COMPILED APRIL 2019

CENTRE FOR RESPIRATORY DISEASE AND MENINGITIS

MENINGITIS
Frequently Asked Questions

1. What is meningitis?
Meningitis is swelling and inflammation of the membranes (meninges) that surround the brain
and spinal cord. Meningitis is most often caused by a viral, bacterial or fungal infection.
Meningitis is a serious disease that can be fatal or cause long-lasting side effects.

2. What is the difference between meningitis and encephalitis?

Meningitis is an inflammation of the meninges (the covering surrounding the brain and spinal
cord) and encephalitis is inflammation of the brain tissue. The both produce similar symptoms
however confusion and altered mental state are more common in encephalitis. Encephalitis
is most often caused by viruses (particularly herpes virus), whereas meningitis can be caused
by a range of viruses or bacteria.

3. What causes meningitis?

The three main causes of meningitis are viral, bacterial or fungal infections. These organisms
usually cause a mild or asymptomatic infection in another part of the body (skin, throat, chest,
gastrointestinal system) and then may spread through the bloodstream or lymphatic system
to the nervous system/brain. Sometimes the organisms enter the nervous system directly
following head surgery, head trauma or a severe infection of the ear canal, eyes or sinuses.
Meningitis caused by fungi usually occurs in those with weakened immune systems, i.e. those
infected with HIV/AIDs, cancer patients, and very young babies. Other very rare causes of
meningitis are protozoa, parasites and certain medications that may lead to inflammation of
the meninges.

4. What is bacterial meningitis?

Bacterial meningitis is a very serious infection of the membranes around the brain and spinal
cord caused by bacteria and can rapidly progress to severe illness and even death. This
condition occurs more often in the winter months. It is caused by bacteria that are commonly
found in the throat and nose of healthy people. It is still unknown why these bacteria move
into the bloodstream and nervous system in some individuals. The 3 most common causes of
bacterial meningitis are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria
meningitidis. Bacterial meningitis should be treated urgently with antibiotics.

5. What is viral meningitis?

Viral meningitis is more common but usually less serious than bacterial meningitis. Most
episodes resolve spontaneously and rarely result in death. It occurs more frequently in the
warmer months (summer and autumn). Enteroviruses, such as coxsackie and echovirus,
usually cause a diarrhoea–like-illness but can often cause meningitis. Others viruses that
lead to meningitis are those that cause mumps, chickenpox, mononucleosis and herpes.

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 Clinically is may be difficult to differentiate between bacterial and viral meningitis as the
symptoms can be similar.

6. What is fungal meningitis?

Meningitis may be caused by the fungus Cryptococcus neoformans. This type of meningitis is
most commonly seen in people living with HIV infection, especially when a person’s CD4 count
is low and/or the person is not taking antiretroviral therapy. Cryptococcal meningitis should
be treated with intravenous medication and by doing lumbar punctures to decrease the
pressure in the brain. Meningitis due to other fungal organisms is very rare.

7. How is meningitis spread?

Most bacterial and viral causes of meningitis are spread from person to person through close
contact with respiratory secretions or saliva (such as coughing, sneezing, and intimate kissing).
Enteroviral meningitis is spread through the faecal-oral route. Sharing eating utensils, glasses,
food, or sleeping together in the same room/hostel/barracks can also spread these bacteria
and viruses. Cryptococcal meningitis is not infectious, and is not spread from one person to
another.

8. What are the signs and symptoms of meningitis?

Persons with meningitis may start out with flu-like symptoms which may rapidly progress
(sometimes within hours) causing severe illness or even death. Symptoms may vary but the
most common symptoms occurring in children and adults include: a high fever; severe
headache; neck stiffness; dislike of bright lights (photophobia); vomiting, diarrhoea or
stomach pains; painful joints; a purplish skin rash that does not disappear when pressed; cold
hands and feet; seizures; and/or drowsiness that can deteriorate into a coma. Symptoms in
infants are harder to detect and could include: a fever with cold hands and feet, high pitched
moaning or whimpering, blank staring, inactivity, drowsiness, poor feeding, neck retraction
with arching of the back, and/or a bulging fontanelle (the soft spot on the baby’s head).

9. What should I do if someone I know has symptoms of meningitis?

Call the doctor or take them to the nearest clinic or hospital right away. Call an ambulance if
you do not have transport to the hospital/clinic. Bacterial meningitis needs to be treated
urgently.

10. Can meningitis be treated?

Persons with meningitis will usually be hospitalised. Intravenous antibiotics are usually given
to all meningitis suffers whilst waiting for confirmation of the diagnosis. Bacterial meningitis
is usually treated for 3-7 days with intravenous antibiotics. Treatment of viral meningitis is
aimed at relieving symptoms and does not require antibiotics. Cryptococcal meningitis is
treated with amphotericin B with or without other drugs for at least 14 days followed by
lifelong preventive therapy. Meningitis treatment may also include anticonvulsants for any
seizures, pain relievers, and other treatments for brain swelling. These may be administered
in an intensive care unit.

11. What are the long term effects following meningitis?

Persons who have meningitis may recover completely, without any long-term effects,
however approximately 1 in 5 persons who survive an episode of meningitis may be left with
long-term effects of the condition. This could include tiredness/fatigue, behavioural and/or

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 concentration problems, recurring headaches, varying degrees of deafness or blindness,
ongoing seizures, weakness of leg(s)/arm(s), or loss of limb(s). The outcome meningitis
depends on the cause of the infection, how quickly treatment begins, and how severely ill the
person becomes.

12. Who is at risk for meningitis?

A person may develop meningitis at any age or life-stage, however it is most common in
infants aged <1 year. Cryptococcal meningitis typically occurs in HIV-infected adults with very
low immunity. Certain medical conditions may put some people at greater risk of developing
meningitis, such as not having a functioning spleen, or having a weakened immune system
(due to HIV or terminal complement deficiency). People travelling to countries experiencing
epidemics of meningococcal meningitis may also be at increased risk.

13. How can I prevent meningitis?

The routine infant vaccination programme (Expanded Programme on Immunisation) in South
Africa includes vaccines against Streptococcus pneumoniae and Haemophilus influenzae, two
of the most common bacterial causes of meningitis. Vaccines against meningococcal
meningitis are available in South Africa. Persons at increased risk (such as laboratory workers,
students and military personnel living in hostels, persons with asplenia, persons with
complement deficiency) are encouraged to get vaccinated. Other vaccines are available
privately and could prevent viral meningitis. These include the measles, mumps and varicella
zoster (chicken pox) vaccine. If you have been in close contact (same household, share eating
utensils, intimate partners) with someone who has been diagnosed with bacterial meningitis,
the doctor may provide you with an antibiotic to clear the bacteria from your nose/throat.
Other actions to prevent meningitis would be to wash your hands carefully (especially after
going to the toilet), wash your food carefully, do not share eating utensils, take your
antiretroviral treatment if you are HIV-infected and eat healthily to boost your immunity.

14. Where can I find more information?

 NICD webpage: www.nicd.ac.za “Diseases A-Z index”, for specific causes of meningitis
including ‘enteroviral meningitis’, meningococcal meningitis’, ‘Haemophilus influenzae
type B’, ‘Cryptococcosis’ and ‘Pneumococcal infection’
 Health care workers can call the NICD Hotline for after hours and emergency medical
advice and assistance 082-883-9920

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