Meningitis in Children
Bacterial meningitis in children is an infection affecting the meninges or the tissue layers covering the brain as well as the spinal cord.
- Headache and fever, accompanied by a stiff neck, and sometimes confusion, are the usual symptoms appearing in older children. In younger children and infants, irritability, vomiting and refusal to eat may be only indications.
- Sepsis or bacterial infections in the blood are the usual cause of bacterial meningitis.
- Spinal tap for the cultural analysis of the cerebrospinal fluid and certain blood tests help diagnose meningitis and identify the bacteria causing it.
- Meningitis can be fatal in some cases even with timely intervention and the best medical treatment.
- Vaccination against the bacteria causing meningitis can prevent the disease.
- Antibiotic therapy is the main treatment for bacterial meningitis.
Meningitis may occur at any time. However, the meningitis affecting newborns and very young infants is different from the type of disease occurring in older children and adults.
Children who are without a spleen and those who have sickle cell disease are at increased risk of developing meningitis. Certain congenital defects occurring in the bone structure of the skull and the face may make some children more susceptible to bacterial infection of the meninges or the tissue layers covering the brain. Children who have immune-deficiency while undergoing chemotherapy for cancer, and those who have AIDS, are also highly prone to bacterial meningitis.
Causes
Sepsis or a bacterial infection in the blood is the main cause of meningitis affecting newborn infants. Escherichia coli, Streptococci group B and Listeria monocytogenes are the most common causes of bacterial infections affecting the newborn. The infant usually picks it up at the time of its passage through the mother’s birth canal. Older children can contract the bacterial infection from the respiratory secretions of others who are infected. Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitides, are the bacteria commonly causing meningitis in older children. Development of effective vaccines and their widespread usage against Haemophilus influenzae type b have significantly reduced meningitis due to them. Conjugate vaccines have been developed for Neisseria meningitides as well as Streptococcus pneumoniae, and they should make bacterial meningitis in childhood rare.
Symptoms and Diagnosis
Headache and steadily increasing fever, typically accompanied by a stiff neck, can be the indication of meningitis in children. Confusion is another symptom that may be present. An infection may be present in the upper respiratory tract, but it may not be related to the meningitis. Very young children and infants often stop feeding, and become very irritable especially when held. This is an important indication that should alert the parents of the possibility of meningitis since these infants do not usually develop a stiff neck and they are unable to express their discomfort. Fever may be accompanied by vomiting. A skin rash may appear in some. In about one third of the cases, seizures may occur. Damage to the facial nerves may cause a lopsided facial expression. The nerves which control the eye movements may be damaged too, resulting in one of them turning either outward or inward. Bulging of the fontanelles is another indication of meningitis in newborns. The increased pressure in the brain causes these soft spots present in the skull of infants to expand and become firm to touch. Symptoms appear over one or two days, but in very young infants and newborns the progression can be rapid, and their condition may become extremely critical within the day.
Occasionally, meningitis causes pus-filled pockets in the brain referred to as abscesses. These abscesses can get enlarged and exert pressure on the brain. The head may become enlarged and the fontanelles bulge out. It may result in nausea and vomiting too.
Bacterial meningitis is diagnosed by culturing the cerebrospinal fluid collected by doing a procedure called lumbar puncture or spinal tap. A blood sample is also cultured to check if the bacteria are present in the bloodstream also. An ultrasound scan or a CT scan is also performed to detect any abscesses in the brain.
Prognosis
Bacterial meningitis in newborns has a fatal outcome in one fourth of the cases, even with timely medical intervention. Older children have a better chance of survival, but the rate depends on the type of bacteria causing the disease. With Haemophilus influenzae type b infection, less than 5% of those affected succumb to the disease. Meningitis due to Neisseria meningitides carries a slightly higher fatality rate of up to 10%. Streptococcus pneumoniae is the deadliest, with up to 20 % of those with meningitis caused by these bacteria dying of the disease even with treatment.
Among the survivors, up to 25% suffer permanent brain damage which results in various neurological problems. Deafness, intellectual disabilities, cerebral palsy and mental retardation are some of the conditions precipitated by meningitis. Less severe problems such as mild hearing loss, learning disabilities and seizures may occur in about one third of the cases. The severity of the problems depends on the age of the child to a certain extent, with older children suffering less permanent damage and complications than younger children and infants.
Prevention
Bacterial meningitis can be prevented by vaccinating the infants and young children against Haemophilus influenzae type b as well as Streptococcus pneumoniae. Conjugate vaccines are available against these bacteria. Doctors and other health care providers should educate the parents and encourage them to get the children vaccinated. Neisseria meningitidis polysaccharide may be given to older children to prevent meningitis in them. Conjugate vaccine for Neisseria meningitidis is also available.
Treatment
Intravenous administration of antibiotics in high doses is the first step in the treatment of meningitis. Antibiotic therapy is started as soon as meningitis is suspected. If the child appears very sick, the treatment is initiated with general antibiotics even before performing the spinal tap. The particular bacteria causing the meningitis can be identified by the culture of the spinal fluid. Later, the antibiotics may be changed, and specific antibiotics given, based on the results of the culture. Corticosteroids are often given to children above one and a half months old to protect them from permanent neurologic damage. The spinal tap may be repeated, and the fluid is cultured again, to check if the antibiotic therapy is effective.
Watch this educational Video About Meningitis
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Yasser Elnahas
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