Meningitis

What is meningitis?

Meningitis is an infection of the tissues (meninges) and sometimes the fluid (cerebral spinal fluid, or CSF) that surround the brain and spinal cord. Meningitis results in swelling of the brain tissue and in some cases the spinal tissue (spinal meningitis ). When brain tissue swells, less blood and oxygen reach brain cells. If not treated, this can cause brain damage in some cases.

The infection occurs most often in infants, young adults between the ages of 15 and 24, older adults, and people who have a long-standing health condition, such as a weakened immune system.

Meningitis can range from mild to life-threatening. The severity usually depends on the organism causing the infection and a person's age and overall health.

What causes meningitis?

Meningitis usually is caused by viruses or bacteria such as Neisseria meningitidis (also called meningococcus) and Streptococcus pneumoniae (pneumococcus). In rare cases, fungi, parasites, tuberculosis, or the organisms that cause syphilis and Lyme disease can cause meningitis. The infection also can develop as a complication of another illness, an injury, or brain surgery.

On very rare occasions, some medications can cause meningitis, including carbamazepine (Tegretol), co-trimoxazole (Bactrim, Septra, TMP-SMX), nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), levamisole (Ergamisol), metronidazole (Flagyl), immune globulin, and the mumps and rubella vaccines.

Sometimes the cause is not identified.

What are the symptoms of meningitis?

Meningitis causes fever, a severe and persistent headache, and a stiff and painful neck, most noticeable when you try to touch the chin to the chest. Other symptoms that may develop include:

• Vomiting.
• Confusion and decreased level of consciousness.
• Seizures.
• Sluggishness, muscle aches and weakness, and strange feelings (such as tingling) or weakness throughout the body.
• Eye sensitivity and eye pain from bright lights.
• Skin rash.
• Dizzy spells.

Unusual symptoms of meningitis may develop in some people.

• In babies, the signs of meningitis may be a fever, irritability that is difficult to calm, decreased appetite, rash, vomiting, and a shrill cry. Babies less than 18 months of age may not have neck stiffness.
• Young children with meningitis may act like they have the flu, cough, or have trouble breathing.
• Older adults and people with other medical conditions may have only a slight headache and fever.

The incubation period—the time from exposure to the infection to when the first symptoms develop—depends on the type of organism causing the infection.

How is meningitis diagnosed?

Health professionals diagnose meningitis using a medical history, a physical exam, and one or more tests. During a medical history, you will be asked whether you have been exposed to organisms that can cause meningitis, or to someone infected with it. You also will have a physical exam to look for signs of infection, such as a stiff neck and the inability when lying down to touch your chin to your chest without raising your legs.

Lumbar puncture is the most important laboratory test for meningitis. A sample of cerebrospinal fluid is removed and tested for organisms that cause meningitis.

Other tests may be done to confirm the diagnosis, including a blood culture, computed tomography (CT) or magnetic resonance image (MRI) of the head, and biopsy of a skin rash.

How is meningitis treated?

Treatment for meningitis depends on the cause of the infection. See your health professional immediately if you or your child develops symptoms of meningitis, because bacterial meningitis can lead to life-threatening complications if not treated early.

• The majority of cases of meningitis are caused by a virus (viral meningitis), and most people get better in about 2 weeks. With mild cases of viral meningitis you may only need home treatment, including fluids to prevent dehydration and medication to control pain and fever.
• Meningitis caused by bacteria needs to be treated with antibiotics in a hospital. You are more likely to develop complications during illness (such as prolonged fever and seizures) and long-term complications (such as hearing loss and vision problems) if infected with bacterial rather than viral meningitis. Death can occur if bacterial meningitis is not treated promptly.

Can meningitis be prevented?

Vaccination may prevent some types of meningitis. Vaccines against the most common causes of bacterial meningitis (Streptococcus pneumoniae and Neisseria meningitidis) are recommended for people at high risk of infection. These include older adults and children and adults who have a weakened immune system, such as those who have an underlying serious illness or do not have a working spleen (part of the immune system).

People traveling to areas where meningitis is prevalent, such as the "meningitis belt" in sub-Saharan Africa, should receive the Neisseria meningitidis vaccine.^{1, 2} The Centers for Disease Control and Prevention (CDC) recommends vaccination with a new vaccine (Menactra) that protects against certain strains of neisseria meningitidis for children ages 11 and 12, teens entering high school, and college freshman living in dormitories.³

Although college students' overall risk of meningitis is low, freshmen, especially those who live in dormitories, have a moderately higher risk for meningococcal disease than other people their age.³ If you are a college freshman living in a dormitory, the CDC recommends vaccination for neisseria meningitidis. College freshmen who do not live in dormitories may also be vaccinated to reduce their risk of infection.³

Routine vaccination against Streptococcus pneumoniae is recommended for children age 2 and younger and for those age 2 to 4 who are at high risk of serious pneumococcal disease. These include children with no spleen and those who have sickle cell disease or AIDS or HIV.

Children between the ages of 2 months and 5 years also should be vaccinated against Haemophilus influenzae type b bacteria. Since its introduction in 1985, the vaccine has greatly reduced the number of cases of meningitis caused by this bacterium. For more information, see the topic Immunizations.

Frequently Asked Questions

Meningitis is caused most often by viruses or bacteria that infect the tissues (meninges) and sometimes the fluid (cerebral spinal fluid, or CSF) that surround the brain and spinal cord.

Viral meningitis

Between 80% and 92% of people who get viral meningitis every year in the United States are infected with viruses that commonly live in the intestines.⁴ These enteroviruses (such as Coxsackie virus and echovirus) can live in the intestines without causing illness. However, they can cause meningitis when they are passed from one person to another through food, water, or contaminated objects. Meningitis caused by enteroviruses occurs most often in babies and young children.

Herpes viruses also can be a source of meningitis with encephalitis. They are often present in the body without causing illness, although occasionally they become active and cause sickness. Herpes viruses can be passed from one person to another through close contact such as kissing, coughing, sneezing, or having sex. Sometimes, herpes viruses can be passed from a mother to her baby at birth.

In rare cases, other viruses, such as human immunodeficiency (HIV) or mumps, may cause meningitis.

Bacterial meningitis

Most people who develop bacterial meningitis get it from one of two types of bacteria: Streptococcus pneumoniae or Neisseria meningitidis.⁵

These bacteria often live in the body, most often in the nose and throat, without causing illness. However, the bacteria can cause meningitis if they get into the bloodstream and travel to the cerebrospinal fluid or the tissues (meninges) that surround the brain and spinal cord. These bacteria also can be passed from one person to another, usually through infected saliva or mucus.

Two other bacteria that sometimes cause meningitis are group B streptococci and Listeria monocytogenes. Meningitis caused by group B streptococci bacteria occurs most often in newborns, who can become infected during or after birth. Meningitis caused by Listeria monocytogenes bacteria occurs most often in newborns and in older adults.

New guidelines for prevention of group B streptococci have decreased the incidence of disease; the guidelines include recommending prenatal screening of all pregnant women at 35 to 37 weeks and giving antibiotics during labor to women who have the bacteria.⁶

In rare cases, other bacteria cause meningitis, usually in people with long-term medical conditions.

Meningitis also can be caused by other organisms and conditions. It can develop as a complication of an illness, an injury (particularly to the skull or face), or brain surgery.

How meningitis is spread

Organisms that cause meningitis can be passed from one person to another or passed from rodents and insects to people. However, exposure to an organism that causes meningitis does not mean you will get the infection.

Organisms can be passed from one person to another:

• During birth. A mother can pass organisms that cause meningitis to her baby even if the mother does not have symptoms. Delivering a baby by cesarean section rather than through the birth canal does not always protect the baby from getting the infection. Organisms such as enteroviruses, group B streptococci, and Escherichia (E.) coli can be transmitted this way.
• Through stool. The enteroviruses and some bacteria (for example, Listeria monocytogenes and E. coli) can be transmitted in this manner. More children than adults get meningitis this way.
• Through coughing and sneezing. Infected people can pass certain bacteria that are normally found in their noses and throats (such as Streptococcus pneumoniae and Neisseria meningitidis) through saliva or mucus.
• Through kissing, sexual contact, or contact with infected blood. The human immunodeficiency virus (HIV) also can cause meningitis and can be passed from an infected person to another person through blood or sexual contact, but not through kissing.

Some organisms that cause meningitis with encephalitis can be passed to people from rodents and insects. The most common of these are arboviruses (including the St. Louis encephalitis and West Nile viruses) and lymphocytic choriomeningitis, which is transmitted through dust and food contaminated by the urine of infected mice, hamsters, and rats.

Symptoms of bacterial meningitis usually develop suddenly, while those of viral meningitis may develop suddenly or gradually over a period of days. For example, the symptoms of viral meningitis after mumps may take several days or weeks to develop.

The most common symptoms of either form of meningitis include:

• Fever.
• Severe and persistent headache.
• Stiff and painful neck, especially when trying to touch the chin to the chest.
• Vomiting.
• Confusion and decreased level of consciousness.
• Seizures.

Other symptoms of meningitis include:

• Sluggishness, muscle aches and weakness, and strange feelings (such as tingling) or weakness throughout the body.
• Eye sensitivity and eye pain from bright lights.
• Skin rash.
• Dizzy spells.

The incubation period—the time from exposure to the infection to when the first symptoms develop—depends on the type of organism causing the infection.

Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis.

• In babies, the signs of meningitis may be a fever, irritability that is difficult to calm, decreased appetite, rash, vomiting, and a shrill cry. Babies also may have bulging soft spots on their heads that are not caused by crying, and a stiff body. Babies with meningitis may cry when handled.
• Young children with meningitis may act like they have the flu, cough, or have trouble breathing.
• Older adults and people with other medical conditions may have only a slight headache and fever. They may not feel well and may have little energy.

Other conditions with similar symptoms to meningitis include viral hepatis and influenza (flu).

The course of meningitis often depends on your age, general health, and the organism causing the infection. The illness can range from mild to severe.

Viral meningitis is more common in the late summer and early fall. It usually does not cause serious illness. However, it is important to see your health professional if symptoms of meningitis develop so that he or she can rule out bacterial meningitis, which is more serious. With mild cases of viral meningitis you may need only home treatment and can recover within 2 weeks. However, some people may feel lightheaded and tired for several months after the illness.

Bacterial meningitis occurs most often from late winter to early spring. It usually causes serious illness and can be life-threatening. The symptoms of bacterial meningitis usually develop suddenly and last for 2 to 3 weeks. A person with bacterial meningitis is treated with antibiotics in a hospital.

Complications during illness and long-term complications are more common with bacterial than with viral meningitis. Newborns and young children with bacterial meningitis, people with impaired immune systems, and older adults with long-term medical conditions are more likely than others to develop immediate and/or long-term complications of meningitis.

People who have bacterial meningitis run the risk of death if they are not treated promptly. Newborns, children younger than 2, older adults, or people with weakened immune systems are at a greater risk of death than other people.

The likelihood of death from bacterial meningitis in adults is highest in those who are older than 50, have seizures during the first 24 hours of illness, delay getting treatment, are in a coma when admitted to the hospital, are in shock, or cannot breathe without help from a machine.⁵

Meningitis caused by Streptococcus (S.) pneumoniae is more likely to cause death than meningitis caused by other bacteria.⁵ Getting the vaccine against S. pneumoniae usually protects people from diseases (including meningitis) caused by most strains of the bacteria.

Factors that may increase the risk for meningitis include:

• Genetics. Some people may inherit the tendency to develop meningitis if they come in contact with organisms that can cause the infection.
• Sex. Males get meningitis more often than females.
• Age. In general, babies, young children, young adults, and older adults are at highest risk of getting meningitis.
• Crowded living conditions. People in camps, schools, and college dormitories are more likely than others to get meningitis caused by organisms that can spread easily from one person to another. For example:
  • College freshmen living in dormitories. College freshmen have a moderately increased risk of meningitis compared with other people their age. However, the risk in college students overall is low.
  • Children attending day care centers. Children who attend day care centers are more likely than other children to get meningitis caused by organisms that are easily spread through stool or contaminated hands or water.
• Exposure to insects and rodents. People who live in areas where insects or rodents carry organisms that cause meningitis risk getting the disease.
• Not being immunized against the mumps, Haemophilus influenzae, and the pneumococcal vaccine for children age 2 and younger. The pneumococcal vaccine protects against the strains of the bacteria that are in the vaccine.
• Being an older adult who is not vaccinated against Streptococcus pneumoniae and/or does not have a working spleen, which is part of the body's immune system .
• Travel to areas where meningitis is prevalent. For example, people traveling to the "meningitis belt" in sub-Saharan Africa should receive the Neisseria meningitidis vaccine.^{1, 2}

Medical conditions that increase the risk of meningitis include:

• Poor overall health. People who are in poor health or have other medical conditions may be at risk for meningitis because their bodies' natural defenses may be weak. For example, children who have sickle cell disease or cancer are at higher risk than other children.
• Having a birth defect of the skull, a head injury, or brain surgery.
• Undergoing treatment with a kidney dialysis machine.
• Having other infections, such as upper respiratory infections, mumps, tuberculosis (TB), syphilis, Lyme disease, and illnesses caused by herpes viruses.
• Having a cochlear implant for severe hearing loss. A recent study indicates that children with cochlear implants have an increased risk for bacterial meningitis.⁷
• Being born to a mother infected with an organism that causes meningitis. Viruses such as the enteroviruses and herpes viruses, and bacteria such as group B streptococci, Listeria monocytogenes, and E. coli can be passed from an infected mother to a baby during birth.
• Having had meningitis in the past. Some people who have had meningitis are more likely than others to get it again. These include people with birth defects or injuries to their skull and face, impaired immune systems, or unexpected reactions to some medications.

Call 911 or other emergency services immediately if:

• You or your child has symptoms of severe meningitis, such as fever, seizures, and confusion.
• Your baby has signs of severe meningitis such as trouble breathing or fever with a bulging soft spot on the head not caused by crying.

Call your health professional immediately if:

• You or your child has symptoms or signs of meningitis, such as severe and persistent headache, stiff neck, fever, rash, nausea, and vomiting.
• You or your child has viral meningitis and does not get better with home treatment after 3 days.
• You or your child is being treated for viral meningitis and develops signs of complications during illness (for example, a fever that lasts longer than 3 full days and does not go down with home treatment).
• Your baby has a fever that comes and goes, diarrhea, vomiting, swollen abdomen, and a shrill cry.

Call a health professional promptly if you believe you may have been exposed to meningitis. You can be treated with antibiotics, which may keep you from developing the illness.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Bacterial meningitis, especially in a newborn, is a medical emergency. Watchful waiting is not appropriate if you think that you or your child has meningitis, especially because you will not know whether the infection is bacterial or viral. Call your health professional as soon as symptoms or signs appear.

Who To See

The following health professionals can diagnose and treat meningitis:

• Pediatrician
• Family medicine physician or internist
• Emergency room doctor
• Pediatric nurse practitioner or family nurse practitioner
• Physician assistant

Specialists may be needed to treat meningitis, especially if complications develop:

• Infectious disease specialist
• Neurologist

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Diagnosis of meningitis is based on a medical history, a physical exam, and tests.

If meningitis is suspected, your health professional may do tests without admitting you to a hospital.

Lumbar puncture

The lumbar puncture (also known as a spinal tap) almost always is performed if meningitis is suspected.

A lumbar puncture is used to obtain samples of the fluid around the spine and brain, known as cerebral spinal fluid (CSF). A culture of the spinal fluid is done to check for organisms known to cause illness. It often takes several days to several weeks to get results from a spinal fluid culture. However, other tests also can be done on the spinal fluid to determine which organism is causing the infection. The results of these tests may be ready before the results of a culture.

Other tests

A health professional also may do the following tests:

• Computed tomography (CT scan) or magnetic resonance image (MRI) to look for swelling of brain tissue or for complications such as brain damage
• Urine test, to check for infection in the urinary tract
• Chest X-ray, to check for lung infections
• Blood culture, to check for infections
• Biopsy of a skin rash

Treatment for meningitis depends on the organism causing the infection, your age, the extent of the infection, and the presence of other medical conditions or complications of meningitis.

Most people with viral meningitis usually start getting better within 3 days of feeling sick and recover within 2 weeks .However, it is important to see your health professional if symptoms of meningitis develop so that he or she can rule out bacterial meningitis, which is more serious. With mild cases of viral meningitis you may only need home treatment, including fluids to prevent dehydration and medication to control pain and fever. If you do not get better or if symptoms worsen, you may need further testing to check for other causes of illness.

Bacterial or severe viral meningitis may require treatment in a hospital, including:

• Antibiotics. These medications usually are given through a vein (intravenously, or IV). Antibiotics are given only when bacteria are causing the infection. Giving antibiotics when they are not needed may cause drug resistance.
• Measures to reduce pressure within the brain. If meningitis is causing increased pressure within the brain, corticosteroid medications such as dexamethasone may be given. Dexamethasone given along with antibiotics early in the course of meningitis may reduce the risk of disability and death.⁸ However, one study found that steroids did not improve the outcome in children in developing countries, where children often do not get to a hospital soon after bacterial meningitis develops.⁹
• Measures to reduce fever. Medications such as acetaminophen (Tylenol), fluids, and good room ventilation reduce fever. If you have a high fever, you also may need a device such as a cooling pad placed on the bed.
• Measures to prevent seizures. If you have seizures, surroundings are kept quiet and calm. Medications such as phenobarbital or dilantin can be given to stop seizures. For more information, see the topic Seizures.
• Oxygen therapy. Oxygen may be given if you have trouble breathing and to increase the amount of oxygen in all parts of the body. Oxygen may be delivered by a hood or tent placed over the body, a face mask placed over the nose and mouth, a nose piece (nasal cannula) held loosely under the nose, or in severe cases, a tube through the mouth into the trachea (windpipe).
• Monitoring fluids. You may need to drink extra liquids because infections increase the body's need for fluids. Increasing liquids also reduces the possibility of dehydration. Liquids are given into a vein (IV) if you have an infection and are vomiting or are not able to drink enough. Health professionals control the amount of fluids given because people with meningitis may develop problems if they have too much or not enough fluid.
• Monitoring blood chemicals. Frequent blood tests are done to measure essential body chemicals, such as sodium and sugar in the blood.

A person who has severe meningitis may need to be treated in the intensive care unit (ICU) of a hospital. Health professionals watch the person closely and provide care if needed. See the Other Treatment section of this topic for more information on intensive care in a hospital.

What To Think About

Most healthy adults who have recovered from meningitis do not need follow-up care. However, adults who have existing medical conditions that make them more likely than others to develop long-term complications or get meningitis again should see their health professional after recovery. Babies and children treated for meningitis always need follow-up care after recovery and need to be checked for long-term complications such as hearing loss.

Immunization against some of the organisms that can cause meningitis is the most effective way to prevent the illness. Immunizations against some common causes of meningitis include:

• Measles, mumps, and rubella (MMR) vaccine. This vaccine is routinely given to babies between 12 months and 15 months of age.
• Varicella (chickenpox) vaccine. This vaccine is recommended for babies before the age of 18 months and for older children, teens, and adults who have not had chickenpox.
• Haemophilus influenzae type b vaccine. Immunization against Haemophilus influenzae type b is recommended for all children between 2 months and 5 years of age and anyone older than 5 who has a medical condition such as sickle cell disease or an impaired immune system.
• Neisseria meningitidis and Streptococcus pneumoniae vaccines. Immunizations against these bacteria are recommended for people who have medical conditions such as impaired immune systems or people who have had meningitis in the past. The Centers for Disease Control and Prevention (CDC) recommends vaccination with a new vaccine (Menactra) that protects against certain strains of neisseria meningitidis for children ages 11 and 12, teens entering high school, and college freshman living in dormitories.³ Neisseria meningitidis vaccines also may be given to others who may be at higher-than-normal risk, such as travelers to countries known to have outbreaks of meningitis, people without a spleen, and those with HIV. Routine vaccination with a new pneumococcal vaccine is recommended for children age 2 and younger.

College students

Although college students' overall risk of meningitis from Neisseria meningitidis (meningococcal disease) is low, freshmen, especially those who live in dormitories, have a moderately higher risk than other people their age.³ If you are a college freshman living in a dormitory, the CDC recommends vaccination for neisseria meningitidis. College freshmen who do not live in dormitories may also be vaccinated to reduce their risk of infection.³

Cochlear implants

An association has been found between meningitis and cochlear implants for severe hearing loss. To reduce the risk of meningitis, experts recommend that people with cochlear implants be vaccinated against Streptococcus pneumoniae. Also, some people with implants had ear infections before they developed meningitis; therefore, people with implants should receive prompt antibiotic treatment for ear infections.

Breast-feeding

Breast-feeding may protect children ages 2 to 5 months against meningitis caused by Haemophilus influenzae type b bacteria. However, it is still important to give breast-fed babies the vaccine for Haemophilus influenzae.

For more information about immunizations, see the topic Immunizations.

Reduce your risk

You can take steps to reduce your risk of infection and prevent the spread of meningitis by:

• Avoiding people who have meningitis.
• Separating people with meningitis from other people in the home.
• Washing your hands often if you have meningitis or are caring for someone with meningitis. Wash your hands after using the toilet or helping a sick child use the toilet, changing a sick baby's diaper, and handling used bed sheets, towels, clothes, or personal items of a person with meningitis.
• Avoiding insects and rodents that carry organisms that cause meningitis. If you live in an area where there are insects (such as mosquitoes and ticks) and rodents (such as mice and rats) that carry organisms that cause meningitis, take steps to avoid contact with them, such as using insect repellent and keeping all rodents out of your home and other buildings.

If you come in close contact with someone who has meningococcal disease, taking antibiotics may keep you from developing the illness. For example, a person who has come in contact with the saliva or mucus of someone with meningitis caused by Neisseria meningitidis bacteria may be given the antibiotics ciprofloxacin, ceftriaxone, or rifampin. However, ciprofloxacin is not usually used in people younger than 16 years of age or in pregnant women. Rifampin also is not recommended for pregnant women.

If you have only casual contact with someone who has meningitis, for example at school or at work, you do not need to take antibiotics.

Home treatment usually is all that is needed for most people who have viral meningitis. It includes:

• Reducing fever. Sometimes no treatment is needed for fever. Cool washcloths to the forehead, cool baths, and medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Nuprin) can be used to reduce fever. For more information on fever, see the topics Fever, Age 3 and Younger and Fever, Age 4 and Older.
• Relieving minor pain. Headache is a common symptom of meningitis. Some people also have muscle aches and pains. Minor pain usually can be relieved with medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Nuprin).
• Preventing dehydration. Common signs of dehydration include a dry, sticky mouth and urinating only small amounts of dark-colored urine. You can prevent dehydration by drinking extra liquids such as water, juices, teas, and rehydration drinks. Children may enjoy frozen juice bars or snow cones. If a person vomits, he or she needs to avoid solid food and take frequent small sips of water or other liquids.
• Resting. Rest promotes healing and provides relief from symptoms such as headache. Quiet activities, such as reading books, playing board games, watching videos, or listening to music, help pass the time.
• Watching for signs of complications during illness. The most common complications include fever lasting for longer than expected and seizures. Some people with complications during illness may need to be treated in a hospital.

Home treatment also is necessary after recovery. It is important to look for signs of long-term complications of meningitis, such as hearing loss.

Medications used to treat meningitis depend on the organism causing the infection, the extent of the infection, and the person's age and general health. Medications include antibiotics to treat bacterial infection and other medications to treat seizures and pressure on the brain, and to reduce fever and relieve muscle aches.

Medication Choices

Antibiotics

Medications to treat seizures

Medications to treat pressure on the brain

Medications to treat fever and muscle aches. The most commonly used medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Common side effects include nausea or upset stomach. In addition, NSAIDs may cause ringing in the ears and blurred vision.

What To Think About

Before starting antibiotics to treat bacterial meningitis, it is important to find out which bacteria is causing the infection. A sample of spinal fluid or blood is tested to detect the organism.

The type of antibiotic used and length of treatment depend on the bacteria, the extent of the infection, your age, and how likely you are to develop severe meningitis or complications during illness. Often two antibiotics are given together, such as ampicillin and gentamicin sulfate.

There is no surgical treatment for meningitis.

People with severe meningitis or complications during illness may need to be treated in the intensive care unit of a hospital. They may need:

• Oxygen therapy, to help ease breathing and reduce the amount of work on the heart. A pulse oximeter often is used to measure the amount of oxygen in the blood. In addition, if people are too sick to breathe on their own, they may need a machine called a ventilator.
• Suctioning, to remove mucus from the bronchial tubes. A small plastic tube is inserted into the mouth or nose. The tube is attached to a machine that gently sucks out mucus. Other treatments, such as breathing exercises and massage, also can be used to remove mucus.
• Liquids given through a vein (intravenous, or IV). Sometimes people are too sick to drink liquids.

Organization

• Encephalitis

Citations

1. American Public Health Association (2004). Meningitis. In J Chin, ed., Control of Communicable Diseases Manual, 18th edition, pp. 357–371. Washington, DC: American Public Health Association.

2. American Academy of Pediatrics (2003). Meningococcal infections. In LK Pickering, ed., Red Book: 2003 Report of the Committee on Infectious Diseases, 25th ed, pp. 430–437. Elk Grove Village, IL: American Academy of Pediatrics.

3. Centers for Disease Control and Prevention (2005). Meningococcal Conjugate Vaccine: ACIP recommends meningococcal for adolescents and college freshmen. Available online: http://www.cdc.gov/nip/vaccine/meningitis/mcv4/mcv4_acip.htm.

4. Ramers C, et al. (2000). Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA, 283(20): 2680–2685.

5. Roos KL, Tyler KL (2005). Meningitis, encephalitis, brain abscess, and empyema. In DL Kaspar et al., eds., Harrison's Principles of Internal Medicine, 16th ed., pp. 2471–2490. New York: McGraw-Hill.

6. Schrag S, et al. (2002). Prevention of perinatal group B streptococcal disease: Revised guidelines from CDC. MMWR, 51(RR-11): 1–22.

7. Reefhuis J, et al. (2003). Risk of bacterial meningitis in children with cochlear implants. New England Journal of Medicine, 349(5): 435–445.

8. De Gans J, van de Beek D (2002). Dexamethasone in adults with bacterial meningitis. New England Journal of Medicine, 347(20): 1549–1556.

9. Molyneux EM, et al. (2002). Dexamethasone treatment in childhood bacterial meningitis in Malawi: A randomised controlled trial. Lancet, 360(9328): 211–218.

Author:	Merrill Hayden	Last Updated February 28, 2005
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Oleg O. Bilukha, MD, PhD - Center's for Disease Control and Prevention
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