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Meningitis

What is meningitis?

  • Meningitis is an inflammation and swelling of the tissues that cover the brain and spinal cord.
  • Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF), the fluid that protects and cushions the brain and spinal cord.
  • Many of the bacteria or viruses that can cause meningitis are common causes of other everyday illnesses. However, sometimes they spread through the bloodstream to the CSF from an infection in another part of the body.
  • In some cases of bacterial meningitis, the bacteria spread directly to the CSF from a nearby infection, such as a serious ear infection or severe sinus infection.
  • Meningitis occurs in people of all ages but is relatively common in infants and young children. Teenagers and college students are also more at risk for the infection because of time spent in close contact with many of their peers.

 

What is the difference between bacterial and viral meningitis?

  • Bacterial meningitis is less common than viral meningitis (also called aseptic meningitis) but is usually much more serious and can be life-threatening if not treated promptly.
  • For bacterial meningitis, it is important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people.
  • Haemophilus influenzae type b (Hib) use to be the leading cause of bacterial meningitis a vaccine was made and given to all children as part of their routine immunizations.
  • Today, Streptococcus pneumoniae (also known as pneumococcus) and Neisseria meningitidis (which causes meningococcal meningitis) are the leading causes of bacterial meningitis.
  • Viral meningitis is more common than but less serious than bacterial meningitis. It may go undiagnosed because its symptoms are similar to those of the common flu.
  • About 90% of cases of viral meningitis are caused by members of a group of viruses known as enteroviruses, such as coxsackievirus.

 

How long will it take my child to become ill after being exposed to someone else with meningitis?

  • Once a person is infected with enterovirus it usually takes between 3 and 6 days before they develop symptoms.
  • Once a person is infected with Streptococcus pneumoniae or Neisseria meningitidis it is usually takes less than 4 days before they develop symptoms.

What are the signs and symptoms of meningitis in a child?

  • The signs and symptoms of meningitis depend on factors such as the age of the child and the type of germ causing the infection.
  • The signs and symptoms of viral meningitis are usually milder than those of bacterial meningitis.
  • The first signs and symptoms of meningitis may be noticeable several days after a child has had a routine illness such as diarrhea and vomiting or a cold.
  • Signs and symptoms in newborns or infants may include:o  fever
    o  sleeping more than usual
    o  irritability
    o  poor feeding/weak suck
    o  high-pitched cry or inconsolable crying
    o  bulging fontanelle (soft spot on an infants head)
    o  seizures
  • Signs and symptoms in children older than one year:o  fever
    o  nausea and vomiting 
    o  headache 
    o  confusion
    o  irritability
    o  lethargy
    o  neck and/or back pain
    o  neck stiffness
    o  photophobia (eyes sensitive to light)
    o  seizures

What are the possible complications of meningitis in a child?

  • Complications, if any, depends on the childs age, the germ causing the infection, any other complications, and the promptness and type of treatment the child receives.
  • The complications of bacterial meningitis can be severe and include neurological problems such as visual impairment, hearing loss, and seizures.
  • Although some children develop long-lasting neurological problems from bacterial meningitis, most who receive prompt diagnosis and treatment recover fully.
  • The majority of cases of viral meningitis resolve with no complications.

How can meningitis be diagnosed?

  • Early diagnosis and treatment are crucial.
  • Bacteria meningitis is diagnosed by growing bacteria from a sample of cerebral spinal fluid (CSF). CSF is the fluid that bathes your childs brain and spinal cord.
  • CSF is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal is easy to get to.
  • The doctor performing the spinal tap will explain the procedure to you in detail including a few potential risks, such as bleeding or infection at the needle site.
  • If the sample of CSF does not grow a bacterial germ then the case of meningitis is considered to be from a virus.
  • Identification of the type of bacteria responsible is important so that the best antibiotic can be used to treat the child.
  • If your child is very ill, a spinal tap may not be done right away and treatment with antibiotics for possible meningitis may be started immediately.

What is the treatment for meningitis?

  • Treatment for bacterial meningitis involves intravenous (IV) antibiotics.
  • The child may be started on antibiotics before the results of the spinal tap are available.
  • The child will be hospitalized and closely monitored.
  • Treatment for viral meningitis is usually given to relieve the symptoms and most children recover on their own without treatment.
  • Treatment should include plenty of rest and fluids and acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) can be used to relieve fever and headache.
  • The herpes simplex virus is the only virus that requires a specific medication.
  • A child who has viral meningitis may also be hospitalized depending on the severity of their symptoms.
  • A child with meningitis may be given steroids to help reduce inflammation of the meninges, depending on the cause of the disease.
  • A 2005 study published in Archives of Disease in Childhood showed improved outcome in children with pneumococcal meningitis who were given dexamethasone, a steroid, along with antibiotics.

How long will my child be sick with meningitis?

  • This will depend on many factors including the type of germ involved, the age of the child and any complications that may develop.

Is meningitis contagious?

  • Meningitis can be spread by a person who has meningitis or, more likely, spread by a person who has a common infection (e.g., pneumonia or gastroenteritis) caused by the same germ.
  • The germs that can cause meningitis can be spread from person to person through tiny drops of fluid from the throat and nose of someone who is infected (through coughing or sneezing) OR can be spread through contact with a persons infected stool.
  • Sharing eating utensils, drinking glasses and tissues may spread infection as well.
  • Neisseria meningitidis can spread between two persons who have had close or prolonged contact (e.g., same household, day-care center).
  • People who are considered close contacts of a person with meningitis caused by Neisseria meningitidis should receive antibiotics to prevent them from getting the disease.
  • Fortunately, just because someone becomes infected with a particular germ does not automatically mean that person will get meningitis.
  • In most cases, the germ will just cause a “routine” respiratory or gastrointestinal infection.
  • In some cases, people may carry a germ that can cause meningitis without becoming ill; however, they can still spread the germ to others.

When can my child return to daycare or school?

  • For meningitis caused by Neisseria meningitides, infected children are not considered contagious after 24 hours of appropriate antibiotic therapy and pose no risk to classmates after discharge from the hospital.
  • For viral meningitis, it will depend on how quickly your child’s symptoms go away, especially their fever

When should I call my pediatrician?

  • It is best to call for specific instructions when your child first develops any signs and symptoms that may indicate your child has meningitis.

How can meningitis be prevented?

  • Good hygiene is an important way to prevent infection. Click on preventing infections for more details.
  • In cases of meningococcal meningitis or meningitis due to Haemophilus influenzae type b (Hib), doctors may decide to give antibiotics to anyone who has been in close contact with the person who is ill to help prevent additional cases.
  • Routine immunization against the following germs is one of the most important steps in preventing meningitis:

1.Haemophilus influenzae type b (Hib)

2.Streptococcus pneumoniae (pneumococcus)

- pneumococcal conjugate vaccine (Prevnar) is recommended
for all children 2 to 23 months and for children aged 24 – 59
months with weak immune systems (e.g., sickle cell disease).

- immunization with this vaccine has led to an important decline
in meningitis from Streptococcus in children 2 to 23 months.
3.Measles

4.Mumps

5.Neisseria meningitidis (meningococcus)

- in early 2005 a new vaccine was licensed which is recommended
for all children aged 11 to 12, children entering high school,
college freshman living in dormitories, and children with immune
disorders.