Signs and symptoms of bacterial meningitis differ depending on the type of infection and the affected person’s age. The incubation period, or time between exposure to infection and appearance of symptoms, also varies depending on the bacteria causing the disease. Generally, meningitis symptoms appear 2-10 days after the exposure.
Signs of bacterial meningitis include:
- Sudden onset fever
- Severe headache
- Neck stiffness (rigidity)
- Diplopia (double vision)
- Drowsiness, confusion, or difficulty staying awake
- Photophobia (intolerance to bright light)
These symptoms need urgent medical attention. Early diagnosis and treatment aid faster recovery and minimize the risk of serious and potentially fatal complications.
Other symptoms include:
- Skin rash over the trunk and inner side of the limbs
- Abnormal body movements or seizures
- Joint pain
- Cold hands and feet
- Poor appetite
Newborns and infants (12 months and younger) may present with different symptoms:
- Poor feeding
- Excessive sleepiness, difficulty waking, or loss of consciousness
- Fullness or bulging of the fontanelles (soft spots on the top of the head)
- Inconsolable, high-pitched crying, especially when handled
- Neck rigidity
- Grunting or noisy breathing
- Skin rash
- Pale or blotchy skin
What is bacterial meningitis?
Meningitis is an inflammation of the membranes that surround the brain and spinal cord (meninges). It can be caused by bacterial, fungal, viral, or parasitic infection. When meningitis is caused by bacterial infection, it is called bacterial meningitis.
Three layers of membranes or meninges surround and protect the brain and spinal cord.
- Outer tough layer (dura mater)
- Web-like middle layer (arachnoid mater)
- Innermost layer that closely follows the contours of the brain (pia mater)
In addition to protecting the brain and spinal cord, the meninges support the blood vessels and provide a continuous channel for the flow of cerebrospinal fluid.
Bacterial meningitis may begin as a cold-like illness that progresses to frank meningitis (with symptoms such as high fever, neck stiffness, vomiting, and seizures). The bacteria generally infect the respiratory tract and then travel to the meninges via the bloodstream. Direct infection of the meninges may occur, such as after a skull fracture, sinus infection, and, rarely, after a brain or spine surgery.
6 causes of bacterial meningitis
Various bacteria can cause bacterial meningitis, the most common being meningococcal and pneumococcal bacteria.
1. Streptococcus pneumoniae
Meningitis caused by Streptococcus pneumoniae (pneumococcus) is called pneumococcal meningitis and is the most common form of meningitis, accounting for about 6,000 cases each year in the United States.
Pneumococcal meningitis is the most serious variety of bacterial meningitis with a risk of complications, such as hearing loss and brain damage. Fortunately, safe and effective vaccines are available to protect against certain pneumococcal strains.
Besides meningitis, Streptococcus pneumoniae causes other diseases, including pneumonia, sinus and ear infections, and septicemia (blood poisoning). People who are immunocompromised (such as patients with human immunodeficiency virus, organ transplant and cancer) and children under the age of 2 are particularly at risk.
2. Neisseria meningitidis (meningococcus)
Meningococcal meningitis is a highly infectious disease, particularly affecting immunocompromised infants and adults. The risk is high in people traveling to places where meningococcal infections are endemic. Military recruits and people residing in dormitories also have a high risk. Due to its high infectivity, close contacts of a person diagnosed with meningococcal meningitis are administered prophylactic (preventive) antibiotics.
Like pneumococcal meningitis, meningococcal meningitis can cause serious disease, leading to death in about 10%-15% of cases. Affected people have a 10%-15% of developing serious complications such as brain damage.
3. Haemophilus influenzae
Previously one of the most common forms of meningitis (particularly in children under age 5), Haemophilus influenzae meningitis cases have declined due to the widespread use of the Haemophilus influenzae b vaccine in the United States. The disease is particularly seen in immunocompromised individuals, unvaccinated children, and people in child-care settings.
4. Listeria monocytogenes
Meningitis caused by listeria is particularly seen in pregnant women and immunocompromised individuals. The infection generally occurs upon consuming contaminated foods such as raw vegetables, deli meats, hot dogs, and foods made with unpasteurized milk.
5. Escherichia coli (E coli)
Some strains of E coli (such as E coli K1) may cause meningitis particularly in newborns (especially premature and low birth weight babies) and elderly individuals. Newborns typically get the infection through the mother’s birth canal. People with a cerebrospinal fluid shunt (a device to relieve excessive pressure around the brain) are also at risk of getting E coli meningitis.
6. Mycobacterium tuberculosis
Meningitis caused by mycobacterium is called tuberculous meningitis, which is typically seen in people who have or had tuberculosis. The infection is generally seen in developing countries where tuberculosis is common.
How is bacterial meningitis diagnosed?
Diagnosis of bacterial meningitis involves taking a detailed medical history, performing a physical examination (particularly neurological examination), and ordering certain tests.
Tests used to diagnose bacterial meningitis include:
- Blood tests
- Urine tests
- Cerebrospinal fluid exam
- Computed tomography scan
- Magnetic resonance imaging
What is the treatment for bacterial meningitis?
Appropriate antibiotics to target the particular bacteria are the first line of treatment. Because the passage of substances, including medications, is limited from the blood to the brain via a layer of specialized cells (blood-brain barrier), antibiotics that cross the blood-brain barrier are used to treat bacterial meningitis.
Medications may also be prescribed to treat fever, pain, seizures, vomiting, and other symptoms. Patients are generally hospitalized where an intravenous line may be established to administer medications and correct fluid and electrolyte imbalances. Steroid medications may be administered to reduce inflammation and prevent complications such as hearing loss.
National Institutes of Health. Meningitis and Encephalitis Fact Sheet. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Meningitis-and-Encephalitis-Fact-Sheet
Centers for Disease Control and Prevention. Bacterial Meningitis. https://www.cdc.gov/meningitis/bacterial.html
World Health Organization. Meningitis. https://www.who.int/news-room/fact-sheets/detail/meningitis
Mayo Clinic. Meningitis. https://www.mayoclinic.org/diseases-conditions/meningitis/diagnosis-treatment/drc-20350514
Top Signs and Symptoms of Bacterial Meningitis Related Articles
Bacterial Infections 101Get more information on bacterial skin infections, which bacteria cause food poisoning, sexually transmitted bacteria, and more. Explore the most common bacterial infections.
Hidden Places Where Germs LurkExplore the germiest places you may encounter daily. Bacteria is everywhere. Learn tips to avoid germs and bacteria in public places.
How Do You Get Bacterial Meningitis?Bacterial meningitis is an infection of the tissue surrounding the brain and spinal cord. Learn more about the signs of bacterial meningitis, what causes bacterial meningitis, when to see a doctor, and how to treat bacterial meningitis.
How Do You Know if You Have Meningitis?Meningitis is a potentially life-threatening inflammation of the layers of tissue and fluid that cover the spine and brain. Learn the signs of meningitis, what causes it, how doctors diagnose it, and what you can do to treat it.
Mono (Infectious Mononucleosis)Infectious mononucleosis is a virus infection in which there is an increase of white blood cells that are mononuclear (with a single nucleus) "Mono" and "kissing disease" are popular terms for this very common illness caused by the Epstein-Barr virus (EBV).
Is Meningitis Contagious?Meningitis, inflammation of the meninges, symptoms and signs include neck stiffness, headache, and fever. There are five types of meningitis: viral, bacterial, fungal, parasitic, and noninfectious.
Is Pus a Sign of Infection? What Causes It?Learn about pus and what to do if a wound gets infected and contains pus. Bacteria are microbes that are invisible to the naked eye because of their size. You can observe them under a microscope.
MeningitisMeningitis is inflammation of the membranes that cover the spinal cord and brain. Symptoms include fever, headache, and a stiff neck. Treatment of meningitis depends upon the cause of the infection and may include antibiotics or antiviral medications.
Meningitis QuizWhat is meningitis and what causes it? Take our Meningitis Quiz to learn the causes, symptoms, treatments, and complications of this potentially life-threatening disease.
Meningitis TreatmentMeningitis is an inflammation of the membrane (meninges) surrounding the brain and spinal cord and is characterized by an abnormal number of white blood cells in the cerebrospinal fluid. Meninges act as a protective layer to the brain and spinal cord.
Meningitis: Symptoms,Treatment, and MoreMeningitis is an inflammation of the membrane (meninges) surrounding the brain and spinal cord and is characterized by an abnormal number of white blood cells in the cerebrospinal fluid. Meninges act as a protective layer to the brain and spinal cord.
The Most Common Infectious Diseases in the U.S.In 2016, infectious diseases sent Americans to the doctor more than 15 million times. That's a lot of trouble for organisms you can't see but can catch through something as simple as a sneeze. According to the CDC, these are some of the most common infectious illnesses in the U.S.
Strep Throat QuizTake the Strep (Streptococcal) Throat Infection Quiz to learn about causes, symptoms, treatments, prevention methods, diagnosis, and complications of this common infectious disease.
What Are the 3 Types of Meningitis?Meningitis is a serious condition that needs medical attention. Learn about the 3 types of meningitis, what causes meningitis, how doctors diagnose meningitis, and how meningitis is treated.
Where Does Bacterial Meningitis Come From?Bacterial meningitis is characterized by inflammation around your brain and spinal cord that leads to dangerous — and sometimes deadly — pressure in this area. Bacterial meningitis comes from person-to-person contact with an infected person.