Everyone gets sick from time to time. But sometimes, what we think of as a normal cold or flu might actually be far more dangerous. With flu season fast approaching, it’s important to understand and recognize the difference between normal illness and more serious conditions. If flu-like symptoms come on and escalate quickly, it may mean you or a loved one has actually contracted meningitis. Meningitis is an infection that causes our meninges—the membranes that provide a protective barrier for the brain and spinal cord—to swell. Meningitis is a serious condition that requires immediate attention from a medical professional. It can be life-threatening if left untreated, so it is important to understand the telltale symptoms. When you can spot symptoms early on, you can quickly seek out medical attention that can mitigate the negative effects of the disease.
Understanding the Types of Meningitis
There are a few different types of meningitis, but bacterial and viral meningitis are the two most common. Bacterial meningitis is the most severe form of meningitis and can be fatal, especially if treatment is delayed. There are many types of bacteria that can cause meningitis, including Streptococcus pneumoniae, Group B Streptococcus, and Listeria monocytogenes. Thankfully, the introduction of and increased access to safe and effective vaccines resulted in a steady decrease in bacterial meningitis cases since the 1990s. However, cases that do occur are dangerous and can be fatal if left untreated. Bacterial meningitis is treated with oral or IV antibiotics, and treatment can last between 10 and 21 days, according to Allan Greissman, MD, of Pediatric Critical Care of South Florida. The second most commonly experienced meningitis is viral meningitis. Although there is no vaccine for viral meningitis, you can be vaccinated against some of the viruses that could cause meningitis, like measles, mumps, or influenza. It helps to think of viral meningitis as a potential complication of these other viruses. This means that, although you might catch measles, mumps, or the flu from someone with viral meningitis, that doesn’t necessarily mean you will also develop viral meningitis. “Viral meningitis will run its course and should not [be], and is not, treated with IV antibiotics,” says Greissman. He notes that one exception is a form of viral meningitis caused by the herpes viruses, which is treated with an antiviral medication. Other types of meningitis do exist—fungal, parasitic, and non-infectious—but these are rare when compared to the other two types. The most important thing to understand about the different types of meningitis is that only a spinal fluid culture can provide an accurate diagnosis. “I really would encourage people not to get too focused in terms of trying to differentiate [between types of meningitis],” says Christina Johns, MD, Fellow of the American Academy of Pediatrics and senior medical advisor at PM Pediatrics. “While sometimes they can present differently in terms of time or severity, the symptoms or the typical [experiences] are the same.”
Meningitis Risk Factors
Certain populations are more at risk for developing meningitis than others. Being unvaccinated for meningitis puts you at a higher risk for developing a meningococcal disease, according to Johns. Additionally, being immunosuppressed because of another condition, like HIV, increases the risk of developing infections in general. Age is also a risk factor, with young children, young adults, and older adults at an increased risk for developing the disease. Living in a communal setting, like a boarding school or military base, is another risk factor for developing meningitis. For instance, thanks to the close living quarters of college dorms, there have been recent infectious disease outbreaks on college campuses, as reported by the Centers for Disease Control and Prevention.
Symptoms Everyone Should Know
It may seem that meningitis presents much like less serious or more common illnesses, but there are a few symptoms that set this disease apart. At times, the symptoms can seem subtle, according to Greissman, but they can rapidly escalate, especially in the case of bacterial meningitis. This is why he recommends that any patient presenting with the following symptoms seek immediate medical attention, especially if the patient is an infant who cannot verbally share what they are experiencing.
Because this infection causes inflammation, neck pain (and general muscle soreness) is one of the primary symptoms of meningitis, according to Greissman. Although it might be true that other viral and bacterial illnesses cause neck pain, the neck pain associated with meningitis is on a distinct level. “It’s not just, ‘oh my neck is sore,’ but really, I have likened this clinical picture with people kind of looking like they’re as stiff as a board and moving as a unit,” says Johns. “It really hurts to turn their neck in any direction.” The same inflammation that causes neck and muscle pain also causes meningitis patients to experience extraordinarily intense headaches. These headaches will steadily become more intense and medication often won’t provide notable relief.
Sensitivity to Light
One of the earliest warning signs of meningitis is photophobia. An individual may develop a dislike of or sensitivity to all light, but especially brighter lights. In addition to eye discomfort because of light, individuals experiencing photophobia may develop headaches and nausea. Since photophobia is an early symptom of meningitis, it is certainly worth taking seriously as a cue for seeking medical advice, especially when experienced alongside other symptoms.
Sudden High Fever
A high fever is one symptom of meningitis that is admittedly subtle or easily mistaken for another illness. Even so, it is an important symptom to take seriously, especially in young children. For children too young to communicate that they have a sore neck, are experiencing photosensitivity, or have extreme headaches, a fever is one of the most objective ways to determine if that child needs to see a doctor. Kathy Fray, former midwife, parenting author, and private maternity consultant, says that high fevers of 100 degrees or more in children under six months always warrant medical attention. In children over the age of six months, a fever that persists after a dose of acetaminophen or continues to escalate warrants a medical assessment.
A Persistent Rash
The presence of a distinctive rash is a symptom of a more developed case of meningitis and indicates that the infection has progressed to a dangerous point. The rash that develops is caused by broken blood vessels under the skin, according to Fray, and it is an indication that the individual is now experiencing septicemia, otherwise known as blood poisoning. When the infection has gotten to this point, the rash will appear all over the skin. While many other viruses and infections might come with a rash, the rash associated with meningitis quickly appears and spreads. What differentiates this rash from others is that it is under the skin, not on the surface. The rash may even begin to look more like bruises than hives, according to Healthline. An at-home test using a clear drinking glass can help determine if the rash is on the surface or under the skin. When you push the glass against a typical rash, it actually blanches (meaning the color disappears), explains Fray. In the case of a rash associated with meningitis, it doesn’t blanch, since it is under the skin. The rash may be harder to spot on darker skin tones. To be certain, check paler areas of the body, like the stomach, the palms of hands, or the soles of feet.
Changes in Mental Status
As meningitis escalates, some patients experience changes in mental status or personality. They may become confused or extremely lethargic, according to Johns. “A change in mental status in this situation can usually be described as a decreased level of responsiveness; true lethargy or difficult to arouse,” she says. “It’s much more than ‘sleepier than usual.’” It is also fairly common for meningitis to cause unusual irritability, according to Greissman. Because of the common occurrence of irritability and agitation in young children with meningitis, when this symptom is experience in combination with a high fever it warrants evaluation for meningitis, even when the child does not or cannot report a stiff neck, according to research published in the European Journal of Pediatrics.
Some people who contract meningitis will develop seizures that typically subside quickly after treatment. Seizures associated with meningitis mimic seizures with other causes: The person may stiffen up, experience muscle spasms, or even lose consciousness. What sets a seizure apart in meningitis is the cause, according to Johns. For instance, with epilepsy, seizures are caused by an abnormal electrical impulse within the brain tissues. In meningitis, however, seizures result from the brain being irritated from the infection. If your child or loved one is experiencing a seizure, especially in the presence of other symptoms, seek medical help right away. Until help arrives, roll the person onto their side, place something soft under their head, and stay with them. Do not restrain them or put anything in their mouth, as this could lead to choking.
Rapidly Escalating Symptoms
One final thing that sets meningitis, especially bacterial meningitis, apart from other less-serious illnesses is that it escalates rapidly, according to Greissman. The symptoms above may be confused for another illness at first, but they become dramatically worse over a short period of time.
The most effective form of treatment for bacterial meningitis is following early childhood vaccine protocols. “In the year 2018, given all the vaccines that we now give, bacterial [meningitis] is much less common than 20 years ago,” says Greissman. “We now have vaccines for the pneumococcal bacteria, the meningococcal bacteria, and haemophilus influenzae bacteria.” When it comes to viral meningitis, there aren’t specific prevention protocols since there is no vaccine. Instead, Johns reminds us that preventing the spread of viruses comes back to the basic practices that prevent the spread of any disease. Wash your hands well, avoid touching your face, and stay home from work or school if you don’t feel well. No matter what, it is always a good idea to seek advice and help from a medical professional if you’re uncertain. Because early diagnosis of meningitis is important, recognizing these symptoms in yourself or loved ones can help you catch this illness early and get care and treatment before it becomes dangerous.