Meningitis

Signs and Symptoms

Early symptoms of meningitis can easily be mistaken for the flu.

In newborns, signs and symptoms include the following:

• Irritability
• High-pitched cry
• Poor feeding
• Vomiting
• Fever
• Seizures
• Bulging fontanelle ("soft spot" in the skull) or stiff neck (less common)

In children and young adults, signs and symptoms include the following:

• High fever
• Severe headache
• Vomiting or nausea
• Stiff neck
• Sensitivity to light
• Drowsiness
• Skin rash (in cases of meningococcal meningitis -- see section titled What Causes It?)
• Confusion
• Seizures
• Clouding or loss of consciousness

Older adults may have no signs or symptoms other than altered mental state and lethargy. Often they have no fever.

What Causes It?

Bacterial meningitis is not as common as viral meningitis, but it is more serious. Several types of bacteria can cause meningitis. Knowing the right type is crucial for proper treatment:

• Neisseria meningitidis causes meningococcal meningitis, a common form of meningitis in children and young adults, and the only type that occurs in outbreaks. It is highly contagious.
• Haemophilus influenzae was the most common cause in infants and children under 6 years old before 1986 when a vaccine (HiB) was introduced. The vaccine has mostly eradicated this kind of meningitis in countries where it is given to infants.
• Streptococcus pneumonia is the most common cause of bacterial meningitis in children. It may occur along with an ear or sinus infection or pneumonia.
• Listeria monocytogenes is a common form of bacteria. It does not tend to infect most people, but the very young and very old, as well as pregnant women, can be at risk.
• Staphylococcus aureus may be seen following a head injury or brain surgery.

Viral meningitis can be caused by several types of viruses, but the most common are enteroviruses (which cause stomach flu and multiply in the intestinal tract). Other viruses that cause meningitis include:

• Enteroviruses, spread through houseflies, wastewater, and sewage
• Arboviruses, carried by arthropods, such as ticks or mosquitoes
• Mumps virus, seen in children ages 5 to 9 who have not had the MMR vaccine
• Herpes viruses
• Human immunodeficiency virus (HIV), meningitis may be the first sign a person is infected with HIV.

Who is Most At Risk?

These conditions and characteristics increase the risk for bacterial meningitis:

• Living in a crowded setting, such as a dormitory or childcare facility (for meningococcal meningitis).
• Age. Children, young people, and older adults are more likely to develop meningitis.
• Significant head injury, skull trauma, or cerebrospinal rhinorrhea (flow of cerebrospinal fluid from the nose after a head injury)
• A suppressed immune system (for pneumococcal meningitis).
• Never receiving the HiB vaccine (see section titled What Causes It?).
• Doing laboratory work that requires handling rats, hamsters, and mice, or working with animals on a farm or ranch (for listeria).
• People who have recently undergone a neurosurgical procedure.

What to Expect at Your Provider's Office

If you or your child has symptoms of meningitis, seek emergency treatment. Early diagnosis is the key to treating meningitis successfully. Doctors will ask for a detailed medical history and may order a lumbar puncture (spinal tap). In this test, doctors remove cerebrospinal fluid from the spine through a needle so that the fluid can be tested for infection, and to identify the kind of bacteria responsible. If your doctor suspects bacterial meningitis, your doctor may start you on antibiotics before the test results are available.

Treatment Options

Prevention

Children should be vaccinated against H. influenzae and mumps. People over 50 and those whose immune systems are compromised should receive a pneumococcal vaccine (PPV). A meningococcal vaccine may be given to control epidemics in dormitories, for example. Because meningitis is usually contagious, practicing good hygiene, such as washing your hands frequently and teaching children to do the same, can reduce your risk of catching the disease.

Drug Therapies

The length and type of treatment varies depending on the kind of meningitis being treated, ranging from 1 to 3 weeks. The treatment for most cases of viral meningitis is aimed at reducing symptoms of fever and aches. Sometimes, doctors prescribe acyclovir, an antiviral drug. If your doctor suspects bacterial meningitis, he may prescribe immediate treatment with antibiotics, even before the lab results come in. Some of the medications used for bacterial meningitis are:

• Antibiotics, often in combination, including ampicillin, cephalosporins, gentamicin, vancomycin, or trimethoprim-sulfamethoxazole
• Corticosteroids to reduce inflammation
• Diazepam or phenytoin if seizures occur
• Rifampin, given to family members to reduce their risk of contracting the disease.

Complementary and Alternative Therapies

Meningitis must be treated with conventional medical therapies, especially antibiotics. Complementary and alternative therapies (CAM) should be used only with conventional treatment, not in place of it, and only under the guidance of a qualified health professional. Some supplements and herbs may help strengthen the immune system. Tell all your providers about any CAM therapies you may be using.

Several nutrients can help strengthen the immune system, possibly helping to prevent meningitis or to build up the immune system after meningitis has been treated, though scientific studies have not examined these nutrients specifically for meningitis. Talk to your doctor before taking any supplements, and never treat a child without talking to your doctor first.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, to help decrease inflammation and improve immunity. Check recommended dose on packaging. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning drugs, such as warfarin and aspirin.
• Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant and immune activity. CoQ10 might help the blood clot. By helping the blood clot, CoQ10 might decrease the effectiveness of warfarin and other blood-thinning medications.
• Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Some clinicians have concerns about giving probiotics to severely immunocompromised people.

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 to 2 heaping tsps per cup water steeped for 10 to 15 minutes (roots need longer). Some herbs may help support your immune system, although there is no evidence they can prevent or treat meningitis. Meningitis is a medical emergency and should never be treated with herbs alone.

• Cat's claw (Uncaria tomentosa) standardized extract for inflammation and immune stimulation. Take special care if you have leukemia or autoimmune diseases. Cat's claw can interact with several medications.
• Reishi mushroom (Ganoderma lucidum) for inflammation and immunity. You may also take a tincture of this mushroom extract. High doses of Reishi can have blood pressure lowering and blood-thinning effects, and may dangerously increase the effect of blood-thinning medications, such as warfarin and aspirin.
• Olive leaf (Olea europaea) standardized extract for antibacterial or antifungal activity and immunity.
• Aged Garlic (Allium sativum), standardized extract for antibacterial or antifungal and immune activity. Garlic can have a blood-thinning effect and may increase the effect of blood-thinning medications, such as warfarin and aspirin. Garlic can interact with some medications, including some HIV medications. Speak with your doctor.

Meningitis must be treated by a medical doctor using conventional medical treatments.

According to the National Institutes of Health, there is little evidence to support homeopathy as an effective treatment for any specific health condition. Also, while most homeopathic remedies contain small amounts of the active ingredient, they may still have side effects and drug interactions. If you choose a homeopathic product to use on your own, it's best to talk with your health care provider before you use it to check for possible side effects or drug interactions.

Prognosis/Possible Complications

About 15% of people with bacterial meningitis die from it. Among people who survive bacterial meningitis, 30% have lingering neurological problems. Most people who get viral meningitis recover completely without any problems. However, some people will experience headaches, weakness, and fatigue for 2 to 3 weeks after symptoms begin.

Complications of meningitis may include hearing loss, seizures, cerebral edema (brain swelling), weakness on one side of the body, speech problems, visual impairment or blindness, difficulty coordinating movements, trouble breathing, respiratory arrest, and recurring meningitis. Children who have meningitis may experience cognitive impairment and developmental delay.

Following Up

For the first 1 to 2 days, doctors should monitor people in the intensive care unit to be sure:

• The medication is working
• To watch for any seizures
• To watch for breathing difficulties

If signs and symptoms do not improve after 1 to 2 days, health care providers should check the cerebrospinal fluid again.

Special Considerations

Pregnant women often carry L. monocytogenes and S. agalactiae without having symptoms and may pass these infections to their children during birth. Pregnant women should not take rifampin to prevent meningitis because it is not clear whether this drug may harm the fetus.

Supporting Research

Centers for Disease Control and Prevention website. Meningitis. www.cdc.gov/meningitis/about/index.html. Updated February 12, 2024. Accessed June 2, 2025.

Centers for Disease Control and Prevention website. Meningitis: about viral meningitis. www.cdc.gov/meningitis/about/viral-meningitis.html. Updated January 9, 2024. Accessed June 2, 2025.

Centers for Disease Control and Prevention website. Pneumococcal disease: clinical overview of pneumococcal disease. www.cdc.gov/pneumococcal/hcp/clinical-overview/index.html.Updated February 6, 2024. Accessed June 2, 2025.

Centers for Disease Control and Prevention website. Pneumococcal disease: pneumococcal vaccine recommendations. www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html. Updated October 26, 2024. Accessed June 3, 2025.

Centers for Disease Control and Prevention website. Yellow book: meningococcal disease. www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/meningococcal-disease.html. Updated April 23, 2025. Accessed June 3, 2025.

Hasbun R. Meningitis and encephalitis. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 57

Hasbun R, Van de Beek D, Brouwer MC, Tunkel AR. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 87.

Marcdante KJ, Kliegman RM, Schuh AM. Meningitis. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 100.

Mukherjee D, Ryan RM. Postnatal bacterial infections. In: Martin RJ, Fanaroff AA, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 50.

Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 381.

National Center for Complementary and Integrative Medicine website. Cat's claw. www.nccih.nih.gov/health/cats-claw. Updated November 2024. Accessed June 17, 2025.

National Center for Complementary and Integrative Medicine website. Coenzyme Q10. www.nccih.nih.gov/health/coenzyme-q10. Updated January 2019. Accessed June 17, 2025.

National Center for Complementary and Integrative Medicine website. Garlic. www.nccih.nih.gov/health/garlic. Updated February 2025. Accessed June 17, 2025.

National Center for Complementary and Integrative Medicine website. Omega-3 supplements: what you need to know. www.nccih.nih.gov/health/omega3-supplements-what-you-need-to-know. Updated November 2024. Accessed June 17, 2025.

National Center for Complementary and Integrative Medicine website. Probiotics. www.nccih.nih.gov/health/probiotics-usefulness-and-safety. Updated August 2019. Accessed June 17, 2025.

National Foundation for Infectious Diseases website. Pneumococcal disease and older adults. www.nfid.org/infectious-diseases/pneumococcal-disease-and-older-adults/. Updated October 2024. Accessed June 3, 2025.

National Institute of Health. National Institute of Neurological Disorders and Stroke website. Meningitis. www.ninds.nih.gov/health-information/disorders/meningitis. Accessed June 4, 2025.

US Department of Health and Human Services. National Institute of Health. National Center for Complementary and Integrative Health website. Cat's claw. www.nccih.nih.gov/health/cats-claw. Updated November 2024.Accessed June 4, 2025.

US Food & Drug Administration website. Listeria (Listeriosis). www.fda.gov/food/foodborne-pathogens/listeria-listeriosis. Updated January 16, 2025. Accessed June 2, 2025.