E. coli meningitis

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

E. coli is an important cause of bacterial meningitis in newborns and babies under three months globally.
Preterm babies are at higher risk than babies born at term.
E. coli meningitis can occur in older infants, children and adults, but it’s very rare.
It is a serious disease that needs urgent treatment.
Currently, there’s no vaccine to protect against E. coli meningitis.

What is E. coli meningitis?

E. coli meningitis is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. It’s caused by the bacterium Escherichia coli (E. coli).

E. coli is a group of bacteria commonly found living in our intestines. There are many different strains (types) of E. coli and most are harmless to humans. But some can cause serious disease. A strain known as E. coli K1 is the leading cause of E. coli meningitis in newborn babies worldwide.¹

E. coli meningitis happens when the 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.

Key facts

It’s estimated that E. coli meningitis caused nearly 1,500 deaths in babies under one month of age in 2021.²
E. coli was estimated to be the third largest cause of bacterial meningitis in babies under one month of age in 2021,³ responsible for over 12% of bacterial meningitis deaths in this age group worldwide.⁴

What are the symptoms of E. coli meningitis?

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

Early symptoms of E. coli 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 of these symptoms.

People with E. coli meningitis will get worse fast. Check regularly on someone who is unwell and trust your instincts. 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 E. coli meningitis?

E. coli are commonly found living in the intestines and vagina. This is completely harmless most of the time, but a baby can become infected if they are exposed to the bacteria during birth. Babies can also be infected by bacteria present in the environment around them, in hospital or in the home.

Although rare, E. coli can cause meningitis in older infants, children and adults. This may occur if E. coli enter the body via a wound or if the bacteria spread to the fluid surrounding the brain (CSF) following an infection, such as a urinary tract or gastrointestinal infection.⁵

Who can get E. coli meningitis?

Most cases of E. coli meningitis occur in babies under three months of age because they have underdeveloped immune systems. A baby is more at risk if:

They are born prematurely.
They have a low birth weight (<1500g).
Their mother had a fever during the birth.
There was a prolonged or premature rupture of the membrane around the baby before they were born.
An infection occurred in the placenta or fluid around the baby before birth.

E. coli meningitis is much rarer in older infants, children and adults. But there are certain groups of people that are more at risk. They include:

People with health problems that suppress their immune system such as AIDS, cancer, diabetes or those taking immune-suppressing drugs.
People with head injuries or who have had surgery to the head which could allow the bacteria to enter the body via the wound.
People who have a CSF shunt (a device for draining excess fluid from around the brain to relieve pressure).

How is E. coli meningitis treated?

E. coli 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’ll be given antibiotics intravenously (directly into the vein). In the UK, these should be given within an hour of the doctors suspecting meningitis.

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.

What are the after-effects of E. coli meningitis?

Most people who have E. coli meningitis will make a good recovery, but nearly half will be left with serious or long term after-effects as a result of damage to the brain.^6,7,8 Long-term problems following E. coli meningitis are more common in babies born prematurely.⁹

The possible after-effects of E. coli meningitis include:

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.

Long-term after-effects of meningitis are usually identified while you are still in hospital. For very young babies it might not be possible to tell if they have any long-term effects until they get older.

Physical and emotional recovery from meningitis and its impact can be different for everyone. Support is available if meningitis has affected you or someone you know.

If you are in the UK or Ireland, the Meningitis Research Foundation Support Services team are ready to answer your questions.

If you are outside the UK and Ireland, our member network is the Confederation of Meningitis Organisations (CoMO). CoMO is dedicated to reducing the impact of meningitis globally, with members across the world. It is a great resource for finding support where you live.

Find a CoMO member in your country.

Is there any follow-up care after recovery from E. coli 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 your baby has ongoing needs, they might 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.

Can we prevent E. coli meningitis?

Some factors can increase the risk of your baby being born with an E. coli infection. Risk factors include:

The presence of fever during labour.
Premature birth (before 37 weeks).
Prolonged rupture of membranes (for more than 24 hours before the onset of labour).

If doctors believe that your baby is at increased risk they may offer you antibiotics that can be taken during labour. This can reduce the risk of your baby developing disease within the first few days of life. Antibiotics in labour would not prevent your baby from getting E. coli meningitis beyond one week old.

Can I get a vaccine to protect me against E. coli meningitis?

There is currently no vaccine available to prevent E. coli meningitis.

The development of vaccines that protect newborns from E. coli is challenging, but there are vaccines in the pipeline. One day, these vaccines may be able to prevent meningitis caused by E. coli.

Frequently asked questions about E. coli meningitis

What is the survival rate for E. coli meningitis?

E. coli meningitis most commonly affects newborn babies. The likelihood of survival differs depending on where in the world you live. Neonatal meningitis is estimated to be fatal in 40-58% of cases in developing countries and in 5-25% of cases in developed countries. Approximately half of the survivors of this condition are left with some type of long term after-effect such as seizures, hearing loss, cerebral palsy and developmental delays, regardless of geographical location.¹⁰

Are E. coli becoming resistant to antibiotics?

For many years antibiotics have been used to treat E. coli meningitis. But bacteria, including E. coli, are finding new ways to resist antibiotics all the time. This is known as antimicrobial resistance. Some strains of E. coli are now resistant to several widely-used antibiotic treatments. The World Health Organization has identified E. coli as one of the drug-resistant bacteria that are most threatening to human health.¹¹ One study found that 10% of E. coli infections in newborn babies were resistant to ceftriaxone, one of the recommended antibiotics to treat neonatal meningitis.¹²

Is E. coli meningitis bacterial or viral?

E. coli meningitis is caused by bacteria called Escherichia coli (E. coli), which typically live in the intestines and vagina. There are many different strains (types) of E. coli and most are harmless to humans. But some can cause serious disease including meningitis.

Am I at risk of spreading or contracting the disease if I have been in contact with a patient with E. coli meningitis?

E. coli infections are contagious. Infected people can spread the bacteria to others:

By direct contact, such as touching the face or mouth of another person.
Indirectly, by contaminating surfaces, objects or food that may be touched or eaten by others.

However, it’s rare for people infected with E. coli bacteria to get meningitis. So the risk of getting meningitis after being in contact with someone who has E. coli meningitis is very low.

Where does E. coli bacteria come from?

E. coli are a group of bacteria that are found in the intestines of nearly all people and animals. The bacteria can be spread through contact with contaminated food or water, or by contact with people who are sick.

References

Kaper, J. B., Nataro, J. P., & Mobley, H. L. (2004). Pathogenic Escherichia coli. Nature reviews. Microbiology, 2(2), 123–140. https://doi.org/10.1038/nrmicro818
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021 (GBD 2021). Seattle, United States: Institute for Health Metrics and Evaluation (IHME), (2024). Available from: https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021 (GBD 2021). Seattle, United States: Institute for Health Metrics and Evaluation (IHME), (2024). Available from: https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study
Kaper, J. B., Nataro, J. P., & Mobley, H. L. (2004). Pathogenic Escherichia coli. Nature reviews. Microbiology, 2(2), 123–140. https://doi.org/10.1038/nrmicro818
Amulele, A. V., Ong'ayo, G., Arara, A. M., Machanja, E. W., Etyang, A., Aliyan, N. A., Wareham, D. W., Berkley, J. A., & Gordon, N. C. (2023). Recurrent spontaneous Escherichia coli meningitis in an adult: a case report. JAC-antimicrobial resistance, 5(2), dlad029. https://doi.org/10.1093/jacamr/dlad029
Furyk, J. S., Swann, O., & Molyneux, E. (2011). Systematic review: neonatal meningitis in the developing world. Tropical medicine & international health : TM & IH, 16(6), 672–679. https://doi.org/10.1111/j.1365-3156.2011.02750.x
Doran, K. S., Fulde, M., Gratz, N., Kim, B. J., Nau, R., Prasadarao, N., Schubert-Unkmeir, A., Tuomanen, E. I., & Valentin-Weigand, P. (2016). Host-pathogen interactions in bacterial meningitis. Acta neuropathologica, 131(2), 185–209. https://doi.org/10.1007/s00401-015-1531-z
Houdouin, V., Bonacorsi, S., Bidet, P., Blanco, J., De La Rocque, F., Cohen, R., Aujard, Y., & Bingen, E. (2008). Association between mortality of Escherichia coli meningitis in young infants and non-virulent clonal groups of strains. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 14(7), 685–690. https://doi.org/10.1111/j.1469-0691.2008.02019.x
Basmaci, R., Bonacorsi, S., Bidet, P., Biran, V., Aujard, Y., Bingen, E., Béchet, S., Cohen, R., & Levy, C. (2015). Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 61(5), 779–786. https://doi.org/10.1093/cid/civ367.
Basmaci, R., Bonacorsi, S., Bidet, P., Biran, V., Aujard, Y., Bingen, E., Béchet, S., Cohen, R., & Levy, C. (2015). Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 61(5), 779–786. https://doi.org/10.1093/cid/civ367.
World Health Organisation. WHO Bacterial Priority Pathogens List, 2024 Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. (2024). Available at: https://iris.who.int/bitstream/handle/10665/376776/9789240093461-eng.pdf
Wen, S. C. H., Ezure, Y., Rolley, L., Spurling, G., Lau, C. L., Riaz, S., Paterson, D. L., & Irwin, A. D. (2021). Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis. PLoS medicine, 18(9), e1003787. https://doi.org/10.1371/journal.pmed.1003787

Author: Meningitis Research Foundation.
Reviewed by: Ian Alexander, Meningitis Research Foundation Ambassador.
Published: 31 March 2025.

Meningitis in your words: real-life stories

Meningitis affects millions of people, in all regions of the world. Through the bravery of sharing personal stories, we bring together people from every region of the world to support one another, so they are empowered to live a life beyond meningitis.

Martin Yaxley

Type - E.coli
Outcome - Recovery with after effects

"I was left with hearing loss in my right ear."

Meningitis in your words

Ezra Johnson

Type - E.coli
Age group - Baby
Outcome - Bereavement

"I saw the look on her face and I knew my baby was sicker than we all thought."

Meningitis in your words

Seth Buckley

Type - E.coli
Age group - Teenager
Outcome - Full recovery

"The paediatrician asked me to take Seth straight to the hospital."

Meningitis in your words