Meningitis in Children
What is meningitis?
Meningitis is an inflammation of the membranes that surround the brain and the spinal cord.
What causes meningitis?
Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF) and inflames the meninges. Cerebral spinal fluid (CSF) is the fluid within the open spaces of the brain that protects and cushions the brain and spinal cord. The meninges are the thin membranes lining the brain and spinal cord. A fungus or parasite may also cause meningitis, although these usually happen only in patients who are immunocompromised. The severity of a child's symptoms and prognosis depend on the specific organism that is causing the meningitis. Meningitis can happen in infants, children, and adults. Some bacteria and viruses are more common in certain age groups than others, including the following:
Bacteria that can cause meningitis (bacterial meningitis):In newborns and young babies, the most common bacteria include the following:
Group B streptococcus
Escherichia coli (or E. coli)
In older babies and children, the most common bacteria include the following:
Haemophilus influenzae type b (Hib)
Neisseria meningitidis (meningococcal meningitis)
Other bacterial infections that may cause meningitis include the following:
Viruses that can cause meningitis (viral meningitis):
Enteroviruses (such as coxsackie viruses and echoviruses)
Herpes simplex virus (HSV)
Other microorganisms that can cause meningitis:
Borrelia burgdorferi (Lyme disease)
Fungi such as Candida, Aspergillus, or Cryptococcus neoformans
Meningitis caused by a virus is more common and usually less severe. Bacterial meningitis is usually more severe and may produce long-term complications or death.
How is a meningitis infection transmitted?
The organisms that cause meningitis usually colonize in a person's respiratory tract. They may be transmitted by close contact with people who may be carrying the infection. It is also spread by touching contaminated objects, such as doorknobs, hard surfaces, or toys, and then touching the nose, mouth, or eyes. The organisms may also be transmitted through respiratory secretions from a sneeze, close conversation, kissing, or by touching infected matter. The infection usually starts in the respiratory tract and then travels into the bloodstream where it can reach the brain and spinal cord. The organism may first cause a cold, sinus infection, or ear infection (more common in children), and then travel through the sinuses into the brain and CSF, although this method of transmission is less common. A child may have no symptoms at all, but may carry the organism in his or her nose and throat.
What are the symptoms of meningitis?
The symptoms of meningitis vary depending on the organism that is causing the infection. These are the most common symptoms:
In infants (symptoms may be difficult to pinpoint):
Sleeping more than usual
Cries when picked up or being held
Bulging fontanelle (soft spot on an infant's head)
Noticeably different temperament
A purple-red splotchy rash
In children older than one year:
Neck and/or back pain
Refusing to eat
Decreased level of consciousness
Photophobia (sensitivity to light)
Nausea and vomiting
A purple-red splotchy rash
The symptoms of meningitis may surface several days after your child has had a cold and runny nose, or diarrhea and vomiting. The symptoms of meningitis may look like other problems or medical conditions. Always talk with your child's healthcare provider for a diagnosis.
How is meningitis diagnosed?
In addition to a complete medical history and physical exam, tests for meningitis may include:
Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord. This is the only test that will definitively diagnose meningitis.
Blood testing may be helpful in diagnosing infections that cause meningitis, but alone cannot definitively diagnose meningitis.
Brain imaging studies may include either a CT scan or MRI. A CT scan is sometimes done to rule out other conditions, but can't, by itself, diagnose meningitis. An MRI may show inflammatory changes within the meninges, the lining of the brain. These studies are helpful, but alone cannot definitively diagnose meningitis
What is the treatment for meningitis?
Specific treatment for meningitis will be determined by your child's healthcare provider based on:
Your child's age, overall health, and medical history
Extent of the disease
The organism that is causing the infection
Your child's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the disease
Treatment may include:
Bacterial meningitis. Treatment for bacterial meningitis involves intravenous (IV) antibiotics. The earlier the treatment is started, the better your child's outcome. A corticosteroid, or steroid, such as dexamethasone, is generally given for bacterial meningitis in children. Antibiotics work by killing bacteria; fragments of these dying or dead bacteria may cause inflammation. The steroid works by decreasing the inflammation and reducing pressure that can build up in the brain.
Viral meningitis. Treatment for viral meningitis is usually supportive (aimed at relieving symptoms). With the exception of the herpes simplex virus, which needs IV antiviral medicines, there are no specific medicines to treat the organisms that cause viral meningitis. Most children with viral meningitis recover on their own without treatment.
Fungal meningitis. An intravenous antifungal medicine may be given to the child with fungal meningitis.
Tuberculous (TB) meningitis. A long course (one year) of medicines is recommended for children who develop TB meningitis. The therapy usually involves treatment with several different medicines for the first few months, followed by other medicines.
What is supportive therapy for meningitis?
While your child is recovering from meningitis, other therapies may be initiated to improve healing and comfort and provide relief from symptoms. These may include the following:
Increased fluid intake (this may involve encouraging fluids at home or receiving intravenous fluids in the hospital)
Medicines (to reduce fever and headache)
Supplemental oxygen or mechanical ventilation (respirator) may be required if your child becomes very ill and has difficulty breathing
How can meningitis be prevented?
Several vaccines are currently available to prevent some of the bacterial infections that can cause meningitis, including the following:
H. influenzae type b vaccine is given as a 3- or 4-part series during your child's routine immunizations starting at 2 months.
The American Academy of Pediatrics (AAP) recommends the PCV13 pneumococcal vaccine for all healthy children younger than age 2. PCV13 can be given along with other childhood vaccines and is recommended at the following ages:
12 to 15 months
One dose is also recommended for older children who did not receive the 4-dose series and those at high-risk for pneumococcal disease.
Another pneumococcal vaccine, PPSV23, is also recommended for older children at high risk for pneumococcal disease.
For Neisseria meningitidis (meningococcal meningitis), a meningococcal vaccine is part of the routine immunization schedule for:
Children 11 to 12 years of age (with a booster given at age 16)
Teens entering high school if they were not immunized at age 11 or 12 (with a booster at age 16 to 18, or up to 5 years later)
Infants and younger children at increased risk may also have this vaccine. Ask your child's healthcare provider about the number of doses and when they should be given.
If your child has been exposed to someone with meningitis, or you have questions regarding prevention, please talk with your child's healthcare provider.