Salmonella meningitis

On this page you’ll find an overview of meningitis caused by Salmonella bacteria, including symptoms, treatment and prevention.

• Salmonella meningitis is a rare form of meningitis caused by the bacteria Salmonella.
• It’s a life-threatening condition that requires urgent treatment.
• It’s a more common cause of meningitis in low-income countries than in high-income countries.
• Most people infected by Salmonella bacteria develop a feverish illness and diarrhoea. In countries with poor water supply and sanitation, these infections are a major cause of death and disability.
• Young children, the elderly and those with conditions that affect their immune systems are most at risk of Salmonella meningitis.
• Currently, vaccines aren’t available that prevent all causes of Salmonella meningitis.

What is Salmonella meningitis?

Salmonella meningitis is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. It’s caused by the bacteria Salmonella. 

There are many different strains of Salmonella bacteria. Strains are either typhoidal or non-typhoidal, and the type you’re infected with can determine the type of disease you have:

• Non-typhoidal Salmonella bacteria are a common cause of gastroenteritis (diarrhoea and vomiting) worldwide.
• Typhoidal Salmonella bacteria tend to cause more severe disease that needs hospital treatment, and are a common cause of serious illness in low-income countries.

Both typhoidal and non-typhoidal Salmonella bacteria can cause meningitis.

Salmonella meningitis occurs when Salmonella bacteria invade the body and enter the cerebrospinal fluid (CSF), which surrounds and cushions the brain and spinal cord. In the CSF, bacteria can rapidly multiply and release poisons, causing inflammation and swelling in the meninges. This increases pressure on the brain, producing symptoms of meningitis. 

What are the symptoms of Salmonella meningitis?

Salmonella infection usually causes feverish illness and/or diarrhoea and vomiting. In some cases, the infection can cause serious invasive disease such as meningitis.

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

Early symptoms of Salmonella meningitis can look like milder, more common infections.

Symptoms may include: 

• Fever.
• Vomiting.
• Severe headache.
• Stiff neck (less common in young children).
• Dislike of bright lights.
• Seizures (fits).
• Confused / delirious.
• Very sleepy / vacant /difficult to wake.

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).
• Irritability.
• Vomiting / refusing to feed.
• A high-pitched cry.
• A stiff body with jerky movements or else floppy and lifeless.
• Very sleepy / staring expression / too sleepy to wake up.
• Tense or bulging soft spot on the top of their head.

Not everyone with meningitis will get all these symptoms. 

People with Salmonella meningitis will get worse fast. Check regularly on someone who is unwell. Always trust your instincts and get medical help straight away if you or someone you know is seriously ill. 

Read more information about the symptoms of meningitis.

How do you get Salmonella meningitis?

Salmonella meningitis is caused by Salmonella bacteria, which are commonly found living in the intestines of human and animals. You can contract and/or spread the bacteria if you’re in contact with food, water, animals or objects that have been contaminated with Salmonella from human or animal faeces.
 
Infection occurs when Salmonella bacteria are swallowed. This may happen in various ways:⁵

• Eating foods of animal origin contaminated with the bacteria. Raw or undercooked meat (especially poultry), eggs and unpasteurised milk are common food sources of infection.
• Cross-contamination of foods. Eating vegetables cut with the same knife as raw chicken for example.
• Drinking contaminated water.
• Handling infected animals. Turtles, frogs, lizards, and other reptiles and amphibians often carry Salmonella. As the bacteria spread through their faeces, you can become infected by handling them, particularly if you don’t wash your hands afterwards.
• Touching surfaces that are contaminated with the bacteria.
• Infected people can spread the bacteria to others by direct contact (touching the face or mouth of another person, for example).

Who can get Salmonella meningitis?

Salmonella meningitis is rare, but it can affect anyone. Those who are particularly vulnerable include young children and those who:

• Are immunocompromised or HIV-positive.
• Are malnourished.
• Have underlying conditions such as sickle cell disease.
• Have malaria. 

How is Salmonella meningitis treated?

Salmonella meningitis must always be treated urgently with antibiotics. 

When you get to hospital, the doctor may do a lumbar puncture (LP) to help diagnose meningitis. A lumbar puncture involves taking a sample of cerebrospinal fluid from the spinal canal (the space through the back bones which contains the spinal cord). A lumbar puncture is important to confirm the diagnosis of meningitis. It will also show which germ is causing the illness so doctors can choose the most appropriate treatment.

You may be given antibiotics intravenously (directly into the vein).

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.
The availability of effective antibiotics is critical for treating invasive Salmonella infections such as meningitis. But strains of Salmonella bacteria are becoming resistant to antibiotics all over the world.^8,9 This could severely limit treatment options for potentially life-threatening invasive Salmonella infections.

What are the after-effects of Salmonella meningitis?

With early treatment, people with Salmonella meningitis can make a good recovery. But it can cause high rates of neurological damage and other serious after-effects.

The possible after-effects of Salmonella meningitis include:^10,11,12

• 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.
• Hydrocephalus (fluid on the brain).
• Mental health issues and changes to personality or behaviour.
• Difficulties with sleep.
• Fatigue.
• Anxiety and depression.

Is there any follow-up care after recovery from Salmonella 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 in the world you live, the services available, and the guidelines that your local doctors follow. If you or your child have ongoing needs, you will likely have further treatment involving different teams of doctors and specialists.
 
In the UK, doctors will arrange at least one follow up appointment six weeks after the initial illness so they can check for longer term after-effects. For babies under one year of age, there will be an additional follow up appointment one year after the illness. This is particularly important as some long-term neurodevelopmental after-effects can't be identified immediately after your baby’s initial illness.

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

Can we prevent Salmonella meningitis?

Depending on the strain of the bacteria, Salmonella can be typhoidal or non-typhoidal. There are vaccines available that prevent some types of typhoidal Salmonella, but there are currently no vaccines available that prevent non-typhoidal Salmonella.
 
Although it isn’t possible to prevent all types of Salmonella meningitis, food safety and hand washing are important measures that may help to reduce the chance of developing the disease.
 
Hand washing
 
Regularly wash your hands with soap and warm water or use hand sanitizer, especially:

• Before preparing or eating food.
• After using the toilet.
• After touching/handling animals.

• Thoroughly cook food from animal products – especially meat and eggs.
• Keep cooked and raw foods separate.
• Clean all food preparation surfaces with detergent and warm water.
• Don’t use the same chopping board/knife for raw meat as other foods without washing them thoroughly.
• Defrost poultry, meat and other meat products well before cooking.
• Re-heated foods should be piping hot.
• Avoid raw dairy products.
• Thoroughly wash all vegetables and fruits before eating them.
• Avoid drinking untreated water, for example from rivers, streams and lakes.

Salmonella is a relatively rare cause of meningitis. More common causes of bacterial meningitis are Haemophilus influenzae type b, meningococcal and pneumococcal bacteria. There are vaccines widely available that protect against these causes of meningitis and it’s important to take up any vaccines available to you and your family for the best protection.

Can I get a vaccine to protect me against Salmonella meningitis?

Vaccines are available that protect against typhoidal Salmonella. These vaccines are more commonly known as typhoid vaccines. They won’t protect against all causes of Salmonella meningitis.

The World Health Organization (WHO) recommends typhoid conjugate vaccines for children between six months and two years of age, with a catch-up campaign for children up to fifteen years of age in countries that have a high burden of typhoid fever.¹⁴ Countries in South Asia, South-East Asia, Central and South America and sub-Saharan Africa have the highest burden of disease.

Some countries routinely immunise babies and young children with typhoid conjugate vaccines (TCVs). You can find out about your own country’s typhoid immunisation programme on the WHO Immunization Data Portal.

Travelling to countries with a high burden of typhoid