Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection is an important part of developing a treatment plan.
Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. But it can also occur when bacteria directly invade the meninges, as a result of an ear or sinus infection, or a skull fracture, or rarely, after some surgeries.
A number of strains of bacteria can cause acute bacterial meningitis. The most common include:
- Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, young children and adults in the United States. It more commonly causes pneumonia or ear or sinus infections. There is a vaccine to help reduce the occurrence of this infection.
- Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious. It affects mainly teenagers and young adults, and may cause local epidemics in college dormitories, boarding schools and military bases. There is a vaccine to help reduce the occurrence of this infection.
- Haemophilus influenzae (haemophilus). Haemophilus influenzae type b (Hib) bacterium used to be the leading cause of bacterial meningitis in children. But new Hib vaccines — available as part of the routine childhood immunization schedule in the United States — have greatly reduced the number of cases of this type of meningitis.
- Listeria monocytogenes (listeria). These bacteria can be found in soft cheeses, hot dogs and luncheon meats. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns, older adults and people with weakened immune systems tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth. People with weakened immune systems, due to disease or medication effect, are most vulnerable.
Each year, viruses cause a greater number of cases of meningitis than do bacteria. Viral meningitis is usually mild and often clears on its own. A group of viruses known as enteroviruses is responsible for most viral meningitis cases in the United States. These viruses tend to circulate in late summer and early fall. Viruses such as herpes simplex virus, HIV, mumps, West Nile virus and others also can cause viral meningitis.
Chronic forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over two weeks or more. Nevertheless, the signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis.
Fungal meningitis is relatively uncommon and causes chronic meningitis. Occasionally it can mimic acute bacterial meningitis. However, this form of meningitis isn't contagious from person to person. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.
In 2012, fungal meningitis made the news because contaminated corticosteroid injections caused a multistate outbreak. Fungal meningitis cases were associated with contaminated medication injected into the spine for back or neck pain.
Other meningitis causes
Meningitis can also result from noninfectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.
March 19, 2013
- Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm. Accessed Dec. 29, 2012.
- Bacterial meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/bacterial.html. Accessed Jan. 2, 2013.
- Bartt R. Acute bacterial and viral meningitis. Continuum Lifelong Learning in Neurology. 2012;18:1255.
- Viral meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/viral.html. Accessed Jan. 2, 2013.
- Fungal meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/fungal.html. Accessed Jan. 2, 2013.
- Derber CJ, et al. Head and neck emergencies. Medical Clinics of North America. 2012;96:1107.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Dec. 28, 2012.
- Acute bacterial meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/acute_bacterial_meningitis.html. Accessed Dec. 31, 2012.
- Prevention — Listeriosis. Centers for Disease Control and Prevention. http://www.cdc.gov/listeria/prevention.html. Accessed Jan. 2, 2013.
- Subacute and chronic meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/subacute_and_chronic_meningitis.html. Accessed Jan. 2, 2013.
- Van de Beek D, et al. Advances in treatment of bacterial meningitis. The Lancet. 2012;380:1693.
- Recommended immunization schedule for persons aged 0 through 18 years — United States, 2013. Centers for Disease Control and Prevention http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html. Accessed Feb. 19, 2013.
- Recommended adult immunization schedule — United States, 2012. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule.pdf. Accessed Dec. 28, 2012.
- Meningococcal vaccine: Who and when to vaccinate. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/mening/who-vaccinate-hcp.htm. Accessed Dec. 28, 2012.
You Are ... The Campaign for Mayo Clinic
Mayo Clinic is a not-for-profit organization. Make a difference today.