Meningitis (inflammation of the meninges)

What is meningitis?

Meningitis is also known colloquially as inflammation of the meninges. The medical term for meninges is “meninges”. The meninges are connective tissue sheaths that surround the brain in the skull. They ensure the stability of the brain and spinal cord, maintain their shape and cushion changes in volume or movements. They are also involved in the metabolism of nerve tissue. Meningoencephalitis refers to the simultaneous inflammation of the meninges and brain tissue (encephalon).

Meningitis is most frequently caused by viruses. Meningitis caused by bacteria is rarer but far more dangerous.

In some cases, meningitis can also occur as a concomitant symptom of other – non-infectious – diseases, for example cancer.

Causes and risk factors for meningitis

There are many causes of meningitis:

Bacterial meningitis (purulent meningitis)

Bacterial meningitis is mainly caused by meningococci (Neisseria meningititis) and pneumococci (Streptococcus pneumoniae). However, Listeria, Haemophilus influenzae, Borrelia, Streptococcus type B and, in newborns, Escherichia coli can also trigger an infection of the meninges. These bacteria often enter the body via the respiratory tract, spread from there and eventually reach the meninges.

Possible bacterial meningitis triggers are:

• Neisseria meningitidis (meningococcus): A causative agent of severe meningitis, especially in children, adolescents and young adults; infection can occur in community settings such as schools and recruit schools.
• Streptococcus pneumoniae (pneumococcus): The most common pathogen causing pneumonia in adults can also trigger meningitis.
• Listeria monocytogenes: This pathogen is found in contaminated food (e.g. raw milk products). It is a common cause of infection in newborns, pregnant women, elderly or immunocompromised people.
• Group B Streptococcus (GBS): These bacteria can be found in the birth canal and can cause meningitis in newborns after birth. Pregnant women are tested for these bacteria and preventive measures are taken if necessary.
• Escherichia coli (E. coli): This intestinal bacterium can cause meningitis, especially in newborns.
• Haemophilus influenzae type b (Hib): This used to be a common pathogen in children. The introduction of vaccination has made this type rare.
• Mycobacterium tuberculosis: This bacterium causes tuberculous meningitis, which is rare in Switzerland.
• Staphylococcus aureus: An infection with this pathogen is rather rare – usually after operations, head injuries or infections in the head area
• Borrelia: Borrelia can be transmitted through a tick bite. Among other things, these bacteria can affect the nervous system. As a result, neuroborreliosis can develop after weeks or months, which is often accompanied by (mild) meningitis.

You can find out more about bacterial infectious diseases here: Bacterial infectious diseases

Viral meningitis

In Switzerland, most people affected by meningitis suffer from a viral infection. It is less severe and spreads mainly through smear infections (fecal, oral), e.g. by touching contaminated surfaces. Viral meningitis is accompanied by flu-like symptoms and usually heals after two to three weeks.

Possible viral meningitis triggers are:

• Enteroviruses (including Coxsackie viruses): These viruses are responsible for diseases such as hand-foot-and-mouth disease.
• Arboviruses: Ticks or mosquitoes transmit these viruses. A particularly common example of meningitis caused by a tick bite is tick-borne encephalitis (TBE). Around 0.5 percent of all ticks in Switzerland are carriers of TBE viruses. The whole of Switzerland, with the exception of the canton of Ticino, is a TBE risk area. There is no effective treatment for tick-borne encephalitis. Vaccination can protect you from the disease. Read here: I’ve been bitten by a tick – what next?
• Varicella zoster virus: This virus triggers chickenpox and can reactivate during the course of the disease and manifest itself as shingles or meningitis.
• Herpes simplex viruses: These viruses can cause various diseases, including cold sores and genital herpes. A new infection or reactivation can also lead to meningitis.

Risk factors for meningitis

In addition to the pathogens mentioned, certain risk factors play a decisive role. The risk factors for meningitis include

• a weakened immune system, e.g. due to diseases that lead to immunodeficiency (after organ transplants, use of immunosuppression for autoimmune diseases, HIV/AIDS)
• close contact with infected people
• Children under the age of five and young adults are among the most vulnerable groups
• inadequate vaccination protection

The triggers have different effects on the course and severity of the disease. The form of treatment also depends on the cause.

Is meningitis contagious?

Meningitis can be contagious, depending on the cause.

• Bacterial meningitis: Some forms of bacterial meningitis, such as meningitis caused by Neisseria meningitidis (meningococcus), are contagious. Transmission occurs through droplet infection, for example when coughing, sneezing or kissing. Smear infection is also possible.
• Viral meningitis: This form of meningitis can also be contagious. Viruses such as enteroviruses, the most common cause of viral meningitis, are transmitted through direct contact with infected persons or contaminated objects.

Symptoms of meningitis: signs and warning signals

With all these symptoms, there is no time to lose – meningitis is a medical emergency and requires immediate medical attention.

The first symptoms of meningitis usually appear after an incubation period of three to four days. Sufferers are already contagious up to seven days before the onset of symptoms. In the case of bacterial meningitis, the risk of infection is eliminated 24 hours after the start of effective antibiotic therapy.

The symptoms of meningitis often appear suddenly and can be unspecific at first. The first sign is often a severe headache that cannot be alleviated even with painkillers. Stiffness in the neck, which makes it difficult to move or turn the head, is also typical. Many sufferers develop a high fever after a short time.

In addition to these classic symptoms, there are other warning signs that may indicate meningitis. Common accompanying symptoms are nausea and vomiting, sensitivity to light and drowsiness. Some patients report confusion or even unconsciousness. The disease often manifests itself differently in infants and small children: they are unusually sleepy, cry loudly and their fontanel (the soft part of the head) is swollen.

Another alarming symptom, especially in meningococcal infections, is a skin rash. This manifests itself in small, punctiform hemorrhages that become visible under the skin.

Symptoms of meningitis: When to see a doctor?

Meningitis symptoms often occur suddenly and can be severe. The most common symptoms include

Common symptoms Meningitis:

• severe headaches
• Stiff neck
• High fever
• Fatigue, tiredness

Rarer symptoms Meningitis:

• Nausea and vomiting
• Light sensitivity
• Confusion
• in infants: shrill crying, drowsiness, swollen fontanel
• Unconsciousness
• epileptic seizures

If you experience one or more of these symptoms, you should seek medical advice immediately.

Meningitis: examinations and diagnosis

Quick action is required if meningitis is suspected. Immediately consult your family doctor, a pediatrician (for children) or the emergency room of a hospital. Early diagnosis and treatment of meningitis can be life-saving under certain circumstances. First of all, it must be clarified whether the disease is of bacterial or viral origin, as the treatment depends on this.

The first step is a thorough physical examination. The doctor looks for typical signs such as neck stiffness or skin changes. Neurological tests, for example to check reflexes, can also provide initial indications.

The most important diagnostic measure is the lumbar puncture. The doctor takes a sample of the cerebrospinal fluid (CSF). This fluid provides information on whether an inflammation is present and which pathogen is responsible. Blood cultures will also be taken to detect the bacteria directly in the blood.

Imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) help to detect complications such as brain swelling.

Treating meningitis: acting quickly saves lives

The treatment of meningitis depends on its cause. Immediate treatment is crucial for the bacterial form. Patients are usually admitted as inpatients and receive high doses of antibiotics directly into the vein. These specifically attack the bacteria and prevent the infection from progressing. Corticosteroids can also be administered to reduce the swelling in the brain caused by the inflammation.

Viral meningitis, on the other hand, is usually milder and often heals on its own. Treatment here concentrates on alleviating the symptoms. Painkillers, antipyretic medication and sufficient fluid intake are the most important measures here. Antiviral therapy is only possible in rare cases, for example in the case of herpes viruses.

Sometimes additional treatments are necessary to avoid complications. These include medication to control seizures or measures to reduce intracranial pressure. In severe cases, close monitoring in the intensive care unit may be necessary.

Meningitis: prevention and early detection

The best remedy against meningitis is prevention. Vaccinations play a central role in this. In Switzerland, vaccinations against pneumococci, meningococci and Haemophilus influenzae type B (Hib) are part of the regular vaccination program for children. Since 2024, the meningococcal vaccination against serotype B (Bexsero) has also been recommended. This vaccination should be given to children vaccinated before 2024. Adults at increased risk should also have their vaccination protection checked regularly.

There is a safe and highly effective vaccination to prevent TBE, which is generally recommended for all people aged three and over who are in a risk area (the whole of Switzerland, except the canton of Ticino) and are exposed to ticks

Another important factor is hygiene: regular hand washing, especially after contact with potentially contaminated surfaces, can significantly reduce the risk of infection. People who have had close contact with a meningitis patient should take antibiotics as a precaution to prevent a possible infection. This must be discussed with a doctor beforehand.

Early detection is also important, as prompt treatment determines the course of the disease. Parents should look out for symptoms such as fever, restlessness or changes in behavior in their children. Adults should also be vigilant, especially if they belong to a risk group.

Meningitis prognosis: good chances with timely treatment

Thanks to modern medical advances, the chances of recovery from meningitis are now better than ever. Although bacterial meningitis is a serious disease, most patients survive without permanent damage if diagnosed and treated early. It becomes more difficult if the treatment starts too late. Long-term consequences such as hearing loss, cognitive impairment or epileptic seizures can then occur.

Viral meningitis generally has a good prognosis and in most cases heals without complications. Permanent damage is rare. Nevertheless, it is important to monitor the symptoms closely, even in mild forms, in order to recognize a deterioration at an early stage.