Meningitis In Infants And Children

The central nervous system (CNS), consists of the brain and spinal cord. Three layers of fibrous tissue cover the surfaces of the brain and spinal cord. These layers cushion and protect the CNS. Sometimes organisms, such as bacteria or viruses, can infect these layers.

When this happens, the body takes steps to defend itself from infection. White blood cells and other infection-fighting substances pour into the cerebrospinal fluid (CSF), the fluid that circulates within the brain and over its surface. This process results in a series of symptoms known as meningitis.

Meningitis may cause the following symptoms in infants and children:

• bulging of the soft spot on top of a child's head in children younger than 2 years old
• decreased alertness or level of consciousness
• fever
• headache
• irritability
• loss of appetite
• nausea and vomiting
• neck stiffness
• seizures
• sensitivity to light
• sometimes in infants, a temperature that is lower than normal

Meningitis can be caused by a number of different organisms, including:

• bacteria, such as Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae
• organisms similar to bacteria, such as mycobacteria that cause tuberculosis
• viruses, such as Herpes simplex or enteroviruses

Some of the risk factors for meningitis in children include:

• chronic diseases, such as diabetes or sickle cell anemia
• conditions that weaken the immune system, such as cancer or HIV
• day care, preschool, or other large gatherings of children
• head injury
• infections that involve the face and sinuses, such as cellulitis or sinusitis
• poor or crowded conditions
• septic arthritis
• severe illness in newborns
• viral illnesses, such as measles, mumps, or rubella

Meningitis can be caused by a number of different organisms, including:

• bacteria, such asand
• organisms similar to bacteria, such as mycobacteria that cause tuberculosis
• viruses, such as

Following are some of the risk factors for meningitis in children:

• chronic diseases, such as diabetes or sickle cell anemia
• conditions that weaken the immune system, such as cancer or HIV
• day care, preschool, or other large gatherings of children
• head injury
• infections that involve the face and sinuses, such as cellulitis or sinusitis
• poor or crowded conditions
• septic arthritis
• severe illness in newborns
• viral illnesses, such as measles, mumps, or rubella

Routine childhood immunizations are the first line of defense against meningitis. These include the Hib, PCV, polio, and MMR vaccines. A vaccine against meningococcal meningitis is available for children over 2 years of age with medical conditions that place them at high risk for this infection.

Breastfeeding may provide some protection to infants. When there is an outbreak of meningitis caused by certain bacteria, children may be given antibiotics, such as rifampin, to prevent meningitis. Parents should call their child's healthcare professional if the child has been exposed to someone with this condition.

Diagnosis of meningitis begins with a medical history and physical exam. The healthcare professional may order blood tests. A spinal tap usually will be done to obtain a sample of cerebrospinal fluid. A sample of CSF is taken by placing a hollow needle through the skin in the middle of the lower back. The needle is advanced into the spine, where the CSF surrounds the spinal cord. A small sample of CSF fluid is withdrawn and sent to the lab for study.

Bacterial meningitis is quite serious, with a relatively high death rate, especially in newborns. Long-term problems from the disease are common.

Half the newborns who survive the illness will have serious long-term effects, including:

• behavior problems
• deafness
• hydrocephalus, an increase in CSF on the brain
• learning disabilities
• mental retardation
• paralysis
• seizures
• vision loss

Herpes virus meningitis is also a severe condition. The more common types of viral meningitis are less severe, but can be painful and frightening, especially until bacterial meningitis has been ruled out.

A person with meningitis is often contagious and may spread the infection to other children or adults. Parents should call their child's healthcare professional if the child has been exposed to anyone who develops meningitis.

The primary treatment for bacterial meningitis is antibiotic therapy, which is often given through an intravenous, or IV, line. One or more of the following antibiotics may be given:

• ampicillin (i.e.,Principen)
• cefotaxime (i.e., Claforan)
• ceftazidime (i.e., Fortaz, Tazicef)
• ceftriaxone (i.e., Rocephin)
• chloramphenicol (i.e., Chloromycetin)
• gentamicin
• vancomycin (i.e., Vancocin)
• tobramycin (i.e., Tobrex)

Other treatments, such as the following, may be given:

• acetaminophen (i.e., Tylenol) to reduce fever
• corticosteroids, such as dexamethasone (i.e., Decadron), to reduce inflammation
• intravenous fluids to prevent or treat dehydration
• medicines to stop seizures if they occur

The length of treatment depends on the cause of the meningitis and the age of the child. Treatment generally lasts from 1 to 3 weeks.

Antibiotics may cause allergic reactions, kidney damage, or liver damage. Corticosteroids may increase the risk of bleeding in the gut or worsen the infection. Medicines to stop seizures may cause low blood pressure or allergic reactions.

A child may feel weak and tired for several weeks after the meningitis goes away. It may take weeks or months for normal brain function to return in children who went into a coma during the illness. Some children may have permanent brain damage. This can cause deafness or problems in school or later in life. Children who survive very serious meningitis may have severe mental retardation.

The child will have checkups for years after the illness to look for problems with vision, hearing, or movement. Mental functioning is also monitored to detect mental retardation or learning disabilities. Any new or worsening symptoms should be reported to the healthcare professional.