Meningitis

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Causes

Viruses and bacteria that spread to or directly infect the central nervous system cause most cases of infectious meningitis.

About 90% of cases of viral meningitis are caused by one of the enteroviruses (e.g., coxsackievirus, echovirus, poliovirus). Mumps, herpesvirus, and arboviruses (transmitted by insect bites) also may cause viral meningitis. About 30% of mumps cases in people not vaccinated for the disease develop meningitis.

Common causes of bacterial meningitis include Streptococcus pneumoniae, Neisseria meningitides, Staphylococcus aureus, Escherichia coli, and Staphylococcus epidermidis. Prior to the 1990s, Haemophilus influenzae type b was the primary cause, but widespread vaccination (Hib vaccine) has greatly reduced the incidence of this infection.

Candida albicans, Crytococcus neoformans, and Histoplasma are often involved in cases of fungal meningitis.

Noninfectious

Causes of noninfectious meningitis include the following:

• Carcinomatosis (widespread metastatic cancer)
  
• Contaminated water (may contain parasites)
  
• Head injury, birth defect of the skull, brain surgery (may result in infection of the meninges or cerebrospinal fluid)
  
• Medications such as nonsteroidal anti-inflammatories (e.g., ibuprofen, naproxen) and antibiotics (e.g., Bactrim®, Septra®).
  

Signs and Symptoms

Symptoms of bacterial meningitis are usually acute, developing within a few hours and last 2 to 3 weeks. It is important to seek immediate medical attention when symptoms occur, because acute bacterial meningitis can be fatal within hours.

Viral meningitis may develop suddenly or within days or weeks, depending on the virus and the overall health of the patient.

Characteristic symptoms of both viral and bacterial meningitis are stiff neck, headache, and fever. Symptoms may develop over the course a few hours (acute bacterial meningitis) or a few days. Some patients experience cough, runny nose, and congestion prior to developing other symptoms.

Other signs and symptoms of meningitis include the following:

• Confusion
• Drowsiness
• Joint pain
• Lethargy
• Nausea and vomiting
• Seizures
• Sensitivity to light (photophobia)
• Skin rash (commonly near the armpits and on the hands and feet)

Symptoms of meningitis in infants may be difficult to detect and include the following:

• Bulging of the soft spots (fontanels) in the head caused by increased intracranial pressure
• Decreased activity
• Difficulty nursing or eating
• Excessive sleeping
• High-pitched cry
• Increased crying and irritability
• Vomiting

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