Meningitis Questions & Answers

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Questions & Answers

Overview

What is meningitis?

What are the signs and symptoms of bacterial and viral meningitis?

What should be the medical history focus when meningitis is suspected?

Which symptoms suggest enteroviral infection when meningitis is suspected?

What are signs of meningitis in infants?

What should a physical exam for meningitis include?

Which exams should be performed in chronic meningitis?

What are the signs of aseptic meningitis syndrome?

What are the diagnostic challenges in suspected meningitis?

Which blood studies are useful in the diagnosis of meningitis?

Which lab tests should be ordered in suspected meningitis?

What are the initial treatment measures that should be taken in suspected meningitis?

What are the treatment options for bacterial meningitis?

Which complications of acute bacterial meningitis must be treated initially?

In which types of meningitis is therapy dictated by the etiologic pathogen (infectious agent)?

What are the categories of infections of the central nervous system (CNS)?

Which areas of the brain and spinal cord are affected by meningitis?

What are risk factors for meningitis?

What is the clinical presentation of meningitis?

Which anatomical regions does meningitis affect?

What causes meningitis?

What is the mortality rate associated with bacterial meningitis?

How has the emergence of antibiotic-resistant bacteria changed treatment approaches for meningitis?

Which conditions may evolve from bacterial meningitis?

What are the common noninfectious causes of meningitis?

What are the subtypes of acute bacterial meningitis?

What is chronic meningitis?

How is acute meningitis differentiated from subacute or chronic meningitis?

How are fungal and parasitic meningitis classified?

What is aseptic meningitis?

Is aseptic meningitis reclassified once a cause is identified?

What is the most likely pathogenesis of meningitis?

Which pathways allow an infectious agent (pathogen) access to the central nervous system (CNS) in meningitis?

Meningitis infectious agents are spread most often through which pathway to the central nervous system (CNS)?

What are the less common ways meningitis infectious agents are transmitted to the central nervous system (CNS)?

How are meningitis infectious agents transmitted to a newborn?

How do meningitis pathogens travel from the middle ear to the meninges?

What is the role of the blood-brain barrier in the pathogenesis of meningitis?

What is the disease course of untreated bacterial meningitis?

What perpetuates the infectious process in bacterial meningitis?

What is the pathophysiology of increased intracranial pressure (ICP) in meningitis?

What is the disease course if increased intracranial pressure (ICP) due to meningitis is left untreated?

What is the disease course if cerebral edema due to meningitis is left untreated?

Which proinflammatory molecules (proteins) have a role in the pathogenesis of meningitis?

What is the role of cytokines in the pathogenesis of meningitis?

What is the role of secondary proinflammatory mediators in the pathogenesis of meningitis?

What is the cause of profound neutrophilic pleocytosis in meningitis?

What is the role of pattern recognition receptors in the pathogenesis of meningitis?

What is the role of bacterial seeding in the pathogenesis of meningitis?

How do infectious agents gain access to the subarachnoid space in meningitis?

What causes aseptic meningitis?

What are causes of meningitis?

Does HIV infection increase the risk of meningitis?

What are viral causes of meningitis?

What are the common infectious agents (pathogens) of meningitis in patients with trauma or who are undergoing neurosurgery?

What causes pachymeningitis (perimeningitis)?

What is the role of Haemophilus influenza (H influenza) (type b) (Hib) in the development of meningitis?

What does the presence of Haemophilus influenza (H influenza) in adults with meningitis suggest?

What is the role of Streptococcus pneumoniae (S pneumoniae) in the development of meningitis?

What are the risk factors for developing Streptococcus pneumoniae (S pneumoniae) (pneumococcal) meningitis?

What is the role of Streptococcus agalactiae (group B Streptococcus) (GBS) in the transmission of neonatal meningitis?

What are the risk factors for Streptococcus agalactiae (group B Streptococcus) (GBS) meningitis in adults?

What is the role of Neisseria meningitidis (N meningitides) in the development of meningococcal meningitis?

What are risk factors for developing meningococcal meningitis?

What is the role of Listeria monocytogenes (L monocytogenes) in the development of meningitis?

Which groups are at risk for Listeria monocytogenes (L monocytogenes) meningitis?

Which aerobic gram-negative bacilli (Enterobacteriaceae) are etiologic agents of meningitis?

What are risk factors for developing meningitis caused by gram-negative bacilli (Enterobacteriaceae)?

What are risk factors for developing staphylococcal meningitis?

What is the most common cause of aseptic meningitis in children and adults?

How are enteroviruses classified?

How are enteroviruses spread?

How common are nonpolio enteroviruses (NPEVs) as a cause of viral meningitis?

What is the incidence of aseptic meningitis due to echovirus 30 (EV30)?

Which Herpesviridae (herpesviruses) cause meningitis?

Which arthropod-borne viruses cause meningitis?

Which virus causes California encephalitis?

How is lymphocytic choriomeningitis virus (LCMV) transmitted?

How common is aseptic meningitis caused by the mumps virus?

When should HIV infection be suspected as the cause of aseptic meningitis?

Which adenovirus serotypes are etiologic agents of meningoencephalitis?

When should Toscana virus (TOSV) meningitis or encephalitis be suspected?

What causes chronic meningitis?

What is the role of Brucellae in the development of meningitis?

What are the risk factors for developing brucellosis (Brucella meningitis)?

What is the role of Mycobacterium tuberculosis (M tuberculosis) in the development of meningitis?

When should tuberculous meningitis be suspected?

How is Treponema pallidum (T pallidum) transmitted?

What is the role of Borrelia burgdorferi (B burgdorferi) (Lyme disease) in the development of meningitis?

What is the role of Cryptococcus neoformans (C neoformans) in the development of meningitis?

What are the risk factors for developing coccidioidal meningitis?

What are the risk factors for Blastomyces dermatitidis (B dermatitidis) infection and how likely is it to cause meningitis?

What is the role of Histoplasma capsulatum (H capsulatum) in the development of meningitis?

What are the risk factors for developing Candida meningitis?

What are the risk factors for developing Sporothrix schenckii (S schenckii) meningitis?

How is primary amebic meningoencephalitis (PAM) transmitted?

What are the forms of primary amebic meningoencephalitis (PAM) and what are their presentations?

What are Acanthamoeba and Balamuthia granulomatous amebic encephalitis?

What is the role of Angiostrongylus cantonensis (A cantonensis) in the development of eosinophilic meningitis?

What is the role of Gnathostoma spinigerum (G spinigerum) in the development of eosinophilic meningoencephalitis?

What is the role of Baylisascaris procyonis (B procyonis) in the development of eosinophilic meningoencephalitis?

What is the role of injuries, congenital malformations, and surgeries in the development of meningitis?

Why is the incidence of meningitis higher in developing countries than in the US?

What is the incidence of bacterial meningitis in the US?

In what parts of the world is meningococcal meningitis endemic?

What is the incidence of neonatal bacterial meningitis?

Which preventive measures have decreased the incidence of bacterial meningitis in the US?

Which preventive measures have decreased the incidence of pediatric bacterial meningitis in the US?

What age groups are at highest risk for developing acute bacterial meningitis?

How does age affect risk of meningitis from specific etiologic agents?

Is bacterial meningitis more common in females or males?

What is the mortality rate associated with pneumococcal meningitis?

What is the incidence of aseptic meningitis?

What factors influence the infection rates of aseptic meningitis?

In addition to aseptic meningitis, what other disorders are caused by West Nile virus infection?

Which less-common arboviruses have caused aseptic meningitis in the US?

What is the epidemiology of lymphocytic choriomeningitis (LCM) virus infections?

What is the global distribution of fungal pathogens that cause meningitis?

What is the global distribution of parasites that cause meningitis?

What is the global distribution of Brucella chronic meningitis?

What is the global incidence of Mycobacterium tuberculosis (M tuberculosis) infection?

What is the global distribution of Borrelia burgdorferi (B burgdorferi) (Lyme disease)?

What is the global distribution of Cryptococcus neoformans (C neoformans)?

What is the global distribution of Coccidioides immitis (C immitis)?

What is the global distribution of Sporothrix schenckii (S schenckii)?

Which presentations of meningitis increase the risk for neurologic sequelae or death?

What are negative prognostic factors in adults with bacterial meningitis?

What are the serious complications of bacterial meningitis?

What are the delayed complications of pneumococcal meningitis?

How common are seizures in meningitis?

What is the incidence of neurologic complications of bacterial meningitis?

What is mortality rate associated with bacterial meningitis?

What is the prognosis of meningitis caused by opportunistic pathogens?

Which pathogens cause the highest mortality and morbidity in bacterial meningitis?

What is the prognosis for meningococcal meningitis versus pneumococcal meningitis?

What is the prognosis for viral meningitis?

What patient information (education) should be provided and to whom regarding meningitis preventive measures?

Presentation

Which atypical symptoms of meningitis may develop in infants?

What are symptoms of meningitis?

How soon do symptoms of bacterial meningitis develop?

What symptoms may precede viral meningitis?

How common are seizures in bacterial meningitis?

Which patient groups are more likely to present with atypical symptoms of meningitis?

Which factors should be assessed in cases of meningitis to help determine etiology?

What should be the focus of the medical history in suspected meningitis?

How common is bacterial meningitis following antibiotic use?

Does the presence of a ventriculoperitoneal shunt or history of cranial surgery increase the risk of bacterial meningitis?

Are alcoholism and cirrhosis risk factors for meningitis?

What role does geographic location and travel history have in the identification of meningitis etiology?

What roles do season and temperature have in the identification of meningitis etiology?

What is the classic presentation of meningitis?

How does the clinical presentation of acute bacterial meningitis differ from that of subacute bacterial meningitis?

What are possible systemic findings of meningitis?

What are expected physical findings in viral meningitis?

Which etiologies of meningitis may present with nonblanching petechiae and cutaneous hemorrhages?

What is the typical presentation of meningitis in infants?

What are the focal neurologic signs of meningitis?

When is lumbar puncture (LP) indicated in suspected meningitis?

Which systemic findings on physical exam provide clues to the etiology of meningitis?

Which physical exam findings suggest chronic meningitis?

What are the presentation and clinical stages of chronic tuberculous meningitis?

What is the presentation of syphilitic meningitis?

What is the presentation of Lyme meningitis?

What is the presentation of Cryptococcus neoformans (C neoformans) meningitis?

What is the presentation of coccidioidal meningitis?

What is the presentation of meningitis caused by Blastomyces dermatitidis (B dermatitidis) or Histoplasma capsulatum (H capsulatum)?

What is the presentation of helminthic eosinophilic meningitis?

What is the presentation of aseptic meningitis?

What are immediate complications of meningitis?

What disorders are caused by brain parenchymal damage in bacterial meningitis?

What are the delayed complications of meningitis?

Is cerebral edema a common complication of meningitis?

What causes cranial nerve palsy and cerebral infarction in meningitis?

How does cerebritis develop in meningitis?

What are the risk factors for development of subdural effusion in meningitis?

How does ventriculitis develop in meningitis and how common is it?

How does ventriculomegaly develop in meningitis?

DDX

Which disorders should be considered in differential diagnoses of meningitis?

What are the differential diagnoses for Meningitis?

Workup

What are the diagnostic challenges of meningitis?

Why should acute bacterial meningitis be the first diagnosis considered in patients with headache, neck stiffness, fever, and altered mental status?

Why should lumbar puncture be performed whenever meningitis is suspected?

When is a CT scan of the head indicated in suspected meningitis?

What lab tests should be performed in suspected meningitis?

What does evidence of pneumonia on initial chest X-ray indicate in suspected meningitis?

Which blood tests are useful in suspected bacterial meningitis?

When are cultures most useful for diagnosing meningitis?

When is latex agglutination or counterimmunoelectrophoresis (CIE) indicated in the evaluation of suspected meningitis?

What is the role of polymerase chain reaction (PCR) testing in the diagnosis of meningitis?

Which syphilis screening tests should be performed in the evaluation of suspected meningitis?

What is the role of serum procalcitonin (PCT) testing in the diagnosis of meningitis?

What does elevated opening pressure in lumbar puncture (LP) and cerebrospinal fluid (CSF) indicate in meningitis?

What does cerebrospinal fluid (CSF) cell count indicate in meningitis?

Why are four tubes of cerebrospinal fluid (CSF) sample drawn in suspected meningitis and where is each sent?

What is the importance of tumor necrosis factor alpha (TNF-?), interleukin (IL)-1, and other cytokines in suspected bacterial meningitis?

What are the cerebrospinal fluid (CSF) characteristics in acute bacterial meningitis?

What are cerebrospinal fluid (CSF) characteristics in viral meningitis?

What are cerebrospinal fluid (CSF) characteristics in fungal meningitis?

Is fungal serology or cerebrospinal fluid (CSF) culture more commonly used in the workup of fungal meningitis?

Can fungal infection in the blood be used to diagnose fungal meningitis?

What are the cerebrospinal fluid (CSF) characteristics of primary amebic meningoencephalitis (PAM)?

What are the cerebrospinal fluid (CSF) characteristics of Lyme meningitis?

What are the cerebrospinal fluid (CSF) characteristics of tuberculous meningitis?

What is the cerebrospinal fluid (CSF) glucose level in bacterial meningitis?

What is the cerebrospinal fluid (CSF) protein level in bacterial meningitis?

What is the sensitivity and specificity of Gram staining of cerebrospinal fluid (CSF) for bacterial meningitis?

What is the role of acid-fast bacillus (AFB) stain in the diagnosis of meningitis?

How often do cerebrospinal fluid (CSF) bacterial cultures or antigen assays yield the bacterial cause of meningitis?

How effective are cerebrospinal fluid (CSF) culture and antigen testing in the diagnosis of cryptococcal meningitis?

What tests are used to isolate Treponema pallidum (T pallidum) from cerebrospinal fluid (CSF) in syphilitic meningitis?

What is the role of cerebrospinal fluid (CSF) cultures or assays in the diagnosis of Lyme meningitis?

What are the roles of cerebrospinal fluid (CSF) cultures and assays in the diagnosis of tuberculous meningitis?

What is the role of culture from cerebrospinal fluid (CSF) in viral meningitis?

Is neuroimaging (CT scanning, MRI) used in the diagnosis of meningitis?

When is cerebral herniation most likely to occur following lumbar puncture (LP) for meningitis?

What are the IDSA guidelines for screening head CT scanning before lumbar puncture (LP) in adults with suspected meningitis?

What neuroimaging findings suggest bacterial meningitis?

What central nervous system (CNS) complications of bacterial meningitis are detected on neuroimaging?

Treatment

How is meningitis managed after initial treatment?

What initial steps should be taken to treat suspected meningitis prior to arrival in the emergency department (ED)?

Which tests should be performed first for acute meningitis?

When should antimicrobial therapy be initiated for meningitis?

Which systemic complications of acute bacterial meningitis should be immediately treated?

How are patients monitored for systemic complications of acute bacterial meningitis?

How is hyperventilation managed in intubated patients with meningitis?

When is an intracranial pressure (ICP) monitor indicated in meningitis?

How are seizures managed in meningitis?

How is subacute meningitis treated?

How is bacterial meningitis treated?

What is the prevalence of penicillin resistance among Streptococcus pneumoniae (pneumococcal) strains that cause meningitis?

Does treatment reduce the risk of mortality in meningitis?

How should patients with bacterial meningitis be monitored during antibiotic treatment?

What is the treatment for bacterial meningitis in the first month of life?

What is the treatment for bacterial meningitis in infants aged 1-3 months?

What is the treatment for bacterial meningitis in children aged 3 months to 7 years?

What is the treatment for bacterial meningitis in children and adults aged 7-50 years?

What antibiotic alternative is available for bacterial meningitis in children and adults aged 7-50 years with severe penicillin allergy?

What is antibiotic treatment for bacterial meningitis in areas with a low prevalence of drug-resistant Streptococcus pneumoniae (DRSP)?

What is the role of dexamethasone in the treatment of bacterial meningitis?

What is the antibiotic treatment of choice for patients aged 50 years or older with meningitis?

What are the IDSA guidelines for adjunctive dexamethasone in meningitis?

What is the treatment for bacterial meningitis in the setting of HIV infection?

Is the use of steroid therapy (dexamethasone) effective in the treatment of bacterial meningitis?

What are the benefits of steroid therapy for bacterial meningitis?

Is intrathecal administration of antibiotics FDA approved for the treatment of bacterial meningitis?

How are intrathecal antibiotic dosages determined for bacterial meningitis?

How is viral meningitis treated?

How is herpes simplex (HSV) meningitis treated?

How is cytomegalovirus (CMV) meningitis treated?

What are the causes of fungal meningitis?

How is cryptococcal meningitis treated?

How is intracranial pressure (ICP) reduced in cases of cryptococcal meningitis?

How is HIV-related acute cryptococcal meningitis treated?

What is induction and consolidation therapy for cryptococcal meningitis?

What is the treatment for solid-organ transplant recipients with cryptococcal meningitis?

What is the treatment for meningitis caused by Coccidioides immitis (C immitis)?

What is the treatment for Histoplasma capsulatum (H capsulatum) meningitis?

What is treatment for candidal meningitis?

What is the treatment for Sporothrix schenckii (S schenckii) meningitis?

What is the treatment for tuberculous meningitis?

When is corticosteroid therapy indicated for treatment of tuberculous meningitis?

What is the treatment for syphilitic meningitis?

How is parasitic meningitis treated?

How is Lyme meningitis treated?

How is meningitis prevented?

Which patients should receive the H influenzae type B (Hib) or S pneumoniae vaccines?

What vaccinations are recommended for patients with functional or structural asplenia?

Who should be offered the quadrivalent meningococcal polysaccharide vaccine?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for the use of meningococcal conjugate vaccines?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for routine use of meningococcal vaccines in adolescents?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for use of meningococcal vaccines in individuals with HIV?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for use of meningococcal vaccines in individuals with persistent complement component deficiency or asplenia?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for persons with increased risk for exposure to meningitis?

Which meningococcal vaccines for serogroup B are approved by the FDA?

What are the CDC Advisory Committee on Immunization Practices (ACIP) guidelines for routine pneumococcal vaccinations?

When is chemoprophylaxis for meningitis recommended?

When are consultations with specialists indicated in the treatment of meningitis?

How should meningitis be monitored?

Guidelines

What are the IDSA guidelines on the diagnosis of healthcare-associated ventriculitis and meningitis?

What are the IDSA guidelines on the treatment of healthcare-associated ventriculitis and meningitis?

Medications

When should empiric antibiotic medications be given to treat meningitis?

Which medications in the drug class Sulfonamides are used in the treatment of Meningitis?

Which medications in the drug class Tetracyclines are used in the treatment of Meningitis?

Which medications in the drug class Carbapenems are used in the treatment of Meningitis?

Which medications in the drug class Fluoroquinolones are used in the treatment of Meningitis?

Which medications in the drug class Antibiotics, Miscellaneous are used in the treatment of Meningitis?

Which medications in the drug class Glycopeptides are used in the treatment of Meningitis?

Which medications in the drug class Aminoglycosides are used in the treatment of Meningitis?

Which medications in the drug class Penicillins, Amino are used in the treatment of Meningitis?

Which medications in the drug class Penicillins, Natural are used in the treatment of Meningitis?

Which medications in the drug class Cephalosporins, 3rd Generation are used in the treatment of Meningitis?

Which medications in the drug class Antivirals, CMV are used in the treatment of Meningitis?

Which medications in the drug class Antivirals, Other are used in the treatment of Meningitis?

Which medications in the drug class Antifungals, Systemic are used in the treatment of Meningitis?

Which medications in the drug class Antituberculous Agents are used in the treatment of Meningitis?

Which medications in the drug class Vaccines, Inactivated, Bacterial are used in the treatment of Meningitis?

Which medications in the drug class Corticosteroids are used in the treatment of Meningitis?

Which medications in the drug class Diuretics, Osmotic Agents are used in the treatment of Meningitis?

Which medications in the drug class Diuretics, Loop are used in the treatment of Meningitis?

Which medications in the drug class Anticonvulsants, Hydantoins are used in the treatment of Meningitis?

Which medications in the drug class Anticonvulsants, Barbiturates are used in the treatment of Meningitis?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Meningitis?