated before eating. Heating food thoroughly, keeping the fridge cold enough and observing use-by dates reduce the risk. If you belong to a risk group, a doctor or nurse can give you more detailed advice.

How can Dokport help with suspected meningitis and recovery

To say it plainly: if you suspect meningitis and the symptoms include a stiff neck, confusion, spots from bleeding under the skin or a collapse in general condition, do not contact a remote doctor, but go to the emergency department immediately or call the emergency number. A remote consultation cannot take a spinal fluid sample or start intravenous antibiotic treatment. In this situation, no time should be lost.

Through Dokport, however, you can get quick access to a remote doctor in many situations related to fever, headache or recovery. Via chat, the doctor can assess a prolonged feverish infection, for example, help judge whether a headache is ordinary or one that needs closer examination, and advise you if you have been exposed to meningococcal disease. You can also receive individual guidance on questions about vaccinations, for example before travelling.

After hospital treatment, the doctor can help with questions during the recovery phase, such as prolonged tiredness or headache. Medication or sick leave may be provided if, based on the doctor's assessment, it is appropriate for your situation, and if needed the doctor will direct you to further tests, an in-person appointment or straight to the emergency department. The aim is quick, easy and safe access to a doctor's support, and that includes honest guidance to the right place when remote care is not enough.

Summary

Meningitis is an inflammation of the membranes surrounding the brain, and its most common symptoms are fever, severe headache and a stiff neck. Viral disease is usually mild and resolves on its own, but bacterial meningitis is serious and requires immediate hospital treatment. Confusion, a lowered level of consciousness, spots from bleeding under the skin and a rapid collapse in general condition are signs that call for immediate action.

Vaccinations provide effective protection against the most common bacterial causes. If fever and headache continue without easing for more than three days, a doctor's assessment is appropriate, even if there are no other symptoms. When in doubt about serious warning signs, go to the emergency department rather than waiting.