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Signs and symptoms of meningitis in pediatrics: Bacterial Meningitis in Children | Boston Children’s Hospital

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Bacterial Meningitis in Children | Boston Children’s Hospital

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Meningitis is an infection that causes inflammation of the three thin layers of tissue, known as meninges, which cover the brain and spinal cord. Meningitis may be caused by a virus or by bacteria.

In general, bacterial meningitis is more dangerous than viral meningitis. Bacterial meningitis may cause permanent damage, including hearing loss, mental retardation, or even death. Approximately 3,000 people in the U.S. or one in 100,000 are diagnosed with bacterial meningitis each year.

Typical treatment includes hospitalization and antibiotics.

What is the difference between bacterial meningitis and viral meningitis?

Symptoms:

  • viral meningitis: fever, headache, stiff neck, sensitivity to light, drowsiness, confusion
  • bacterial meningitis: high fever, severe headache, stiff neck, sensitivity to light, drowsiness, confusion. A rash, nausea, vomiting, and sore throat can also occur.

Effects:

  • viral meningitis: temporary, flu-like symptoms, headache, and stiff neck.
  • bacterial meningitis: possibility of varying degrees of brain damage, including hearing loss and mental retardation. Can be fatal if not treated in time.

Severity:

  • viral meningitis: goes away on its own usually within three to 10 days.
  • bacterial meningitis: life-threatening; medical treatment is needed immediately

Treatment:

  • viral meningitis: bed rest, Tylenol
  • bacterial meningitis: hospitalization and antibiotics

How common is bacterial meningitis?

Approximately 3,000 people in the United States — or one in 100,000 — are diagnosed with bacterial meningitis each year, most of them infants, children, college students, and the elderly. Incidences of bacterial meningitis usually peak in the winter or early spring. People who show symptoms in the summer time are more likely to have viral meningitis rather than bacterial meningitis.

Preventing bacterial meningitis

The most common cause of bacterial meningitis in children, Haemophilus influenzae b (Hib), has been almost eliminated due to a vaccine that was developed at Boston Children’s Hospital in 1990.

  • Before then, approximately 10,000 children were diagnosed with meningitis each year, and 5 percent of them did not survive.
  • The Hib immunization is now a routine childhood vaccination that prevents hundreds of deaths a year.

The rate of another major cause of bacterial meningitis — the pneumococcus bacteria — also has been reduced dramatically by the widespread use of the Prevnar pneumococcal vaccine.

A meningococcal vaccine, specifically for meningococcus bacteria, is recommended for students entering dormitory situations in high school or college. It is effective for three to five years, however, it does not protect against all strains of meningococcus bacteria.

Bacterial Meningitis in Children | Symptoms & Causes

What are the symptoms and warning signs of bacterial meningitis?

Bacterial meningitis usually starts with headache and fever, which are common to many illnesses, making bacterial meningitis difficult to diagnose at this stage.

  • Symptoms more specific to bacterial meningitis include severe headache, pain when bending the neck forward or a stiff neck, and sometimes sensitivity to light.
  • Later symptoms can include confusion, lethargy, or seizures.
  • Symptoms can progress rapidly, and some patients experience delirium or coma by the time they seek treatment.

In infants, the symptoms to be aware of are:

  • fever
  • irritability (fussy and crying a lot)
  • lethargy
  • high-pitched cry
  • arching back
  • crying when moved
  • a bulging fontanelle (the soft spot on an infant’s head)
  • seizures

For children older than 1 year, look for:

  • fever
  • neck or back pain (or stiff neck)
  • headache
  • confusion
  • sensitivity to light
  • refusing to eat
  • decreased level of consciousness
  • seizures
  • nausea and vomiting

It is important to emphasize that children may not display all of the above signs and symptoms. Watchful waiting is not advised; if you suspect meningitis, consult a doctor immediately.

What causes bacterial meningitis?

Many healthy people carry the bacteria in their mouth or throat and never get sick from it, but in rare cases, it breaks through a person’s immune system and travels through the bloodstream — or sometimes through the sinuses — to the brain. The bacteria then infect the protective membranes that cover the brain and spinal cord, causing dangerous swelling and inflammation that is only relieved with antibiotic treatment.

What are the risk factors for bacterial meningitis?

  • having been in close contact with someone who has bacterial meningitis (especially when it’s due to meningococcus, a type of bacteria that is more contagious than others)
  • having a compromised immune system
  • having traveled to an area of the world where meningitis is widespread (consult your doctor for the recommended vaccinations before traveling overseas)

While some forms of bacterial meningitis are contagious, especially meningococcus, none is transmitted as easily as the common cold or the flu. However, bacterial meningitis can be spread through the exchange of respiratory and throat secretions, such as:

  • coughing or sneezing
  • kissing
  • sharing drinks

If someone is in close contact with a person who has bacterial meningitis, such as a roommate, parent, sibling, daycare worker, classmate, or boyfriend or girlfriend, they are at an increased risk and should go to the doctor for antibiotics to prevent bacterial meningitis before symptoms occur.

Bacterial Meningitis in Children | Diagnosis & Treatments

How is bacterial meningitis diagnosed?

If your pediatrician suspects that your child may have meningitis, they will order blood work and may collect spinal fluid to see what is causing the infection. Understanding the specific cause of meningitis will inform the doctor how to treat it.

How is bacterial meningitis treated?

Early treatment of antibiotics can reduce swelling and inflammation in the brain and prevent injury and death. Corticosteroids also may be given to reduce inflammation.

It is important to remember that timing is crucial. If you or your child has symptoms of bacterial meningitis, go to the nearest emergency room right away.

  • If doctors suspect meningitis, they will diagnose it using a spinal tap, blood tests (including blood cultures), and sometimes a CT scan.
  • Because of the small window of time between when swelling in the brain begins and when brain damage occurs, antibiotics are administered — usually intravenously.
  • Antibiotics are typically continued for one to three weeks.
  • Children with bacterial meningitis are admitted to the hospital for treatment and monitoring while awaiting the results of spinal fluid tests, and for doctors to look for a source of the infection, such as a sinus infection.
  • It is also important that doctors find out which type of bacteria has caused the meningitis because some strains of bacteria, such as meningococcus, are more contagious than others.

How we care for bacterial meningitis

Because of the fast and severe nature of bacterial meningitis, Boston Children’s urges all parents to seek treatment immediately once you suspect bacterial meningitis. After admission, doctors will find the specific cause of your child’s meningitis and administer treatment accordingly. The ultimate goal of quick treatment is to make sure your child recovers without any permanent damage.

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Meningitis Signs and Symptoms in Children

Find out meningitis symptoms in children, teenagers and young people here. Meningitis and septicaemia can happen together, and if you are unsure about the condition of your child be sure to seek medical help immediately

DO NOT wait for a rash.  If a child is ill and getting worse, get medical help immediately.

Symptoms of meningitis in children can appear in any order. Some may not appear at all.

Common signs & symptoms of meningitis and septicaemia in children, teenagers and young people.

  • Fever, cold hands and feet

  • Vomiting

  • Drowsy, difficult to wake

  • Confusion and irritability

  • “>

    Severe muscle pain

  • Pale, blotchy skin. Spots/rash
    See the Glass Test

  • Severe headache

  • Stiff neck

  • Dislike bright lights

  • Convulsions/seizures

Early symptoms can include:

Fever, headache, vomiting, muscle pain and fever with cold hands and feet.

Someone with meningitis or septicaemia can get a lot worse very quickly. Keep checking them.

Trust your instincts – Get medical help immediately

Get medical help immediately

Who is at risk?

Everyone is at risk; however, teenagers – particularly first year university students – and young people are the second most at-risk group.

Why are teenagers and young people at risk?
  • Meningococcal bacteria are the most common cause of bacterial meningitis in the UK. One in four 15-19 year olds carry the bacteria in the back of their throats, compared to one in ten of the UK population, which puts them at greater risk
  • The five main groups of meningococcal bacteria that commonly cause disease are groups A, B, C, W and Y
  • You can carry the bacteria without becoming unwell (in most cases it will boost your natural immunity)
  • Meningococcal bacteria are passed from person to person by coughing, sneezing and intimate kissing. Increased social interaction in this age group means the bacteria can be passed on more easily
  • Meningococcal group W (MenW) has historically been rare in the UK, but in 2009, cases began to increase. A particularly aggressive strain of MenW was causing disease in all age groups but there was a significant increase in university students. The MenACWY vaccine was introduced across the UK in August 2015 in response to the rise in MenW cases.
Why are first year university students at risk

  • Students can be more vulnerable to meningitis because of living in more ‘cramped’ housing or halls of residence. In many cases, young people come together from all over the world to live, study and socialise together. They will be exposed to bacteria and viruses their bodies have not met before. This is why so many new students get ‘freshers’ flu’
  • As early symptoms of meningitis can be similar to common illnesses such as flu or even a hangover, it’s easy to mistake meningitis for something else
  • When students go off to university, it is often the first time they are living away from their parents and, more often than not, their own health and well-being is not a priority. With no parents to keep an eye on them, meningitis can be missed

Download more information about meningitis in teenagers and young people.

Find out more about meningitis, as well as the symptoms in this short video:

how it is transmitted, causes, symptoms, signs, consequences, diagnosis, treatment, prevention

Causes

Symptoms

Classification

Complications

Diagnosis

Treatment

Profile aktika

Meningitis is an inflammatory disease that affects the brain and spinal cord. This is a whole group of pathologies, which is divided into two subtypes: pachymeningitis affects the hard shell of the brain, and leptomeningitis – soft and arachnoid. The second option is much more common.

Meningitis can develop as an independent disease, or become a consequence of another disease and proceed in the form of its complications. Pathology is considered one of the most severe and occurs with a threat to the life of the patient.

Causes and triggers

The causes of meningitis are a variety of viruses, bacteria, fungi, protozoa. Meningococcal meningitis is usually caused by the gram-negative bacteria meningococci. Fighting this pathogen is not so easy, since it has a special capsule that protects meningococcus from the effects of drugs.

This acute infectious disease is most often diagnosed in children under 5 years of age. And if earlier it was whole epidemics, today isolated cases are increasingly being diagnosed, which, with proper early diagnosis, can be treated quite well.

The source of the disease is only an infected person with symptoms of the disease or a carrier. If we talk about how meningitis is transmitted, then it happens by airborne droplets. Most often, children who are in groups or adults who are in the same poorly ventilated room during the working day become infected.

Most diagnoses of this type are made in the autumn-winter period. The provocative factors are:

  • sharp fluctuations in outdoor temperature, when frosts are replaced by thaws;
  • high humidity both indoors and outdoors;
  • long stay in one closed room;
  • lack of walks in the fresh air;
  • constant use of public transport;
  • lack of proper hygiene.

In this acute infectious disease, preventive measures are very important. Only they help not to catch meningitis during its growth.

Symptoms

Meningitis in adults occurs mainly in the male population, and in women, pathology is less common. All manifestations of the disease can be divided into several large groups.

The first will include two striking symptoms of meningitis – photophobia and hyperacusis. In the first case, an increase in pain syndrome will be observed in bright light, and in the second case, with a strong sharp sound.

The second group includes intoxication syndrome. The patient has weakness, lethargy and even apathy, a complete breakdown, aches all over the body, lack of appetite, nausea and vomiting.

The third group is all kinds of syndromes that can be detected when examining a patient using percussion or pressure on certain parts of the body. However, only doctors can perform this procedure correctly.

The fourth group of signs of meningitis is tonic muscle tension. This is expressed in the inability to bend the head at the neck and bring the chin to the chest. Also, the patient cannot return the lower limbs to their original position if they are bent at the knees and hips.

Fifth group – decreased abdominal and tendon reflexes.

Meningitis is more common in children than in adults, the disease is more severe and can have many consequences. Children are often unconscious, while they put their hands on their heads and begin to scream loudly. This is due to high intracranial pressure, which brings unbearable suffering to babies.

The meningitis rash is most often found on the legs, rarely on the shoulders, and very rarely on the head. At first, these are ordinary maculopapular papules, which then change their character to hemorrhagic. Other symptoms include fever, fever, unconsciousness, repeated vomiting.

Classification

Since meningitis can be caused by a variety of bacteria, fungi, viruses, and even protozoa, the classification of the disease begins with this important indicator.

Serous meningitis is caused by enteroviruses. Infection most often occurs while swimming in open water or in a public pool, sauna, bath. Ticks can also be carriers of the virus. Most often, the disease is observed in babies aged 3 to 6 years; in adults, this form practically does not occur.

Viral meningitis is a disease that occurs when infected only with Coxsackie and ECHO viruses. They contain RNA, and all serotypes of this virus are pathogenic for humans. In nature, they are very stable, they are transmitted from a sick person to a healthy person by contact-household or airborne droplets.

Bacterial meningitis is an inflammatory disease that develops when various bacteria enter the body. It can be staphylococci, pneumococci, meningococci, Pseudomonas aeruginosa.

According to its course, the disease is divided into acute, subacute and chronic. Separately, fulminant meningitis should be singled out, in which death can occur in just a few hours from the moment the first symptoms appear.

The severity of the disease can be mild, moderate or severe. Also, after suffering inflammation of the meninges, complications can develop, and complete recovery can occur without any consequences.

Complications

Complications after meningitis are not uncommon. They can be divided into early and late. In this case, not only the central nervous system, but also other organs and systems can suffer.

Among the most common consequences of meningitis, doctors identify:

  • swelling or swelling of the brain;
  • pulmonary edema;
  • infectious-toxic shock;
  • kidney failure;
  • acute adrenal insufficiency;
  • myocarditis;
  • arthritis;
  • epilepsy;
  • paralysis;
  • bleeding.

Treatment of all complications requires mandatory placement of the patient in the intensive care unit. Medicines and other medical procedures are prescribed strictly individually.

Diagnosis

The main reliable method for diagnosing any meningitis is a lumbar puncture followed by examination of the cerebrospinal fluid. During the study, the liquid through the needle will flow out under pressure, although normally it should only drip in frequent drops. With serous meningitis, it will be transparent, with purulent – cloudy.

Other research methods are not as important in making an accurate diagnosis, so they are used quite rarely. This is an MRI of the brain or spinal cord, in some cases CT, but only when it is not possible to perform the first option for examining the patient.

Treatment

Treatment of meningitis should be started as early as possible, often with only suspicion of the disease, antibacterial drugs and sulfonamides are prescribed. Therapy is carried out exclusively in a hospital or intensive care unit. At home and in a clinic, this serious infection is not treated.

In addition to antibiotic therapy, drugs for other forms of meningitis may also be prescribed. These are antiviral, anti-tuberculosis, to combat fungal infections of the brain or spinal cord. Antibiotics are powerless against such pathogens. It is important that all drugs used in treatment are administered directly into the bloodstream, and not performed as intramuscular injections. During the treatment period, it is monitored, which is done with the help of a repeated control lumbar puncture.

Symptomatic therapy is prescribed to improve the general condition of the patient and relieve other symptoms of the disease. These can be diuretics, hormonal agents, antioxidants, glucose, drugs for high fever, vascular agents. They are prescribed strictly individually – it all depends on the general condition of the patient and the severity of the inflammatory process in the body.

According to clinical guidelines for meningitis, it is recommended that a patient be discharged from the hospital not after the improvement of the general condition and the absence of symptoms of the disease, but at the moment when his cerebrospinal fluid tests are normal and they do not contain the causative agent of the disease. After discharge from the hospital, the patient is placed under dispensary observation for up to 3 years.

Prevention and prognosis

Disinfection measures are carried out in the focus of infection, and all contacts, even without initial signs of infection, must undergo a full prophylactic course of antibiotics. Cephalosporins are usually the drugs of choice.

Prevention of meningitis includes specific and non-specific interventions. In the first case, all children are recommended to do all the necessary vaccinations according to age. In the second case, it is recommended to lead a healthy lifestyle, regularly strengthen the immune system, take vitamin and mineral complexes twice a year, and follow the rules of personal hygiene.

In case of a severe course of the disease with the development of complications, it is possible to apply for disability. In mild cases, the patient makes a full recovery without any further mental or physical health effects.

The author of the article:

Markelov Gleb Vladimirovich

neurologist, online consultations

work experience 4 years

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