Bacterial vs. Viral meningitis: Knowing the difference between the two is critical

When talking about meningitis, the most important thing to know is that there are two major types — bacterial meningitis and aseptic, or viral, meningitis. Although they are both contagious illnesses that can start off with similar symptoms, bacterial meningitis is much more serious than the viral type and requires immediate treatment. If you or a loved one begin experiencing any of the symptoms associated with meningitis, viral or bacterial, seek medical attention immediately.

The name meningitis comes from the area of the body that is affected by the disease — the meninges. The meninges are the three layers of membranes that cover the central nervous system, including the brain and spinal cord. When an infection in the fluid surrounding the meninges causes inflammation and swelling in these membranes, that’s meningitis.

Viral meningitis is the most common, and thank goodness. The reason I say thank goodness is that even though there is no cure for it, it is by far the least serious form. This type of meningitis can make a person feel pretty awful, similar to having the flu, so it’s no fun — but it’s not typical for it to lead to permanent consequences. Babies and small children may have a fever, poor appetite, irritability and fatigue. Older children and adults can have the same symptoms as well as a stiff neck and photophobia (sensitivity to light). To manage it we offer supportive treatments to help ease the patient’s symptoms while the condition eventually clears up on its own. Even if your symptoms fit this description if you are concerned that it is meningitis seek medical attention immediately.

Bacterial meningitis, on the other hand, is gravely serious and, if not treated quickly, can lead to some very bad outcomes, including death. This form of the disease can be caused by one of many different bacteria; the most common are the same types that cause other conditions like pneumonia and strep throat. These bacteria aren’t inherently dangerous; they are all around us and often live in our bodies without causing harm. The problem occurs when they get in the bloodstream and cause an infection in the central nervous system.

Symptoms can come on much like they do with viral meningitis — feeling feverish, flu-like and with general malaise — but quickly progress in severity and may include nausea, vomiting, more severe photophobia and stiff neck and even altered mental status, confusion and seizures. In babies, you can also check the soft spot on the top of the head, the fontanel, and if it’s bulging or poking upward that can be an indication of increased pressure in the central nervous system.

When this form is suspected, doctors will get patients to the hospital as quickly as possible to start IV antibiotics, and sometimes will start antibiotics even before tests are back if they suspect the patient has meningitis. The reason for such urgency is that, if not treated quickly enough, bacterial meningitis can lead to disastrous and even fatal outcomes. A diagnosis is made when results of a lumbar puncture, also known as a spinal tap, confirm the presence of bacteria in the spinal fluid.

If you’re experiencing symptoms you should see a doctor

Those who survive may suffer from hearing loss, blindness, stroke, brain damage, necrosis and loss of limbs and other serious consequences. So, the symptoms I’ve described are nothing to take lightly — get medical attention for yourself or your child right away.

Both types of meningitis are spread by direct contact with someone who has the virus or bacteria. Tell your kids not to share food or drinks or eating utensils with others, and to wash their hands often. Droplets containing the virus or bacteria can land on surfaces after a sick person coughs or sneezes, just like a cold, so if your child is sick, be extra diligent with hand washing as well as with cleaning surfaces like toys, highchairs and strollers, and dispose of diapers carefully.

The good news is that we’re seeing far fewer patients with the disease these days because of vaccines. These vaccines contain antigens that trigger the body’s immune system to produce protective antibodies, and the vaccines themselves do not make a person sick. There are two vaccines that have helped greatly with reducing incidences of meningococcal disease in the U.S. to a historic low:

The Pneumococcal Conjugate Vaccine (PCV) helps to protect against the type of bacteria 
that often causes ear infections in kids. The reason this is so important is that an infection in the ear, being so close to the brain, can lead to meningitis. This vaccine is given in four doses, typically recommended at 2, 4, 6 and somewhere between 12 and 15 months of age. It’s a singular vaccine but often given at the same time as other early childhood vaccines. A different version of the vaccine is available for adults. The introduction of pneumococcal vaccine has been a major success in reducing the prevalence of this devastating illness, particularly among children.

The Meningococcal Vaccine (MCV4) protects against four different types of meningococcal disease. This vaccine is given around age 11 or 12, with a booster recommended around age 16. Since the MCV4 vaccine was introduced, cases of these types of bacterial meningitis have also dropped dramatically.

Leonard D. Reeves, MD, FAAFP, is a practicing family physician in Rome, GA, and a founder and associate dean of the Northwest Clinical Campus of the Medical College of Georgia at Augusta University. He is a member of the board of directors of the American Academy of Family Physicians as well as a physician and board president at the Faith and Deeds Free Clinic in Rome, and was awarded the Georgia BIO Innovation Award for New Innovation in Medical Education in 2015.