What Is a Meningitis Rash? This Symptom Can Signal a Medical Emergency, Doctors Say

Bleeding under the skin that produces a blotchy or pinprick-like rash may signal a serious bacterial infection.

If you notice a strange rash that looks like pink or purple pinpricks on your body, don't ignore it. A rash can be a telltale symptom of bacterial meningitis, a potentially life-threatening condition. The disease happens when certain bacteria infect your cerebrospinal fluid and cause severe swelling in a group of membranes known as the "meninges," which protect the brain and spinal cord.

"It causes a very severe inflammation in and around the brain," Frank Esper, MD, pediatric infectious disease specialist at Cleveland Clinic Children's Hospital, tells Health. "And anytime you are messing with the brain, it's a bad, bad problem."

Still, a rash can be caused by a number of things, including less serious health conditions, allergic reactions to skincare products, heat, and bug bites. How can you tell if you actually have a meningitis rash?

Hint: A drinking glass can help. Here's how to use it to distinguish a meningitis rash from other types of rashes, along with symptoms of meningitis to be aware of.

What does a meningitis rash look like?

Meningitis rashes can be tricky to identify because they can look different from person to person. The UK-based Meningitis Research Foundation describes two different types of meningitis rashes: the "petechial" rash, which appears as red or purple pinpricks that can look like flea bites, and the "purpuric" rash, which looks more like a bruise and shows up as reddish-purple blotches on the skin.

Meningitis-Rash-embed-2-Petechiae due to meningococcal disease
DermNet NZ

While a meningitis rash can show up anywhere on your body, it often starts on the arms, legs, or trunk, according to the National Organization for Rare Disorders (NORD). The colored spots may also appear scattered in clusters where pressure occurs (like around the waistband of your underwear or your socks), the Meningitis Research Foundation points out.

It's also worth noting that the so-called meningitis rash isn't really a rash, but rather, bleeding spots under the skin. This happens when a pathogen (usually Meningococcal bacteria) enters the bloodstream and damages blood vessels and organs, according to the Meningitis Research Foundation.

If a meningitis rash spreads quickly, it could be a sign of a severe case that requires emergency care. As the infection progresses, a person's blood vessels can leak, leading the body to produce "an overwhelming clotting response," per the foundation. That can cause the hands, feet, and other body parts to be starved of oxygen, leading to severe scarring and a potential need for amputation.

Meningitis-Rash-embed-meningo-close__WatermarkedWyJXYXRlcm1hcmtlZCJd
DermNet NZ

How to tell if a rash is meningitis

One way you can potentially tell if you have a meningitis rash is with the "tumbler test," according to the Meningitis Research Foundation. Also known as the "glass test," it involves pressing a clear glass tumbler (like the kind you probably have in your kitchen cabinet) firmly against the rash.

"If it doesn't fade [and] you can still see the rash through the glass, then that would be considered a medical emergency, and you should get that person to the hospital as soon as you can," Claire Wright, evidence and policy manager at the foundation, tells Health.

Rashes that disappear when pressed are considered "blanching" rashes. The meningitis rash starts this way, but almost always evolves into a "non-blanching" rash, per the foundation.

That said, even though the meningitis rash is one of the "clearest and most important signs" of meningococcal septicemia (a bloodstream infection from the bacteria that also causes meningitis), per the foundation, it can appear differently on different skin types. And, in some cases, a person with the disease never gets a meningitis rash, which is why it's important to be aware of other symptoms and seek medical care if someone is suspected of having meningitis.

What is bacterial meningitis?

Knowing more about bacterial meningitis can help you understand why addressing symptoms right away is so important.

Bacterial meningitis is caused when bacteria get into the bloodstream and then travel to the brain or spinal cord, causing the meninges to become inflamed. According to the Centers for Disease Control and Prevention (CDC), the bacteria that cause meningitis can be transmitted in a variety of ways, including from mother to infants during birth, through spit (such as when kissing or coughing), or consuming food prepared by someone who didn't wash their hands properly after going to the bathroom.

Bacterial meningitis is considered more dangerous than viral meningitis, which is more common and often clears up on its own without treatment, notes the CDC. Bacterial meningitis, on the other hand, can progress quickly and become deadly in as little as a few hours. Those who recover may be left with long-term disabilities, including hearing loss, brain damage, and learning disabilities, the CDC points out.

While there are many types of bacteria that can cause meningitis, three types are responsible for the majority of cases, according to the NORD, including Haemophilus influenzae (type b), Streptococcus pneumoniae (pneumococcus), and Neisseria meningitidis (meningococcus). It's that last one—meningococcus—that tends to cause the meningitis rash, according to the Meningitis Research Foundation. And it is known to spread rapidly and cause severe symptoms.

"Meningococcus is probably the one that keeps most physicians up at night," says Dr. Esper.

According to the CDC, about one in 10 people carries the meningococcal bacteria in their nose or throat without getting sick. But they can still spread the bacteria to others through close contact or respiratory secretions, resulting in infection.

According to Boston Children's Hospital, approximately 3,000 people in the US, or one in 100,000, are diagnosed with bacterial meningitis every year. The risk tends to be highest among infants, children, and seniors, as well as college students.

"When all the students get together and they're living in close quarters, going partying, it increases [transmission] rates," Wright tells Health.

Anyone is susceptible to bacterial meningitis, however, and should seek immediate medical attention if they're experiencing symptoms.

What-Is-a-Meningitis-Rash-GettyImages-925863720
Getty Images

What are the symptoms of bacterial meningitis?

A rash is just one of a number of symptoms caused by bacterial meningitis. In the early stages, symptoms of bacterial meningitis can mimic those of the flu before rapidly becoming severe, sometimes within hours of onset.

"People who have meningitis all come with similar symptoms," says Dr. Esper. "You have a tremendous headache, the light bothers your eyes, sounds bother your ears, because your brain is just so agitated that any stimulus just really causes pain."

According to the CDC, bacterial meningitis can also cause:

  • Fever
  • Headache
  • Stiff neck
  • Nausea and/or vomiting
  • Confusion

Bacterial meningitis symptoms can differ among newborns and babies, though. For infants, the CDC suggests looking for symptoms like:

  • Moving slowly or being inactive
  • Irritability
  • Vomiting
  • Low appetite
  • Bulging in the "soft spot" (fontanelle) of their head
  • Abnormal reflexes

Wright says that certain types of bacterial meningitis can also cause sepsis. "Sepsis is where the bacteria are into the bloodstream, and they're replicating in the bloodstream, and causing damage," she explains.

That damage comes as a result of toxins released by the bacteria, which can weaken the capillaries, or blood vessels, allowing blood to seep out, leading to the meningitis rash.

How to prevent bacterial meningitis

The best way to prevent bacterial meningitis is to get vaccinated, according to the CDC. Vaccines are available for some of the deadliest types of bacterial meningitis, including pneumococcal, Haemophilus influenzae b (Hib), and meningococcal.

"The most important thing you can do is get the vaccines that are available," explains Wright.

While meningitis vaccines offer strong protection, no vaccine (for meningitis or any other disease) works 100% of the time, the CDC warns. It recommends practicing other healthy habits to protect yourself and others from bacterial meningitis, including:

  • Keeping physical distance from people who are sick
  • Avoiding cigarette smoke
  • Getting adequate sleep
  • Washing your hands properly
  • Using a tissue to cover your mouth and nose when coughing or sneezing

According to the National Meningitis Foundation, between 600 and 1,000 people contract meningococcal disease each year. Of those who get it, 10-15% will die, and one in five who survive will live with permanent disabilities including brain damage, hearing loss, or amputations—hence why it's worth taking steps to prevent the spread of bacterial meningitis.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

Was this page helpful?
Related Articles