BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuGram-negative meningitisMeningitis is present when the membranes covering the brain and spinal cord become swollen and inflamed. This covering is called the meninges.MeningitisMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.ImageRead Article Now Book Mark Article Bacteria are one type of germ that may cause meningitis. Gram-negative bacteria are a type of bacteria that behave in a similar manner in the body. They are called gram-negative because they turn pink when tested in the laboratory with a special stain called Gram stain. Causes Acute bacterial meningitis can be caused by different Gram-negative bacteria including meningococcus and H influenzae.MeningococcusMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges. Bacteria are one type of germ ...ImageRead Article Now Book Mark Article H influenzaeMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges. Bacteria are one type of germ ...ImageRead Article Now Book Mark Article This article covers Gram-negative meningitis caused by the following bacteria:Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Serratia marcescensGram-negative meningitis is more common in infants than adults. But it can also occur in adults, especially those with one or more risk factors. Risk factors in adults and children include:Infection (especially in the abdomen or urinary tract) Recent brain surgery Recent injury to the head Spinal abnormalities Spinal fluid shunt placement after brain surgery ShuntVentriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus)....ImageRead Article Now Book Mark Article Urinary tract abnormalities Urinary tract infection Urinary tract infectionA urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...ImageRead Article Now Book Mark Article Weakened immune system Symptoms Symptoms usually come on quickly, and may include: Fever and chills Mental status changes Mental status changesConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...ImageRead Article Now Book Mark Article Nausea and vomiting Sensitivity to light (photophobia) PhotophobiaPhotophobia is eye discomfort in bright light.ImageRead Article Now Book Mark Article Severe headache Stiff neck (meningismus) Symptoms of a bladder, kidney, intestine, or lung infectionOther symptoms that can occur with this disease:Agitation Bulging fontanelles in infants Bulging fontanellesA bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).ImageRead Article Now Book Mark Article Decreased consciousness Poor feeding or irritability in children Rapid breathing Unusual posture, with the head and neck arched backwards (opisthotonos)OpisthotonosOpisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with thei...Read Article Now Book Mark Article Exams and Tests The health care provider will perform a physical exam. Questions will focus on symptoms and possible exposure to someone who might have the same symptoms, such as a stiff neck and fever.If the provider thinks meningitis is possible, a lumbar puncture (spinal tap) will likely be done to remove a sample of spinal fluid for testing.Spinal tapCerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...ImageRead Article Now Book Mark Article Other tests that may be done include:Blood culture Blood cultureA blood culture is a laboratory test to check for bacteria or other germs in a blood sample.ImageRead Article Now Book Mark Article Chest x-ray Chest x-rayA chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.ImageRead Article Now Book Mark Article CT scan of the head CT scan of the headA head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.ImageRead Article Now Book Mark Article Gram stain or, other special stains, and culture of the spinal fluid Treatment Antibiotics will be started as soon as possible. Ceftriaxone, ceftazidime, and cefepime are the most commonly used antibiotics for this type of meningitis. Other antibiotics may be given, depending on the type of bacteria. If you have a spinal shunt, it may be removed. Outlook (Prognosis) The earlier treatment is started, the better the outcome.Many people recover completely. But, many people have permanent brain damage or die of this type of meningitis. Young children and adults over age 50 have the higher risk for death. How well you do depends on:Your age How soon treatment is started Your overall health Possible Complications Long-term complications may include:Brain damage Buildup of fluid between the skull and brain (subdural effusion) Subdural effusionA subdural effusion is a collection of cerebrospinal fluid (CSF) trapped between the surface of the brain and the outer lining of the brain (the dura...Read Article Now Book Mark Article Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus) HydrocephalusHydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...ImageRead Article Now Book Mark Article Hearing loss SeizuresSeizuresA seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...ImageRead Article Now Book Mark Article When to Contact a Medical Professional Call 911 or the local emergency number or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: Feeding problems High-pitched cry Irritability Persistent unexplained fever Meningitis can quickly become a life-threatening illness. Prevention Prompt treatment of related infections may reduce the severity and complications of meningitis.Open ReferencesReferencesCenters for Disease Control and Prevention website. Bacterial meningitis. www.cdc.gov/meningitis/bacterial.html. Reviewed July 15, 2021. Accessed November 10, 2022.Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 384.Hasbun R, Van de Beek D, Brouwer MC, Tunkel AR. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 87.AllVideoImagesTogMeninges of the brain - illustration The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.Meninges of the brainillustrationMeninges of the spine - illustration The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.Meninges of the spineillustrationCentral nervous system and peripheral nervous system - illustration The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.Central nervous system and peripheral nervous systemillustrationCSF cell count - illustration CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and brain. A CSF cell count is a test to measure the number of red and white blood cells that are in CSF. CSF cell countillustrationGram stain - illustration A Gram stain is a test used to help identify bacteria. The tested sample can be taken from body fluids that do not normally contain bacteria, such as blood, urine, or cerebrospinal fluid. A sample can also be taken from the site of a suspected infection, such as the throat, lungs, genitals, or skin. Bacteria are classified as either Gram-positive or Gram-negative, based on how they color in reaction with the Gram stain. The Gram stain is colored purple. When combined with the bacteria in a sample, the stain will either stay purple inside the bacteria (Gram-positive), or it will turn pink (Gram-negative). Examples of Gram-positive bacteria include Streptococcus and Staphylococcus aureus, as well as bacteria that cause anthrax, diphtheria, and toxic shock syndrome. Examples of Gram-negative bacteria include Escherichia coli (E coli), Salmonella, Hemophilus influenzae, as well as many bacteria that cause urinary tract infections, pneumonia, or peritonitis. Gram stain can be done within a few hours. The results help providers choose the first antibiotics to use. Cultures of bacteria help identify specific bacteria, but take days to complete.Gram stainillustrationMeninges of the brain - illustration The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.Meninges of the brainillustrationMeninges of the spine - illustration The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.Meninges of the spineillustrationCentral nervous system and peripheral nervous system - illustration The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.Central nervous system and peripheral nervous systemillustrationCSF cell count - illustration CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and brain. A CSF cell count is a test to measure the number of red and white blood cells that are in CSF. CSF cell countillustrationGram stain - illustration A Gram stain is a test used to help identify bacteria. The tested sample can be taken from body fluids that do not normally contain bacteria, such as blood, urine, or cerebrospinal fluid. A sample can also be taken from the site of a suspected infection, such as the throat, lungs, genitals, or skin. Bacteria are classified as either Gram-positive or Gram-negative, based on how they color in reaction with the Gram stain. The Gram stain is colored purple. When combined with the bacteria in a sample, the stain will either stay purple inside the bacteria (Gram-positive), or it will turn pink (Gram-negative). Examples of Gram-positive bacteria include Streptococcus and Staphylococcus aureus, as well as bacteria that cause anthrax, diphtheria, and toxic shock syndrome. Examples of Gram-negative bacteria include Escherichia coli (E coli), Salmonella, Hemophilus influenzae, as well as many bacteria that cause urinary tract infections, pneumonia, or peritonitis. Gram stain can be done within a few hours. The results help providers choose the first antibiotics to use. Cultures of bacteria help identify specific bacteria, but take days to complete.Gram stainillustrationRelated Information Meningitis(Condition)Head injury - first aid(Injury)Ventriculoperitoneal shunting(Surgery)Urinary tract infection - adults(Condition)Shock(Injury)Brain abscess(Condition)Urinary tract infection - InDepth(In-Depth) Review Date: 9/10/2022 Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. 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Gram-negative meningitisMeningitis is present when the membranes covering the brain and spinal cord become swollen and inflamed. This covering is called the meninges.MeningitisMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.ImageRead Article Now Book Mark Article Bacteria are one type of germ that may cause meningitis. Gram-negative bacteria are a type of bacteria that behave in a similar manner in the body. They are called gram-negative because they turn pink when tested in the laboratory with a special stain called Gram stain. Causes Acute bacterial meningitis can be caused by different Gram-negative bacteria including meningococcus and H influenzae.MeningococcusMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges. Bacteria are one type of germ ...ImageRead Article Now Book Mark Article H influenzaeMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges. Bacteria are one type of germ ...ImageRead Article Now Book Mark Article This article covers Gram-negative meningitis caused by the following bacteria:Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Serratia marcescensGram-negative meningitis is more common in infants than adults. But it can also occur in adults, especially those with one or more risk factors. Risk factors in adults and children include:Infection (especially in the abdomen or urinary tract) Recent brain surgery Recent injury to the head Spinal abnormalities Spinal fluid shunt placement after brain surgery ShuntVentriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus)....ImageRead Article Now Book Mark Article Urinary tract abnormalities Urinary tract infection Urinary tract infectionA urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...ImageRead Article Now Book Mark Article Weakened immune system Symptoms Symptoms usually come on quickly, and may include: Fever and chills Mental status changes Mental status changesConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...ImageRead Article Now Book Mark Article Nausea and vomiting Sensitivity to light (photophobia) PhotophobiaPhotophobia is eye discomfort in bright light.ImageRead Article Now Book Mark Article Severe headache Stiff neck (meningismus) Symptoms of a bladder, kidney, intestine, or lung infectionOther symptoms that can occur with this disease:Agitation Bulging fontanelles in infants Bulging fontanellesA bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).ImageRead Article Now Book Mark Article Decreased consciousness Poor feeding or irritability in children Rapid breathing Unusual posture, with the head and neck arched backwards (opisthotonos)OpisthotonosOpisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with thei...Read Article Now Book Mark Article Exams and Tests The health care provider will perform a physical exam. Questions will focus on symptoms and possible exposure to someone who might have the same symptoms, such as a stiff neck and fever.If the provider thinks meningitis is possible, a lumbar puncture (spinal tap) will likely be done to remove a sample of spinal fluid for testing.Spinal tapCerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...ImageRead Article Now Book Mark Article Other tests that may be done include:Blood culture Blood cultureA blood culture is a laboratory test to check for bacteria or other germs in a blood sample.ImageRead Article Now Book Mark Article Chest x-ray Chest x-rayA chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.ImageRead Article Now Book Mark Article CT scan of the head CT scan of the headA head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.ImageRead Article Now Book Mark Article Gram stain or, other special stains, and culture of the spinal fluid Treatment Antibiotics will be started as soon as possible. Ceftriaxone, ceftazidime, and cefepime are the most commonly used antibiotics for this type of meningitis. Other antibiotics may be given, depending on the type of bacteria. If you have a spinal shunt, it may be removed. Outlook (Prognosis) The earlier treatment is started, the better the outcome.Many people recover completely. But, many people have permanent brain damage or die of this type of meningitis. Young children and adults over age 50 have the higher risk for death. How well you do depends on:Your age How soon treatment is started Your overall health Possible Complications Long-term complications may include:Brain damage Buildup of fluid between the skull and brain (subdural effusion) Subdural effusionA subdural effusion is a collection of cerebrospinal fluid (CSF) trapped between the surface of the brain and the outer lining of the brain (the dura...Read Article Now Book Mark Article Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus) HydrocephalusHydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...ImageRead Article Now Book Mark Article Hearing loss SeizuresSeizuresA seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...ImageRead Article Now Book Mark Article When to Contact a Medical Professional Call 911 or the local emergency number or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: Feeding problems High-pitched cry Irritability Persistent unexplained fever Meningitis can quickly become a life-threatening illness. Prevention Prompt treatment of related infections may reduce the severity and complications of meningitis.Open ReferencesReferencesCenters for Disease Control and Prevention website. Bacterial meningitis. www.cdc.gov/meningitis/bacterial.html. Reviewed July 15, 2021. Accessed November 10, 2022.Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 384.Hasbun R, Van de Beek D, Brouwer MC, Tunkel AR. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 87.