Meningitis is a swelling of the membranes of the brain and spinal cord. It can be due to viral, fungal, or bacterial infection.

The most common cause of meningitis is a viral infection. But bacterial meningitis is one of the most dangerous forms of the disease.

Symptoms generally occur within 1 week after exposure and include:

  • fever
  • feeling ill
  • headache

Not everyone develops every symptom. But they may develop a distinctive skin rash. In this article, we take a closer look at what that skin rash may look like, as well as other notable symptoms.

See a doctor if you think you or a loved one may have developed meningitis. This infection can be life threatening.

A meningitis skin rash is a distinct symptom of this serious illness. However, a skin rash doesn’t always appear in the early stages of meningitis, and when it does, it starts as small pinpricks on the skin before spreading into larger blotches.

Large, dark or purple rashes may indicate a related bloodstream infection called septicemia.

In these images, we show how an early meningitis skin rash begins and what it looks like as the illness progresses.

A meningitis rash may look similar to other skin rashes. However, what sets a meningitis-related rash apart from other skin symptoms is the presence of other symptoms, such as fever and stiff neck.

The glass test

One sign of meningococcal septicemia is that the rash doesn’t fade when you apply pressure to the skin. You can test this by pressing the side of a clear drinking glass against the skin.

If the rash looks like it fades, check periodically for changes. If you can still see the spots clearly through the glass, it may be a sign of septicemia, especially if you also have a fever.

The glass test is a good tool, but it’s not always accurate. Meningitis is a life threatening illness so it’s important to get medical attention if you have any symptoms.

Other causes of skin rashes that appear like pinpricks or large, bruise-like blotches may include:

  • Petechial rash. This leads to pinpoints in skin that look like tiny bruises. They’re typically less than 2 millimeters in size. Petechiae may develop on the skin or in mucous membranes from a variety of diseases, including meningitis, leukemia, and idiopathic thrombocytopenia (ITP).
  • Vasculitis skin rashes. These rashes can cause petechiae or larger bruises. This rash may also cause itchy hives. Vasculitis is caused by an inflammation in the blood vessels and may also lead to other symptoms, such as fever, fatigue, and muscle pain.
  • Purpura. These lesions may look like bruises but are larger than petechiae. Purpura rashes may be caused by a variety of conditions, such as vascular, platelet, and coagulation disorders.
  • Hives (urticaria). These pale or dark and often itchy welts are common and may result from allergies, infections, and vascular diseases.

The symptoms of a meningitis infection in children are similar to those in adults. In addition to a possible rash, here’s what you might see during the early and later stages of this illness in children.

Early warning signs

Meningococcal bacteria reproduce in the bloodstream and release poisons (septicemia). As the infection progresses, blood vessels can become damaged.

This can cause a faint skin rash that looks like tiny pinpricks. The spots may be pink, red, or purple. In the early stages, these symptoms may be dismissed as a scratch or mild bruising. The skin may simply look blotchy and can appear anywhere on the body.

In addition to a meningitis rash, other symptoms of a meningococcal infection may include:

  • fever
  • a stiff neck
  • nausea or vomiting
  • confusion
  • sensitivity to light (photophobia)

A worsening rash

As the infection spreads, the rash becomes more obvious. More bleeding under the skin may cause the spots to turn dark red or deep purple. The rash may resemble large bruises.

It’s harder to see the rash on darker skin. If you suspect meningitis, check lighter areas like the palms, eyelids, and inside the mouth.

Also, not everyone with meningitis develops a rash.

Tissue damage as the rash spreads

As the condition advances, the rash spreads and continues to darken. Blood vessel damage causes blood pressure and circulation to fall.

Because the limbs are at the far reaches of the circulatory system, a system-wide decrease in blood pressure leads to inadequate oxygen delivery, especially in the limbs. This can injure tissue and lead to permanent scarring.

Plastic surgery and skin grafting may be able to improve function after the illness passes. In severe cases, it becomes necessary to amputate fingers, toes, arms, or legs. Rehabilitative services may be helpful in those cases, but recovery could take years.

Anyone can get meningitis, but infants and children are at particular risk because they may not have fully developed immune systems, especially if they come in close contact with other children who have meningitis.

While the symptoms of meningitis are similar to those in adults, this infection may cause different symptoms in infants. Rather than causing the more classic symptoms, babies who have meningitis may display the following.

Abnormal arching in head, neck, and spine

Neck pain and stiffness are common symptoms of meningitis. It can sometimes cause the head, neck, and spine to become rigid and arch backward (opisthotonos). Infants may also exhibit widespread body stiffness and have jerky, or floppy movements.

Skin rash

Early in the course of infection, infants’ skin sometimes develops a yellow, blue, or pale tone. Like adults, they may also develop blotchy skin or a pinprick rash.

As the infection progresses, the rash grows and darkens. Lesions or blood blisters may form. The infection can spread quickly.

Seek medical attention if your infant has a fever with a rash.

Bulging fontanel

Another sign of meningitis concerns the soft spot on top of a baby’s head (fontanel). A soft spot that feels tight or forms a bulge could be a sign of swelling in the brain.

Always contact your doctor if you see bumps or bulges on your infant’s head. Meningitis can be a very serious illness even if your baby doesn’t develop septicemia.

Other symptoms in infants

In addition to the above symptoms, other signs of meningitis seen in infants may include:

  • breathing difficulties
  • rapid breathing
  • extreme drowsiness
  • diarrhea
  • extreme shivering
  • crying or irritability when being picked up due to pain
  • cold hands and feet
  • refusing to eat
  • vomiting

If your baby exhibits any of these symptoms, it’s important to seek emergency medical help right away. A meningitis infection may spread quickly, and prompt treatment reduces the risk of complications.

Meningitis symptoms in adults are largely the same as those in children.

In addition to the most common symptoms of meningitis, you should look out for signs of septicemia. Seek emergency medical help if you also experience:

  • rash that gets larger
  • a fever accompanied by cold hands and feet
  • severe muscle pain
  • vomiting
  • severe headache
  • extreme drowsiness
  • confusion and irritability
  • severe stiff neck
  • convulsions or seizures

Meningitis can happen at any age, but infants, children, and young adults are at a higher risk, as well as older adults. The disease is also more likely to spread in areas of close quarters, such as day care centers, nursing homes, and college dorms.

Additionally, having certain medical conditions like HIV may increase your risk of developing a meningitis infection, due to a weakened immune system. Chemotherapy treatments and immunosuppressants may also increase your risk.

Infants younger than 1 month old are also more likely to experience severe illness from an underdeveloped immune system.

Vaccines can help prevent some, but not all, types of meningitis. Early diagnosis and treatment can help you avoid complications and potential long-term effects.

While early diagnosis and treatment can help you avoid complications and potential long-term effects, vaccination may also help prevent certain types of meningitis.

Currently, vaccines are available for bacterial meningococcal disease, the most serious type of meningitis. This is a two-dose series, typically administered around age 11 or 12, and then at the age of 16. These vaccines help prevent Neisseria meningitidis bacteria from causing meningitis.

There’s currently no vaccine to help prevent viral meningitis infections. However, the Centers for Disease Control and Prevention (CDC) outlines other types of routine vaccinations may offer some protection against viral meningitis, including those for chickenpox, influenza, and measles.

Besides vaccines, you can help prevent contracting the virus or bacteria that causes meningitis by washing your hands often, regularly disinfecting common surfaces, and avoiding others who may be sick.

It’s also important to prevent the spread of this illness to others. If you or your child are sick, stay home until your doctor says it’s OK to go back to work or school.

Vaccine recommendations

Children ages 11 or 12 should receive a meningococcal vaccine (MenACWY) vaccine, followed by a booster dose at age 16.

Vaccination is also recommended for teens ages 13 to 18 who did not receive this vaccine when they were younger. Talk with your child’s pediatrician about their recommendations for your child. Children who are at increased risk due to certain medical conditions may need additional boosters.

If you’re unsure whether you received a meningococcal vaccine as a child, talk with your doctor. You may still be able to get vaccinated as an adult to protect yourself against this serious illness.

A meningitis rash is a serious sign that a meningitis infection has developed and possibly spread. This distinct rash may start as small pinpricks but rapidly develop into larger blotches over your entire body. The appearance of the rash is similar across all age groups.

However, not everyone with meningitis experiences a rash. This is why it’s important to pay attention to other possible symptoms of meningitis, such as fever, headache, stiff neck, and photosensitivity.

Infants may also have bulging soft spots on their heads, along with unexplained fussiness and floppy movements.

If you suspect that you or your child has meningitis, seek emergency medical care right away.