Meningitis
Meningitis is inflammation of the membranes surrounding the brain and spinal cord. It can be caused by bacteria, viruses, fungi, parasites and non-infectious conditions. Bacterial meningitis is particularly dangerous because it can progress quickly and cause death or permanent disability.
At a glance
Quick facts
- Category
- Neurologic / infectious syndrome
- Common causes
- Bacteria · viruses · fungi · parasites
- Classic pattern
- Fever · headache · neck stiffness
- Core test
- Lumbar puncture / CSF
- Emergency rule
- Do not delay antibiotics for suspected bacterial meningitis
- Prevention
- Vaccines + selected prophylaxis
Names & terminology
How this entity may be named or searched
- Canonical name
- Meningitis describes inflammation of the meninges; the cause must be specified when known.
- Bacterial meningitis
- A medical emergency caused by bacteria such as meningococcus, pneumococcus, Hib or group B streptococcus.
- Meningococcal disease
- Can present as meningitis, bloodstream infection/sepsis, or both.
- Meningitis belt
- A high-risk region of sub-Saharan Africa extending from Senegal to Ethiopia, with recurrent meningococcal epidemics.
Structured entity profile
Clinical profile
Overview
Meningitis is a syndrome rather than a single infection. Bacteria, viruses, fungi and parasites can all cause meningitis, and the likely pathogen depends on age, immune status, exposure and geography. [1] [2]
Bacterial meningitis is the most time-critical form. WHO reports that around one in six people with bacterial meningitis die and one in five survivors experience severe long-term complications. [1]
Symptoms and warning signs
Common symptoms in older children and adults include fever, severe headache, neck stiffness, confusion or altered mental status, light sensitivity, nausea and vomiting. Infants may instead have poor feeding, irritability, reduced activity, difficulty waking, temperature instability or a bulging fontanelle. [1] [2]
SYMPTOM MATRIX
Classic symptoms are useful — but their absence does not rule out meningitis
Age, immune status and pathogen can change the presentation substantially.
- Fever
- Severe headache
- Neck stiffness
- Nausea or vomiting
- Light sensitivity
- Poor feeding
- Irritability or lethargy
- Reduced responsiveness
- Bulging fontanelle
- Seizures
- Confusion or reduced consciousness
- Seizure
- Rapid clinical deterioration
- Shock or severe breathlessness
- Non-blanching rash with systemic illness
A rash may be absent in meningococcal disease; do not wait for one before seeking emergency care.
Diagnosis
Lumbar puncture is central to the diagnosis because cerebrospinal fluid (CSF) can show inflammation and allow microbiological testing. Blood cultures and molecular tests can also help identify the cause and guide treatment and public-health action. [1] [2]
If bacterial meningitis is strongly suspected, antibiotics should not be delayed while waiting for lumbar puncture, imaging or laboratory confirmation. Brain imaging is selective rather than routine before every lumbar puncture and is used when clinical features raise concern about raised intracranial pressure or another contraindication. [1] [2]
Diagnostic pathway
Recognize the emergency, obtain samples when safe, and treat without delay
The diagnostic sequence must never create a harmful delay in suspected bacterial meningitis.
Lumbar puncture should ideally precede antibiotics when this can be done promptly and safely; it must not delay urgent treatment.
Causes vary by age and immune status
Group B streptococcus is particularly important in newborns; meningococcus, pneumococcus and Haemophilus influenzae are important bacterial causes in children and adolescents, while pneumococcus and meningococcus account for much adult bacterial meningitis. HIV and other immunocompromising conditions increase the risk of additional causes such as cryptococcal and tuberculous meningitis. [1]
Treatment and management
Bacterial meningitis is a medical emergency. Empiric intravenous antibiotics should be started as soon as possible, with initial choice based on age, immune status, epidemiology and local antimicrobial resistance. Treatment is refined when the pathogen and susceptibility are known. [1] [2]
WHO recommends intravenous corticosteroids with the first antibiotic dose in children and adults with suspected acute bacterial meningitis in non-epidemic settings when appropriate. Supportive care may include oxygen, fluid and electrolyte management, seizure treatment, shock management and monitoring for raised intracranial pressure. Viral, fungal and tuberculous meningitis require cause-specific treatment. [2]
Treatment & care hub
The first priority is timely treatment of possible bacterial meningitis
Once immediate care is underway, microbiology can narrow treatment and guide public-health action.
Treat suspected bacterial meningitis
Start appropriate intravenous antibiotics promptly; do not wait for final CSF results.
Corticosteroids in appropriate settings
WHO recommends intravenous corticosteroids with the first antibiotic dose in selected non-epidemic presentations.
Treat seizures, shock and organ dysfunction
Clinical deterioration may require intensive monitoring and organ support.
Target the pathogen
Antivirals, antifungals or prolonged TB treatment are used when those causes are identified or strongly suspected.
Antibiotic choices and doses must follow age-specific and local antimicrobial-resistance guidance.
Complications and follow-up
Survivors of bacterial meningitis can have hearing loss, seizures, weakness, visual problems, cognitive or learning difficulties and other neurologic disability. Follow-up should include hearing assessment and age-appropriate neurologic, developmental and rehabilitation review. [1] [2]
Vaccination and contact prevention
Vaccines are available against meningococcus, pneumococcus and Haemophilus influenzae type b. Close contacts of meningococcal disease may need prompt antibiotic prophylaxis. In the African meningitis belt, WHO recommends Men5CV, a pentavalent conjugate vaccine covering serogroups A, C, W, Y and X, as countries transition vaccination programmes. [1] [3]
African meningitis belt · WHO 2026
The world’s highest meningitis burden is concentrated in the African meningitis belt
Enhanced surveillance across the belt recorded substantial suspected disease in 2025 despite major vaccine progress.
Common questions
Frequently asked questions
No. Viruses, fungi, parasites and non-infectious conditions can also cause meningitis.
No. Classic symptoms are not present in every patient, especially infants, older adults and immunocompromised people.
Bacterial meningitis can progress rapidly. Treatment should not be delayed for lumbar puncture, imaging or laboratory confirmation when bacterial meningitis is strongly suspected.
Vaccines prevent several important bacterial causes, and selected close contacts of meningococcal disease receive antibiotic prophylaxis.
The African meningitis belt has the world’s highest burden and remains at risk of recurrent meningococcal epidemics despite major gains from vaccination.
Sources
- WHO — Meningitis fact sheet, 29 September 2026
- WHO — Guidelines on meningitis diagnosis, treatment and care, 10 April 2025
- WHO — Preparedness and response to bacterial meningitis outbreaks: toolkit for frontline healthcare workers, 28 April 2026
This article is based on trusted medical sources and is awaiting clinician review. It is not a substitute for personalized medical advice.