Bacterial Meningitis

(Spinal Meningitis)



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 and cerebrospinal fluid (CSF), a clear fluid that surrounds and protects the brain and spinal cord.

Bacterial meningitis is a serious infection. It is a medical emergency, requiring immediate treatment. Depending on the severity of the infection, it can result in death within hours.

Bacterial Meningitis

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Bacterial meningitis can be caused by many different bacteria. The likelihood of having one type of bacteria over another varies by age group. Severity of the infection depends on the bacteria causing it and the overall health of your immune system.

Transmission of the bacteria usually occurs by direct contact with oral or respiratory secretions, such as inhaling droplets from someone who sneezes or coughs, or by kissing. The spread of the bacteria depends on the time of the year, crowding, and the presence other respiratory infections.

Risk Factors

Risk Factors

Bacterial meningitis is more common in infancy and childhood. For adults, the risk increases as you age. Other factors that may increase your chance of getting bacterial meningitis include:

  • Not having recommended vaccinations
  • Community living arrangements, such as a college dormitory or military base
  • People in close and prolonged contact with people with meningitis
  • Supressed immune system caused by certain health conditions or medications
  • Penetrating head trauma
  • 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



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

In newborns and infants, symptoms are hard to notice. As a result, 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



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 and cultures
  • Urine tests
  • Tests of mucous and pus from your skin
  • Lumbar puncture

Imaging tests of the brain and spinal cord may be done with an MRI scan or CT scan.



More than 90% of all people with this infection survive with immediate care, including:

  • Antibiotics and corticosteroids—often given together
  • Fluids


Antibiotics are given through an IV. This is started as soon as the infection is suspected. The antibiotics may be changed once tests find the exact bacterial cause. People usually stay in the hospital until the fever has fallen

and the fluid around the spine and the brain is clear of infection.

This may require a hospital stay of several days.


These are usually given by IV early in treatment, but are generally used for specific causes of meningitis.

Corticosteroids control brain pressure and swelling. They also reduce the body’s production of inflammatory substances. This treatment can prevent further damage.

Specifically, it reduces the risk of hearing loss and neurological complications.

Fluid Replacement

Fluids can be lost due to fever, sweating, or vomiting. They may be replaced through an IV. It will be done carefully to avoid complications of fluid overloading.

Other Medications

Your doctor may also recommend:

  • Pain relievers
  • Sedatives
  • Anticonvulsants

  • Medications to help reduce brain swelling
  • Glycerol to reduce the risk of hearing loss and neurological complications



To help reduce your chance of getting bacterial meningitis:

  • If you have been exposed to meningitis, or are a carrier or healthcare worker, you may need to take prophylactic antibiotics to prevent infection.
  • Make sure your vaccinations are up to date. Check on the vaccination status of your family members as well.
  • Buy pasteurized milk and milk products.
  • Talk to your doctor if you are pregnant so you can be monitored.


Centers for Disease Control and Prevention

Meningitis Foundation of American


Health Canada

Meningitis Research Foundation of Canada


Bacterial meningitis in adults. EBSCO DynaMed website. Available at:
Updated June 15, 2015. Accessed August 10, 2015.

Bacterial meningitis in infants and children. EBSCO DynaMed website. Available at:
Updated May 27, 2015. Accessed August 10, 2015.

Bamberger D. Diagnosis, initial management, and prevention of meningitis. Am Fam Physician. 2010;82(12):1491-1498.

Lumbar puncture (LP). EBSCO DynaMed website. Available at:
Updated May 31, 2012. Accessed August 10, 2015.

Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at:
Updated April 30, 2015. Accessed August 10, 2015.

Meningococcal disease. Centers for Disease Control and Prevention website. Available at:
Updated April 1, 2014. Accessed August 10, 2015.

Weisfelt M, de Gans J, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in alcoholic patients. PLoS One. 2010;5(2):e9102.

10/2/2009 DynaMed’s Systematic Literature Surveillance
Centers for Disease Control and Prevention. Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. MMWR. 2009;58(37):1042-1043.

4/22/2011 DynaMed’s Systematic Literature Surveillance
Lee CC, Middaugh NA, Howie SR, Ezzati M. Association of secondhand smoke exposure with pediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLoS Med. 2010;7(12).

1/2/2014 DynaMed’s Systematic Literature Surveillance
Zalmanovici T, Fraser A, et al. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev. 2013;10:CD004785.

Last reviewed August 2015 by David Horn, MD
Last Updated: 8/10/2015

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