Author: Azara Singh, MBBS, MD – Charleston Area Medical Center, Charleston, WV
Reviewed: March 2023
SUMMARY
Meningitis and encephalitis are two conditions that affect the central nervous system. The central nervous system is made up of:
- The brain
- The spinal cord
Membranes surround the brain and spinal cord. These membranes are called the meninges. The meninges have three layers. From the outside in, these layers are:
- The dura mater
- The arachnoid mater
- The pia mater
Meningitis occurs when these membranes or meninges become inflamed or infected.
Encephalitis occurs when the brain tissue becomes inflamed, infected, or swollen.
Both conditions can be caused by a virus or bacteria.
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Disorder Overview
DESCRIPTION
Meningitis is when the meninges become infected. The meninges are membranes. They cover the brain and spinal cord.
There are two main types of meningitis:
- Viral meningitis
- Bacterial meningitis
Encephalitis is when the brain becomes inflamed.
There are also two types of encephalitis:
- Viral encephalitis
- Bacterial encephalitis
Some types of meningitis and encephalitis are mild. Some types are severe. These types can be life-threatening. They need to be identified and treated urgently.
SIGNS AND SYMPTOMS
Common symptoms and signs of meningitis are:
- Headache
- Stiffness at the back of the neck
- Sensitivity to bright lights
- Vomiting and nausea
- Being less active than usual
- Lethargy (sleepiness and difficulty waking up)
Common symptoms and signs of encephalitis are:
In babies under one year, and especially newborns, additional signs of meningitis and encephalitis can be:
- Increased fussiness
- Poor feeding
- Sleeping much more than usual
- Difficulty waking
- Bulging soft spot
CAUSES
Meningitis and encephalitis can be caused by:
- Viruses
- Bacteria
Some children have a higher risk. These include:
- Newborns
- Children who have not received all their childhood vaccines
- Children with a compromised immune system
Infections in other parts of the body can spread to the brain. When this happens, it can cause meningitis and encephalitis. Some examples of these infections are:
- Untreated ear infections
- Long-standing sinus infections
- Infections in the blood stream
Viral cases are caused by a particular virus. However, this virus is not always identified.
In bacterial cases, the type of bacteria can usually be found. However, it is not always found. This is particularly true when a person has taken antibiotics before tests are performed.
LABORATORY INVESTIGATIONS
Meningitis is diagnosed by testing cerebrospinal fluid (CSF). CSF is a clear fluid that surrounds:
- The brain
- The spinal cord
The doctor will take a sample of CSF. This is done with a procedure called a lumbar puncture. A thin needle is inserted into the lower back. CSF is extracted. A child may need some sedation in order to lay still for this procedure. This is a very important test. It ensures that the right treatments are chosen.
Scans that take images of the brain may help in diagnosis. These may include:
- Magnetic resonance imaging (MRI) scans
- Computerized tomography (CT) scans
When they are performed for meningitis or encephalitis, these scans are usually done with contrast. Contrast lights up the areas of infection on the scan. This makes them easier to identify.
TREATMENT AND THERAPIES
Antibiotics and Antivirals
Treatment for meningitis and encephalitis varies. It depends on the cause of infection. It can be caused by a virus or bacteria.
Antibiotics are used to treat bacterial meningitis. Antibiotics are not effective in viral cases.
It is helpful to identify which bacteria caused the infection. This allows the doctor to use specific antibiotics. Sometimes, the exact cause cannot be found. In this case, the doctor may use “broad-spectrum” antibiotics. These work against many different types of bacteria.
For some viruses, medications called antivirals are used. These are not available for all viruses.
Other Treatments
For all types of meningitis and encephalitis, other treatments can help the patient feel more comfortable. These treatments include:
- Medications to treat severe headache
- IV fluids, if a patient is unable to eat or drink properly
- Medication to prevent vomiting
It is important that both conditions are treated as early as possible. Otherwise, the infection can damage the brain. This is particularly true for bacterial meningitis.
Duration of Treatment
Treatment usually lasts for ten to fourteen days. Rare forms (such as meningitis with tuberculosis) may need antibiotics for several months.
OUTLOOK
Prognosis
Many children with meningitis or encephalitis recover completely. This is especially true if treatment starts very early.
Prognosis usually depends on:
- The age of the patient
- The severity of the infection
- The cause of the infection
- How early the disease was diagnosed
- Whether infection was limited to the meninges or if it affected the brain tissue
In newborns, these conditions can be harder to treat. Long-term brain damage may occur (but not always). If the disease is diagnosed and treated early, the outlook is usually very good.
Long-Term Effects
Rarely, in some types of encephalitis, children may have long-term effects. These effects last even after the infection has cleared.
Long-term effects may include:
- Delays in development (including speech, motor, hearing, and vision)
- Difficulty with learning
- Difficulty with memory
- Difficulty with attention
- Mood changes
When these occur, they are usually addressed with therapy. Types of therapy that are useful may include:
- Physical therapy
- Occupational therapy
- Speech and language therapy
- Behavioral therapy
RELATED DISORDERS
Autoimmune encephalitis is caused by a problem with the immune system. It can cause symptoms that look similar to:
- Viral encephalitis
- Bacterial encephalitis
A healthy immune system can tell the difference between:
- The body’s own cells.
- Foreign cells. Such cells include bacteria and viruses.
In autoimmune disease, the immune system loses this ability. It then attacks the body’s own cells. Sometimes, these cells are in the brain. Sometimes, they are in the spinal cord.
Autoimmune encephalitis is diagnosed in a similar way. Diagnosis is made with:
- CSF testing. A sample of CSF is taken through a lumbar puncture.
- Brain scans.
Autoimmune encephalitis is treated differently. Steroids and other immune treatments are often used.
Resources
Meningitis Research Foundation
Meningitis Research Foundation (MRF) is a leading UK, Irish and international charity that brings together people and expertise to defeat meningitis and septicaemia wherever it exists. MRF plays a key role in funding vital research, advocating for change as a dedicated champion for those it affects, and taking action that benefits people. In addition, MRF runs awareness campaigns, works with health policy leads and practitioners, and provides support and information. The Confederation of Meningitis Organizations (CoMO) works within MRF and coordinates 110 members in 51 countries, including organizations and individuals dedicated to defeating meningitis. You can look up CoMO member organizations specific to your country or region with the links provided for: Europe, the Americas, Asia Pacific, and Africa.
Encephalitis Society
The Encephalitis Society is an organization based in the UK which supports people who have been affected by encephalitis, family members, and those professionals involved in their care worldwide. Their mission is to build better futures by driving research, accelerating awareness, and saving lives. The ES provides support and information for encephalitis in children and young people , connects people with similar experience and organizes in-person and virtual meetings and events.
Encephalitis 411 Encephalitis411’s mission is to improve the quality of life for those impacted by encephalitis through research, awareness, and advocacy. They provide books, articles, videos, and events, some of which pertain to the children and teens with encephalitis. Encephalitis411 also hosts a private Facebook group, Encephalitis Global, with over 3,000 members.
Family Stories
Anencephaly.info shares over one hundred stories of the lives of infants with anencephaly.
Find out what meningitis feels like, looks like, and what it’s like to survive meningitis with the Meningitis Research Foundation’s Book of Experience. Read the lived experiences of those directly impacted by meningitis and septicaemia, through illness, bereavement loss, and disability. Stories can be selected by age, disease, and outcome.
The Encephalitis Society welcomes stories from anyone impacted by encephalitis. Their Your Stories page helps to raise awareness of encephalitis among the general public and encourage and inspire others whose lives are only just beginning after encephalitis.
Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF.
Research
These are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.
ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.
Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.
For more information about participation in clinical trials, check out our education hub on the topic here.
Information for research and clinical trials specific to Meningitis can be found on the Meningitis Research Foundation website.
Information for research and clinical trials specific to Encephalitis can be found on the Encephalitis Society and Encephalitis411 websites.
The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only. CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options.
References
Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis. 2010 Jan;10(1):32-42. https://doi.org/10.1016/S1473-3099(09)70306-8. PMID: 20129147.
Fraley CE, Pettersson DR, Nolt D. Encephalitis in Previously Healthy Children. Pediatr Rev. 2021 Feb;42(2):68-77. https://doi.org/10.1542/pir.2018-0175. PMID: 33526572.
Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018 Apr;42(3):168-175. https://doi.org/10.1053/j.semperi.2018.02.004. Epub 2018 Mar 12. PMID: 29544668.