What is bacterial meningitis?

On this page you’ll find an overview of meningitis caused by bacteria, including the symptoms, treatment and possible after-effects.

• Many different bacteria can cause meningitis.
• Bacterial meningitis is a life-threatening illness that needs fast treatment with antibiotics. If you suspect someone you know is ill with bacterial meningitis, always trust your instincts and get professional medical help fast.
• Bacterial meningitis is the deadliest form of meningitis, with the World Health Organization estimating that around one in six people who get it will die.
• There are vaccines available to protect against some of the leading causes of bacterial meningitis.

What is bacterial meningitis?

Bacterial meningitis is the swelling of the lining of the brain and spinal cord (called meninges). It’s caused by bacteria infecting the fluid that surrounds the brain and spinal cord, known as cerebrospinal fluid or CSF.

Bacterial meningitis is a serious, life-threatening illness. The bacteria that cause meningitis can also sometimes cause life-threatening sepsis.

What is sepsis?

• Sepsis is a life-threatening reaction to germs in the bloodstream.
• Sepsis is sometimes called septicaemia or blood poisoning.
• Some of the germs that cause meningitis also commonly cause sepsis, like the bacteria responsible for meningococcal meningitis and group B streptococcal meningitis.
• Sepsis symptoms usually appear earlier than meningitis symptoms.
• Sepsis and meningitis symptoms appear the same in babies.
• It’s important to be aware of sepsis symptoms so life-saving treatment can be accessed fast.

Bacterial meningitis and sepsis are medical emergencies that need rapid treatment with life-saving antibiotics.

What are the symptoms of bacterial meningitis and sepsis?

The symptoms of bacterial meningitis can progress rapidly, and early diagnosis and treatment will increase the chances of a full recovery.

Early symptoms can look like milder, more common infections.  
 
Symptoms may include:

• Fever.
• Vomiting.
• Severe headache.
• Limb / joint / muscle pain (sometimes with stomach pain and / or diarrhoea).
• Pale or mottled skin.
• Breathing fast / breathlessness.
• Cold hands and feet / shivering.
• Dislike of bright lights (less common in young children).
• Rash (anywhere on the body).
• Very sleepy / vacant / difficult to wake.
• Seizures (fits).
• Stiff neck (less common in young children).
• Confused / delirious.

Symptoms in babies and very young children can be slightly different. Their symptoms may include:

• High temperature (warning: could be normal or low in babies under three months old).
• Irritable when picked up, with a high pitched or moaning cry.
• Vomiting / refusing to feed.
• Pain / irritability from muscle aches or severe limb / joint pain.
• Breathing fast / difficulty breathing.
• Unusual grunting sounds.
• Cold hands and feet.
• Diarrhoea (though only sometimes).
• Extreme shivering.
• ‘Pin prick’ rash / marks or purple bruises anywhere on the body.
• Blotchy skin / getting paler or turning blue.
• Tense or bulging soft spot on the top of their head.
• A stiff body with jerky movements or else floppy and lifeless.
• Very sleepy / staring expression / too sleepy to wake up.

Not everyone with meningitis will get all of these symptoms and they can appear in any order.

People with bacterial meningitis will get worse fast. Check regularly on someone who is unwell.

Always trust your instincts and get medical help immediately if you or someone you know is seriously ill.

Read more information about the symptoms of meningitis.

How do you get bacterial meningitis?

Bacterial meningitis spreads when you are exposed to bacteria that go on to invade the body and cause illness.

Over 50 different types of bacteria can cause meningitis. But only a few bacteria are responsible for most cases worldwide.

The most common causes of bacterial meningitis across all age groups are:

• Meningococcal bacteria.
• Pneumococcal bacteria.
• Haemophilus influenzae type b (Hib) bacteria.
• Mycobacterium tuberculosis (TB) bacteria.

The bacteria that cause most cases of meningitis in newborn babies globally are:

• Group B streptococci.
• E.coli.
• Listeria.
• Salmonella.
• Klebsiella.

The most common ways that bacteria can enter the body are:

• Coughing, sneezing and kissing: meningococcal, pneumococcal and Hib bacteria often live harmlessly in the back of people’s noses and throats and spread from person to person through close breath-on-breath contact.
• During labour: group B streptococcus and E.coli bacteria live in the guts and vagina and can infect babies during labour.
• In the womb: listeria can pass from mothers to unborn babies across the placenta. Pregnant women can reduce this risk by avoiding certain foods such as unpasteurised milk and cheese.
• From contaminated surfaces: sometimes people undergoing medical procedures in hospital can be exposed from contaminated medical equipment or contamination on the hands of people handling them.

Who can get bacterial meningitis?

Bacterial meningitis can affect anyone, but some people are more at risk than others.

Your risk of developing meningitis depends on where you live, how old you are and whether you have other medical conditions which might weaken your immune system.

Learn more about the risk factors for meningitis.

How is bacterial meningitis treated?

Bacterial meningitis requires urgent treatment with antibiotics.

Prompt recognition and hospital treatment offer the best chance of a good recovery.

When you get to hospital, you may be kept under regular observation at first. Along with a physical examination, blood will be taken for tests. You may be given antibiotics intravenously (directly into the vein and the doctor may do a lumbar puncture. A lumbar puncture is the procedure used to collect a sample of cerebrospinal fluid (CSF), which is needed to confirm the diagnosis of meningitis.

The blood and CSF samples will be tested to:

• Show which germ is causing the illness.
• Make sure you are given the most effective treatment.

If you’re very unwell, you might be transferred to a special ward in the hospital where you can be regularly monitored by hospital staff. In the UK this is known as an Intensive Care Unit. Most intensive care patients begin to improve after a few days and return to regular wards. But very severely ill patients may have a prolonged stay, for weeks or even months.

Doctors across many countries will follow clinical guidelines to treat patients with meningitis. These guidelines describe the best way to recognise, diagnose, treat and provide follow-up care for patients with meningitis in their country.

Not all countries have clinical guidelines specifically for the treatment of meningitis. The World Health Organization and UNICEF have designed the Integrated Management of Childhood Illness (IMCI) strategy which promotes accurate identification and appropriate treatment of serious illness in children under five.

Clinicians in the UK follow guidance produced by the National Institute for Health Care and Excellence (NICE). The European Society of Clinical Microbiology and Infectious Diseases have also produced guidelines for the European region.

What are the after-effects of bacterial meningitis?

Bacterial meningitis affects everyone differently. Most people make a full recovery without any lasting problems. But in some cases, it can cause ongoing problems which may need further treatment and support.

Around one in five people who have bacterial meningitis have permanent after-effects that can include:^{1, 2}

• Learning and intellectual disabilities such as memory loss, lack of concentration or issues with thinking and problem solving.
• Clumsiness and co-ordination problems.
• Headaches.
• Deafness, hearing problems, tinnitus, dizziness or loss of balance.
• Epilepsy or seizures.
• Weakness, paralysis or spasms.
• Loss of sight or vision problems.
• Mental health issues and changes to personality or behaviour.
• Difficulties with sleep.
• Fatigue.
• Anxiety and depression.

After-effects from sepsis can include:

• Arthritis or joint stiffness.
• Scarring or skin damage.
• Loss of fingers, toes and limbs (amputations).
• Kidney damage.
• Damage to bones and joints.

Is there any follow-up care after recovery from bacterial meningitis?

Ideally, you should be given information about what to expect during recovery before you leave the hospital. The follow-up care you receive will be different depending on where you are in the world, and the guidelines that your local doctors follow. You may have further treatment involving different teams of doctors and specialists. 

In some countries (including the UK) doctors will arrange at least one follow-up appointment so they can check for longer term after-effects. This is particularly important for children, as some long-term neurodevelopmental complications can't always be identified immediately after their illness. 

Read more about the follow-up care after recovery from meningitis.

Can we prevent bacterial meningitis?

Yes, we can prevent the leading causes of bacterial meningitis. Vaccines are available that protect against meningococcal, pneumococcal, Haemophilus influenzae type B and Mycobacterium tuberculosis bacteria.

Meningitis vaccines are freely available to people at the highest risk of illness in many countries across the world. The meningitis vaccines you and your family can access free of charge will depend on where in the world you live.

You can find out about your own country’s immunisation programme on the WHO Immunization Data Portal.

Not all types of bacterial meningitis are preventable, so it’s important to know the symptoms.