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Meningitis: A Guide To The Different Types, Symptoms & Treatments
When you hear the word "meningitis," your mind might jump to a scary, life-threatening brain infection. While that's partially true for some types, the reality is more nuanced. Meningitis is an inflammation of the meninges, the delicate membranes that act like a protective wrapper around your brain and spinal cord (these meninges are also known as protective membranes).
The cause of that inflammation is what truly matters, as it dictates everything from the severity of the illness to the urgency of treatment. Infectious diseases—such as bacteria, viruses, fungi, and parasites—can cause meningitis, as can non infectious causes like autoimmune conditions or certain medications. These different agents can cause meningitis by triggering inflammation of the protective membranes. The treatment and outcome of meningitis depends on the underlying cause. Think of it less as a single disease and more as a category of conditions. Let's break down the different types—bacterial, viral, and fungal—to understand what they are, how they're treated, and how you can protect yourself.
Table of ContentsWhat Is Meningitis, Really?Imagine your brain and spinal cord are the most important VIPs at a party. The meninges are their security detail—three layers of protective tissue. When these layers become inflamed or swollen, usually due to an infection, it's called meningitis. This swelling can interfere with the central nervous system's normal functions, leading to the condition's hallmark symptoms: a pounding headache, fever, and a stiff neck [4]. Other symptoms, such as altered mental status (confusion or changes in consciousness), can also occur. This is different than from others like Brain Swelling.
While these symptoms are classic, they don't always appear together, and some people—especially infants and those with weakened immune systems—may show different signs, like irritability, sleepiness, or a lack of appetite. In infants, poor feeding and a bulging fontanelle (baby's head) can be important signs. Symptoms can also differ between children and adults.
Bacterial Meningitis: A True Medical EmergencyAcute bacterial meningitis is the type of meningitis that warrants its serious reputation due to its rapid progression and severity. When a bacterial infection invades the bloodstream and travels to the brain and spinal cord, bacteria such as group b streptococcus, listeria monocytogenes, and listeria bacteria can cause severe inflammation, quickly causing meningitis.
Certain populations, such as pregnant women and those with increased risk due to occupational exposure (for example, those working with animals), are more susceptible to listeria infection. The global disease burden of bacterial meningitis cases is significant, with high rates of morbidity and mortality worldwide.
Without immediate antibiotic treatment, acute bacterial meningitis can lead to serious complications, including low blood pressure as an early complication, permanent disabilities like brain damage, hearing loss, or even death within hours. Because of this, the condition must be treated quickly.
Because of this, doctors don't wait for a definitive diagnosis if they suspect bacterial meningitis. They begin antibiotic treatment immediately with powerful, broad-spectrum intravenous (IV) antibiotics, typically a combination including ceftriaxone and vancomycin [1]. The goal is to attack the bacteria right away, even before lab tests identify the specific culprit.
In some cases, especially with suspected pneumococcal meningitis, doctors may also administer a corticosteroid called dexamethasone just before or with the first dose of antibiotics. This can help reduce the inflammatory response, potentially lowering the risk of severe neurological complications [4]. To identify bacteria causing meningitis, doctors perform specific tests on cerebrospinal fluid or blood samples. Once the specific bacterium is identified from a spinal fluid culture, the antibiotic regimen may be adjusted for more targeted treatment, which usually lasts for one to two weeks.
Viral Meningitis: The More Common, Milder CulpritViral meningitis is far more common and usually much less severe than its bacterial counterpart. Viral meningitis typically has a mild, self-limiting course and often resolves without specific treatment, unlike bacterial meningitis, which can be life-threatening and requires prompt antibiotic therapy. Many different viruses can cause it, including the same ones responsible for mumps, measles, and even the flu.
It is important to distinguish between bacterial and viral meningitis, as they differ in severity, treatment, and outcomes. Bacterial meningitis often leads to more serious complications and requires immediate medical intervention, while viral meningitis typically results in a benign outcome with supportive care.
For most people with a healthy immune system, viral meningitis is a self-limiting illness, meaning it typically resolves on its own without specific medical treatment. The body's immune system is usually capable of fighting off the viral invader. Management focuses on supportive care:
The main exception is when meningitis is caused by viruses like herpes simplex virus (HSV) or varicella-zoster virus (VZV). In these cases, doctors will prescribe antiviral medication, such as acyclovir, to fight the infection directly [2].
Fungal Meningitis: A Rare but Serious ThreatFungal meningitis is the least common of the three types and typically occurs in people with a weakened immune system, such as those with HIV/AIDS, cancer, or who have had an organ transplant. Cryptococcal meningitis is a common form of fungal meningitis, especially in individuals with HIV/AIDS, and is a serious opportunistic infection. It is caused by inhaling fungal spores from the environment [6].
Unlike the acute onset of bacterial meningitis, the fungal form tends to develop more slowly and can present as chronic meningitis, with symptoms lasting more than four weeks. However, it is a serious condition that requires a long and intensive course of treatment with high-dose antifungal medications, starting with an IV drug like amphotericin B, followed by oral medications like fluconazole. This treatment can last for weeks or even months [3].
How Doctors Diagnose MeningitisDoctors assess symptoms of meningitis—such as fever, headache, neck stiffness, and neurological changes—alongside test results to guide diagnosis.
So, if the symptoms can overlap, how do doctors tell the difference? The definitive diagnostic tool is a lumbar puncture, also known as a spinal tap. While it may sound intimidating, this procedure is essential. A doctor carefully inserts a thin needle into the lower back to collect a small sample of cerebrospinal fluid (CSF)—the fluid that surrounds the brain and spinal cord.
Analyzing the CSF is the key to unlocking the diagnosis. Lab technicians look for:
Blood cultures and neuroimaging, like a CT or MRI scan, may also be used to gather more information and rule out other conditions [4]. While diagnostic tests are crucial, a doctor's clinical judgment is paramount, as lab results alone may not always provide a clear-cut answer [5].
Prevention: Your Best DefenseWhen it comes to the most dangerous forms of meningitis, prevention is far better than a cure. Strategies to prevent meningitis include vaccination, practicing good hygiene, and avoiding the sharing of utensils or drinks to reduce transmission. The most effective preventive measure is vaccination. The development of vaccines against the most common culprits of bacterial meningitis has been a major public health victory. Key vaccines recommended by the CDC include:
These vaccines are part of the routine childhood immunization schedule but are also recommended for adolescents, young adults (especially those in group settings like college dorms or military barracks, who have a higher risk of meningitis), and other at-risk adults [7]. Vaccination strategies may vary depending on the types of meningitis and individual risk factors. Targeted vaccination campaigns are especially important in regions with high risk, such as the African meningitis belt, to control epidemics of meningococcal disease. You can find detailed information on meningitis and vaccination from leading health organizations like the World Health Organization (WHO).
Closing ThoughtsUnderstanding the different faces of meningitis is key to knowing how to react. While viral meningitis often just requires rest and patience, bacterial meningitis is a race against time where every second counts. Never hesitate to seek immediate medical attention for the "classic trio" of severe headache, fever, and neck stiffness. Staying up-to-date on vaccinations for yourself and your family is the single most powerful step you can take to prevent this devastating disease. For more in-depth clinical information, resources like PubMed offer access to the latest research and guidelines.
References[1] van de Beek, D., Cabellos, C., Dzupova, O., Esposito, S., Klein, M., Kloek, A. T., Leib, S. L., Mourvillier, B., Ostergaard, C., Pagliano, P., Pfister, H. W., Read, R. C., Sipahi, O. R., Brouwer, M. C., & ESCMID Study Group for Infections of the Brain (ESGIB) (2016). ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 22 Suppl 3, S37–S62. Https://doi.Org/10.1016/j.Cmi.2016.01.007
[2] McGill, F., Heyderman, R. S., Michael, B. D., Defres, S., Beeching, N. J., Borrow, R., Glennie, L., Gaillemin, O., Wyncoll, D., Kaczmarski, E., Nadel, S., Thwaites, G., Cohen, J., Davies, N. W., Miller, A., Rhodes, A., Read, R. C., & Solomon, T. (2016). The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. The Journal of infection, 72(4), 405–438. Https://doi.Org/10.1016/j.Jinf.2016.01.007
[3] Lin, A. L., & Safdieh, J. E. (2010). The evaluation and management of bacterial meningitis: current practice and emerging developments. The neurologist, 16(3), 143–151. Https://doi.Org/10.1097/NRL.0b013e3181d14185
[4] Fitch, M. T., & van de Beek, D. (2007). Emergency diagnosis and treatment of adult meningitis. The Lancet. Infectious diseases, 7(3), 191–200. Https://doi.Org/10.1016/S1473-3099(07)70050-6
[5] Scheld W. M. (1991). Ceftriaxone in treatment of serious infections. Meningitis. Hospital practice (Office ed.), 26 Suppl 5, 14–55. Https://doi.Org/10.1080/21548331.1991.11707738
[6] Tyski, S., & Grzybowska, W. (1998). Analysis of bacterial meningitis during 1992-1996 in Poland. Central European journal of public health, 6(3), 225–230. Https://pubmed.Ncbi.Nlm.Nih.Gov/9787925/
[7] Scholz, H., Hofmann, T., Noack, R., Edwards, D. J., & Stoeckel, K. (1998). Prospective comparison of ceftriaxone and cefotaxime for the short-term treatment of bacterial meningitis in children. Chemotherapy, 44(2), 142–147. Https://doi.Org/10.1159/000007106
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Urgent Summer Holiday Warning As Cases Of Highly Contagious 'bull-neck' Infection Spread Rapidly Across Europe
HEALTH officials have issued a warning over a highly contagious bacterial infection spreading through Europe that strikes victims with a telltale "bull neck".
A total of 234 diphtheria cases have been reported in European countries since January 2023, according to the European Centre for Disease Prevention and Control (ECDC).
1
Diphtheria is a contagious and serious infection that can turn fatal if not treatedCredit: GettyDiphtheria can be a serious illness that sometimes turns fatal, especially in children, if it's not treated quickly.
It causes a thick grey-white coating at the back of the throat, nose and tongue, and fever.
More severe cases can lead to a characteristic swollen neck and throat, or "bull neck." This can make it hard for the person to breathe properly.
If the disease affects the skin, it can cause pus-filled blisters on the legs, feet and hands, as well as large ulcers surrounded by red, sore-looking skin.
Diphtheria is thought to be rare in Europe and the UK, with cases falling steadily since the 1950s after the introduction of vaccines.
Between 2009 and 2020, an average of 21 cases were reported each year in Europe.
But "a marked shift occurred in 2022", as 320 cases - two of them probable - were detected in European countries, the ECDC wrote in recent report.
"Similar trends" were also reported in the UK, according to the health watchdog.
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Urgent warning to parents over dangerous ways to cool kids off in the garden"Ten European countries were affected by this outbreak, with Germany, Austria, the UK, Switzerland and France reporting the highest case numbers," the ECDC said.
The outbreak was "mainly linked to groups of migrants who had recently arrived in Europe" and been exposed to diphtheria on their journey, it added.
What is Rat Lungworm (Angiostrongylus) Disease-Since then, the number of diphtheria cases in Europe has "consistently declined", but the ECDC warned that infections were still being reported - especially among vulnerable people.
A total of 165 cases were flagged to the ECDC in 2023, 56 in 2024 and 13 so far into 2025.
"Published data and recent personal communications indicate that after the 2022 outbreak, Corynebacterium diphtheriae continued to circulate in at least five EU/EEA countries and in Switzerland," the health watchdog said.
"A significant proportion of these cases has been among people more vulnerable to diphtheria," it added.
These include people experiencing homelessness, people living, working or volunteering in transitional housing centres, migrants, and those who use and inject drugs.
Bruno Ciancio, head of ECDC's unit for directly-transmitted and vaccine-preventable diseases, said: "The fact that we see diphtheria infections acquired by vulnerable populations in the EU/EEA indicates ongoing unnoticed transmission in the community.
"This is a cause for concern, and calls for more intense efforts to address barriers to vaccination among these vulnerable groups.
"Effective vaccination programmes have helped to almost eliminate diphtheria, but this also means that healthcare workers may be less likely to recognise the symptoms.
"Increasing awareness of symptoms, quick diagnosis and prompt public health action are essential."
Diphtheria symptoms
Symptoms usually start two to five days after becoming infected.
Symptoms of diphtheria include:
In countries with poor hygiene, infection of the skin (cutaneous diphtheria) is more common.
If it's cutaneous diphtheria, it can cause:
You should get urgent medical help if you have the above symptoms.
Source: NHS
The ECDC noted the risk of catching diphtheria remained low for the general population, thanks to high vaccination coverage in most European countries.
But for vulnerable people, it upped the risk to moderate.
"There could be sporadic cases among groups more vulnerable to infection and pockets of unvaccinated individuals," the health watchdog said.
It added that Germany in particular had "reported an increase in diphtheria cases with respiratory presentation, raising concerns about more severe clinical manifestations, and possibly wider community spread".
In places with high vaccines coverage, most diphtheria infections don't cause symptoms or are mild.
But respiratory diphtheria - when the infections affects the nose and throat - can kill up to 10 per cent of its victims, the ECDC said.
Diphtheria is mostly spread by coughs, sneezing or close contact.
You can, however, also get it from sharing items such as cups, clothing or bedding with an infected person.
In the UK, babies and children have been routinely vaccinated against diphtheria since the 1940s.
A case of the highly contagious disease was spotted in a UK primary school in 2023.
In 2022, 87 people in England were infected with the disease. This fell to 27 in 2023.
What You Need To Know About Legionnaires' Disease
An air-conditioning unit sits atop a building at Lincoln Hospital in the Bronx borough of New York City in 2015. Heavy-duty rooftop air-conditioning equipment was suspected of releasing bacteria-laden mist and causing a deadly outbreak of legionnaires' disease. (Seth Wenig/The Associated Press - image credit)
Legionnaires' disease is in the headlines this week after public health officials in southwestern Ontario declared an outbreak of the severe respiratory illness.
What is legionnaires' disease?
Legionnaires' disease is a respiratory infection caused by the Legionella bacteria.
Early symptoms include fever, chills and a dry cough.
It can lead to a serious chest infection or pneumonia, with symptoms that may include high fever. The symptoms usually develop days after being exposed to the bacteria — and can be fatal.
The name of the disease comes from an outbreak of pneumonia that killed 29 people at an American Legion Convention in Philadelphia in 1976.
How does it spread?
Legionella bacteria live in various sources of water — both natural and man-made.
People can get infected after inhaling water droplets contaminated with the bacteria. That might be through breathing in droplets, or mist released to the air from things like cooling towers, hot tubs or plumbing systems.
Legionnaires' disease cannot be spread from one person to another, the Public Health Agency of Canada (PHAC) said.
Cooling towers, a component of industrial air-conditioning equipment, can be a good environment for the bacteria to grow, and these towers can release large quantities of water droplets into the air.
Since a cooling tower emits evaporated air, it could create conditions for water droplets contaminated with bacteria to be sent into the air and spread by wind, control experts say.
Legionella bacteria live in various sources of water. (The Canadian Press)
This is why they are often linked to outbreaks of legionnaires' disease, PHAC said.
Outbreaks occur more frequently during periods of warm weather, researchers have found.
Risk factors for developing legionnaires' disease include being older than 40 years of age, smoking, alcohol consumption, chronic lung disease, chronic kidney disease, diabetes, being immunocompromised and recent travel.
Is it a severe disease?
The infection can lead to pneumonia, with symptoms that may include high fever and chills.
Sometimes there can be gastrointestinal symptoms.
"By the time they come to the hospital, they're already very short of breath," said Dr. Zaki Ahmed, chief of staff at Toronto's Humber River Hospital and a critical care physician who has treated legionnaires' disease.
"They're having some chest pains, they're having nausea, vomiting. They may or may not have confusion," he said.
Because it's a rare disease, the mortality rates are difficult to estimate, Ahmed said.
How is it treated?
When patients come to the hospital with pneumonia, the antibiotics that doctors commonly prescribe typically kill Legionella, said Dr. Isaac Bogoch, an infectious diseases specialist based out of the University Health Network's Toronto General Hospital.
But the antibiotics won't be enough in some severe cases, he said.
"It's not just the infection, it's also the inflammatory response following the infection," Bogoch said.
In the most severe cases, multiple parts of the lungs can be impacted by the disease, and some people with the infection will need to be treated in the intensive care unit, he said.
What about prevention?
Public Services and Procurement Canada notes that Legionella bacteria can proliferate in building water systems under certain conditions:
Overall, the risk of getting legionnaires' disease is generally quite low, PHAC said.
"In your home, you can reduce the risks through proper maintenance of all mist-producing devices, such as shower heads, hot tubs, whirlpool bathtubs and humidifiers," the federal health agency suggests. "Make sure you clean and disinfect these devices regularly according to manufacturer directions."
But bigger buildings often use water as a cooling source, Humber River's Ahmed said. As they do, the cooling units aerosolize that water into the air, which we then inhale, he said.
Why is it so widespread in London, Ont.?
On Tuesday, health officials in London, Ont., said one person died and more than 40 people became ill in the city.
The Middlesex-London Health Unit, which declared an outbreak of legionnaires' disease, said the bulk of cases were reported within the last week.
Most of the people with the severe respiratory illness live or work on the southeast side of the city, officials said.
WATCHPinpointing outbreak source in London, Ont.:
Investigators are trying to pinpoint the source of the outbreak, but they need to analyze environmental samples of many types of cooling systems.
"I know this is what most people are anxious to understand, is where it is coming from. So are we. Unfortunately, we don't yet have a location," said Dr. Joanne Kearon, associate medical officer of health at the Middlesex-London Health Unit.
In 2024, the city also had an outbreak of legionnaires' disease that led to two deaths and 30 infections. Public health authorities weren't able to find the source of that outbreak, Kearon said.
"The outbreak came to a natural end at the end of the summer, which is very often when cooling systems would be turned off. So it was something we were hypothesizing ... May return. And that's unfortunately what we have seen," she said.
It's not known whether the same location is affected in the current outbreak, the health unit said.
Public Health Ontario said Legionella bacteria are "ubiquitous" in the environment and most cases in the province are sporadic.
Between 2018 and 2023, PHAC reported about 620 confirmed cases each year on average.
What's happened in previous outbreaks in Canada?
In 2012, an outbreak of legionnaires' disease in Quebec City caused 14 deaths and made about 200 people sick. Health authorities confirmed that an air-conditioning unit at the top of an office building in Quebec City was the origin of the bacteria. The building was owned by the Centrale des syndicats du Québec.
In response, the Quebec government introduced new regulations for the operation and maintenance of cooling towers, such as a registry and a certified control plan for each tower.
In New Brunswick, public health officials also recommended a cooling tower registry and associated rules to stem outbreaks.
A long-term care home in Toronto's east end was linked to 23 deaths in 2005.
That outbreak was traced back to water droplets from a cooling tower on the roof of the nursing home, city officials said at the time.
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