Bacterial meningitis: warning signs, emergency treatment and recovery

Meningitis means inflammation of the meninges, the membranes surrounding the brain and spinal cord. NHS inform explains that it is usually caused by a viral or bacterial infection, that viral meningitis is the most common and least serious type, and that bacterial meningitis is rare but can be very serious if it is not treated quickly. It can also cause septicaemia, a life-threatening form of blood poisoning, and result in permanent damage to the brain or nerves.

The UK Health Security Agency describes meningococcal disease as a systemic bacterial infection caused by Neisseria meningitidis, which fits with the way the infection can affect the blood as well as the lining of the brain. Meningitis Now emphasises that meningitis and septicaemia can happen together and that someone can get worse very quickly.

The NHS says symptoms develop suddenly. In people of any age they can include high temperature, very cold hands and feet, a stiff neck, joint and muscle pain, a severe headache that is getting worse, eye pain in bright light, seizures, vomiting and diarrhoea, confusion, being very sleepy or hard to wake, and spots or a rash that does not fade under a glass. Meningitis Now adds fever with cold hands and feet and severe muscle pain to its list of common signs, and says symptoms can appear in any order and some may not appear at all.

The NHS lists extra signs in babies and children under 5: not wanting to feed, a high-pitched unusual cry, a stiff body or floppiness, unresponsiveness and a bulging soft spot on the top of the head. It gives temperature thresholds for babies: 38C or more in a baby under 3 months, or 39C or more at 3 to 6 months, and also lists a very low temperature, under 36C, or feeling cold to the touch.

The rash is a late and unreliable sign. It usually begins as small red pinpricks, then spreads quickly and turns into red or purple blotches. On brown or black skin the NHS advises checking paler areas, such as the palms of the hands, soles of the feet, roof of the mouth, whites of the eyes or inside the eyelids. Meningitis Now's message is not to wait for a rash: if someone is ill and getting worse, trust your instincts and get medical help immediately.

The NHS puts it plainly: you need medical help immediately if you think you or your child might have meningitis. For an adult or a child aged 5 or over it lists a very painful headache, confusion or slurred speech, a stiff neck with dislike of bright light, a rash that does not fade, a first seizure and a very high or very low temperature as reasons to call 999 or go to A&E, as well as any symptoms you are worried might be meningitis. Do not drive yourself to A&E.

NHS inform adds a second tier: phone 111 or contact your GP practice urgently if you have symptoms that could be meningitis but are not sure they are serious, or if you think you have been exposed to someone with meningitis. If you have had advice but still feel worried, or symptoms worsen, get help again.

NHS inform lists meningococcal bacteria (types A, B, C, W, X, Y and Z), pneumococcal bacteria and Haemophilus influenzae type b (Hib) among the causes. The NHS says these germs spread through close contact: spit, for example through kissing or sharing drinks or vapes, and prolonged close contact such as living in the same home. NHS inform lists coughing, sneezing, sharing cutlery or toothbrushes and close contact as ways of spreading.

Often the infection is passed on by people who carry the bacteria in the nose or throat without being ill. Meningitis Now says one in four 15 to 19 year olds carry the bacteria in the back of the throat, compared with one in ten of the UK population, which puts that age group at greater risk. The NHS says meningitis is more common in babies and young children, teenagers and young adults, older people and people with a weakened immune system, and that it is possible to get it more than once.

NHS inform says people with suspected meningitis usually need tests in hospital. These may include a physical examination, blood tests to look for infection, a lumbar puncture in which a sample of spinal fluid is checked for bacteria or viruses, and a CT scan to look for problems such as brain swelling. Treatment with antibiotics usually starts before the diagnosis is confirmed and is stopped later if tests show a virus is responsible.

The NHS says bacterial meningitis needs hospital treatment, usually for at least a week, and may involve antibiotics, fluids and oxygen through a face mask. NHS inform adds that steroid medication may be used in some cases to reduce swelling around the brain, and that treatment can occasionally last several weeks.

NHS inform says the risk of someone with meningitis spreading it to others is generally low. If someone is thought to be at high risk, a precautionary dose of antibiotics may be given. This may include people in prolonged close contact, such as those living in the same house, pupils sharing a dormitory, university students sharing a hall of residence and a partner. People who had only brief contact will not usually need antibiotics. Public health teams make these decisions, so anyone told they are a close contact should follow that advice.

Most people make a full recovery from meningitis, but NHS inform says it can sometimes cause serious long-term problems. The NHS lists hearing or vision loss, seizures, problems with movement and co-ordination and difficulties with memory and concentration after bacterial meningitis. NHS inform adds learning and behavioural difficulties, bone and joint problems, kidney problems and, sometimes, amputation to stop infection spreading and remove damaged tissue.

NHS inform says people who have had meningitis will usually have a hearing test after a few weeks. After discharge it may take time to feel back to normal, and further treatment and support may be needed if there are complications. The NHS points to Meningitis Now and the Meningitis Research Foundation for support.

The NHS says vaccines are among the safest and most effective ways to protect against meningitis. Children and teenagers are offered vaccines against the main causes as part of the NHS schedule, including MenB, MenACWY, pneumococcal, 6-in-1 and MMRV. No vaccine covers every cause, so symptoms must still be taken seriously in vaccinated people. See the meningococcal vaccination guide on this site for the programme in more detail.