Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It can be caused by bacterial or viral infections. Bacterial meningitis requires urgent treatment to prevent permanent damage. Symptoms may include fever, headache, neck stiffness, and confusion. Diagnosis involves spinal fluid analysis. Treatment involves antibiotics and supportive care. Vaccines exist to prevent some common causes of bacterial meningitis.

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 Meningitis is a term used to describe an
inflammation of the membranes that surround the
brain or the spinal cord.
 Meningitis, especially bacterial meningitis, is a
potentially life-threatening condition that can rapidly
progress to permanent brain damage, neurologic
problems, and even death.
 Doctors need to diagnose and treat meningitis
quickly to prevent or reduce any long-term effects.
 The inflammation causing meningitis is
normally a direct result of either a bacterial
infection or a viral infection. However, the
inflammation can also be caused by more
rare conditions, such as cancer, a drug
reaction, a disease of the immune system or
from other infectious agents such as fungi
(cryptococcal meningitis) or parasites.
 Normally, meningitis causes fever, lethargy,
and a decreased mental status (problems
thinking), but these symptoms are often hard
to detect in young children.
 If the infection or resulting inflammation
progresses past the membranes of the brain
or the spinal cord, then the process is
called encephalitis (inflammation of the
brain).

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 The highest incidence of meningitis is
between birth and 2 years, with the greatest
risk immediately following birth and at 3-8
months of age. Increased exposure to
infections and underlying immune system
problems present at birth increase an infant's
risk of meningitis.
 The focus of this article will be on the common
infectious causes of meningitis as they account for
the large majority of problems; however, less
common causes will be presented.
Causes
 Bacteria and viruses cause the great majority of
meningitis disease in infants and children.
 The most serious occurrences of meningitis are
caused by bacteria; viral-caused meningitis is
common but usually is less severe and, except for
the very rare instance of rabies infection, almost
never lethal.
 However, both bacterial and viral types of the
disease are contagious.
 Meningitis normally occurs as a complication from
an infection in the bloodstream.
 A barrier normally protects the brain from
contamination by the blood. Sometimes, infections

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directly decrease the protective ability of the blood-
brain barrier.
 Other times, infections release substances that
decrease this protective ability.
 Once the blood-brain barrier becomes leaky, a
chain of reactions can occur. Infectious organisms
can invade the fluid surrounding the brain.
 The body tries to fight the infection by increasing
the number of white blood cells (normally a helpful
immune system response), but this can lead to
increased inflammation.
 As the inflammation increases, brain tissue can
start swelling and blood flow to vital areas of the
brain can decrease due to extra pressure on the
blood vessels.
 Meningitis can also be caused by the direct spread
of a nearby severe infection, such as an ear
infection (otitis media) or a nasal sinus
infection(sinusitis). An infection can also occur any
time following direct trauma to the head or after any
type of head surgery.
 Usually, the infections that cause the most
problems are due to bacterial infections.
 Bacterial meningitis can be caused by many
different types of bacteria. Certain age groups
are predisposed to infections of specific types
of bacteria.

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 Immediately after birth, bacteria called
group B Streptococcus, Escherichia
coli, and Listeria species are the most
common.
 After approximately 1 month of age,
bacteria called Streptococcus
pneumoniae, Haemophilus influenzae type
B (Hib), and Neisseria meningitidis are
more frequent. The widespread use of the
Hib vaccine as a routine
childhood immunization has dramatically
decreased the frequency of meningitis
caused by Hib.
 Viral meningitis is much less serious than
bacterial meningitis and frequently remains
undiagnosed because its symptoms are similar
to the common flu. The frequency of viral
meningitis increases slightly in the summer
months because of greater exposure to the
most common viral agents, called
enteroviruses.
Symptoms
 In infants, the signs and symptoms of meningitis are
not always obvious due to the infant's inability to
communicate symptoms.
 Therefore, caregivers (parents, relatives, guardians)
must pay very close attention to the infant's overall
condition.

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 The following is a list of possible symptoms seen in
infants or children with bacterial meningitis
 Classic or common symptoms of meningitis in
infants younger than 3 months of age may include
some of the following:
 Decreased liquid intake/poor feeding
 Vomiting
 Lethargy
 Rash
 Stiff neck
 Increased irritability
 Increased lethargy
 Fever
 Bulging fontanelle (soft spot on the top of the
head)
 Seizure activity
 Hypothermia (low temperature)
 Shock
 Hypotonia (floppiness)
 Hypoglycemia (low blood sugar)
 Jaundice (yellowing of skin)
 Classic symptoms in children older than 1 year of
age are as follows:
 Nausea and vomiting
 Headache
 Increased sensitivity to light
 Fever
 Altered mental status (seems confused or
odd)
 Lethargy

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 Seizure activity
 Coma
 Neck stiffness or neck pain
 Knees automatically brought up toward the
body when the neck is bent forward or pain in
the legs when bent (called Brudzinski sign)
 Inability to straighten the lower legs after the
hips have already been flexed 90 degrees
(called Kernig sign)
 Rash
Diagnosis
 Upon arrival at the emergency department, the
child's temperature, blood pressure, respiratory
rate, pulse, and oxygen in the blood may be
checked.
 After quickly checking the child's airway, breathing,
and circulation, the doctor completely examines the
child to look for a focal source of infection, to
assess any alteration in mental status, and to
determine the presence of meningitis. If meningitis
is suspected, several tests and procedures are
needed to determine the diagnosis.
 The child will usually not need the following tests:
 A spinal tap, or lumbar puncture, is an essential
procedure in which cerebrospinal fluid is obtained from
the child and then analyzed in a laboratory.

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 Cerebrospinal fluid is the fluid surrounding the brain
and spinal cord where the infection in meningitis
occurs.
 Occasionally, a CT of the brain is done before the
spinal tap if other problems are suspected by the
doctor.
 Most clinicians will treat the child
with antibiotics before the spinal tap if bacterial-caused
meningitis is strongly suspected because of the
possibility of a rapid decline in condition of the patient.
 To perform this simple procedure, the doctor
numbs the skin on the child's lower back with
a local anesthetic.
 A needle is then inserted into the lower back
to obtain the necessary fluid from inside the
spinal cord because the fluid bathing the
spinal nerves is essentially the same that
bathes the brain.
 The fluid is sent to a laboratory and is checked
for white and red blood cells, protein, glucose
(sugar), and organisms (bacteria, fungus,
parasites; viruses are not visualized). The fluid
is also sent for culture (cultures may take
about a week for viruses).
 After the needle is removed, a small bandage
is placed on the skin where the needle was
inserted.

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 A spinal tap is not a dangerous procedure for
a child. The needle is inserted at a location
below the end of the main body of the spinal
cord. A spinal tap is a simple procedure that is
necessary to determine if a person has
meningitis. Currently, no other procedure is
available to aid in the diagnosis of meningitis.
 An IV may be started to obtain blood and to give fluids.
This helps prevent dehydration and maintain a good
blood pressure.
 Urine may be obtained to determine if any infection is
present in the child's urinary tract system.
 A chest X-ray film may be taken to look for signs of
infection in the child's lungs.
Treatment
 Because meningitis is a potentially life-threatening
infection, therapy (IV antibiotics) may begin before
all of the tests are performed and prior to having all
of the results available.
 If any indication of respiratory distress is
present, a breathing tube (intubation) may be
needed to provide oxygen to help the child
breathe.
 A heart and breathing monitor is connected to
accurately monitor the child's vital signs
(respiratory rate, oxygen level, heart rate and
rhythm).

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 An IV is started to give fluids and to correct
any dehydration. An IV also helps to maintain
blood pressure and good circulation.
 A tube (catheter) may be placed in the bladder
to obtain urine and to help accurately measure
the child's hydration.
 A child who has bacterial meningitis or is
suspected to have bacterial meningitis is
admitted to the hospital. The type of
monitoring, such as in a pediatric intensive-
care unit, is determined by the doctor in the
emergency department and the doctors who
care for the child in the hospital.
 A child who has viral meningitis and is
improving may be sent home for supportive
therapy. Supportive therapy includes
encouraging fluids to prevent dehydration and
giving acetaminophen (Tylenol)
or ibuprofen(Motrin) for pain and fever. If the
child is sent home, a doctor must check the
child within 24 hours to make certain his or her
condition has improved.
Medications
 Antibiotics may be given early in treatment of
meningitis to help fight the infection as quickly as
possible. The type of antibiotic depends on the
child's age and any known allergies. Antibiotics are
not helpful for viral meningitis.
 Steroids may be given to help minimize
inflammation depending on which organism is
suspected to be causing the infection.

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 More aggressive medications may be necessary
depending on the severity of the child's illness.
 In general, the Infectious Diseases Society
recommends vancomycin plus ceftriaxoneor cefota
xime IV be used; the extent (time span) of
treatment may vary with the bacterial species being
treated. The treatment may vary from about seven
to 21 or more days.
 Fungal or parasitic infections require special drugs
to treat these relatively rare infections and usually
are managed by infectious disease specialists.
 Noninfectious causes of meningitis, which are rare,
are treated according to the underlying problem(s)
such as cancer, drug-induced, or surgical
problems.
Prevention
 Specific vaccines are available to protect and
reduce the chances of developing both the bacterial
and viral types of meningitis.
 The antibacterial vaccines include Hib,
meningococcal, and pneumococcal and the antiviral
vaccines include influenza, varicella, polio, measles,
and mumps.
 Antibiotics are given to all intimate contacts of a
child with meningococcal meningitis, a very specific
type of bacterial meningitis.
 These intimate contacts may include family
members, friends, health-care workers, and even
day-care or nursery contacts.

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 Adults can contract this type of meningitis and
become carriers of these bacteria.
 If adults have been given preventive antibiotics and
then become sick or develop any symptoms, they
need a full medical evaluation.
 Preventive antibiotics are not needed for cases of
viral meningitis or with other types of bacterial
meningitis except for some relatives or caregivers
who are caring for patients with Hib infections.
 Vaccine side effects vary from none to transient
pain or discomfort at the inoculation site. Some
children may develop a mild fever, headache, and
feel tired.
 In most individuals who get these side effects,
Tylenol can reduce the discomfort. These effects
rarely last more than 24 hours.
 Infrequently, some children may develop more
severe allergic reactions.
Reference:-
 Kapitan Pediatrics Book
 GHAI Essential Pediatrics (Eighth Edition)
 Health line ( https://www.healthline.com )
 WebMd ( https://www.webmd.com )
 Mayo Clinic ( https://www.mayclinic.org )
 My Self