Angelite Nurses

from Pediatrics for Parents .. 

By Belson, Martin MD 

Types of Meningitis Meningitis is an inflammation and swelling of the tissues that cover the brain and spinal cord. It 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. 

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. Haemophilus influenzae type b (Hib) used to be the leading cause of bacterial meningitis but now a vaccine is 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. About 90% of cases of viral meningitis are caused by members of a group of viruses known as enteroviruses, such as coxsackie virus. 

Signs and Symptoms 

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 fever, sleeping more than usual, irritability, poor feeding, inconsolable crying, a bulging fontanel (soft spot on an infant's head) or seizures. Signs and symptoms in children older than one year may include fever, vomiting, headache, confusion, irritability, lethargy, neck and/or back pain, neck stiffness, photophobia (eyes sensitive to light) or seizures. 

Complications 

Complications, if any, depend on the child's 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. 

Diagnosis 

Early diagnosis and treatment are crucial. Bacterial meningitis is diagnosed by growing bacteria from a sample of CSF. Cerebral spinal fluid 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 easily accessed. The doctor performing the spinal tap will explain the procedure 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. 

Treatment 

Treatment for bacterial meningitis involves intravenous (IV) antibiotics and hospitalization. The child may be started on antibiotics before the results of the spinal tap are available. 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. 

A child who has viral meningitis may also be hospitalized depending on the severity of her 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 pneuniococcal meningitis who were given dexamethasone, a steroid, along with antibiotics. 

Contagion 

A person who has meningitis or, more commonly, who has a common infection (e.g., pneumonia or gastroenteritis) caused by the same germ, can spread meningitis. 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 person's 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, daycare center). People who are considered close contacts of a person with meningitis caused by this bacterium 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 some cases, people may carry a germ that can cause meningitis without becoming ill; however, they can still spread the germ to others. 

Prevention 

Good hygiene (i.e. washing hands) is an important way to prevent infection. 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: Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcus), measles, mumps and Neisseria meningitidis (meningococcus). 

For Streptococcus pneumonia, pneuniococcal conjugate vaccine (Prevnar) is recommended for all children two 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 two to 23 months. 

For Neisseria meningitidis (meningococcus), a vaccine was licensed in 2005 and is recommended for all children aged 11 to 12, children entering high school, college freshman living in dormitories, and children with immune disorders. 

Copyright Pediatrics for Parents, Inc. Dec 2008 

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