Meningitis

What is meningitis?

Meningitis is an inflammation of the membranes that surround the brain and the spinal cord.

What causes meningitis?

Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF). Cerebral spinal fluid (CSF) is the fluid within the open spaces of the brain that protect and cushion the brain and spinal cord. A fungus or parasite may also cause meningitis. The severity of a child's symptoms and prognosis depend on the specific organism that is causing the meningitis. Meningitis can occur in infants, children and adults. Some bacteria and viruses are more common in certain age groups than others.

In newborns and young babies, possible bacteria include:

  • Group B streptococcus
  • Escherichia coli (or E. coli)
  • Listeria monocytogenes

In older babies and children, possible bacteria include the following:

  • Haemophilus influenzae type b or H. influenzae
  • Neisseria meningitides (meningococcal meningitis)
  • Streptococcus pneumoniae

Other bacteria that may cause meningitis include:

  • Syphilis
  • Tuberculosis (TB)

Viruses that can cause meningitis (viral meningitis):

  • Polioviruses
  • Enteroviruses (such as coxsackieviruses and echoviruses)
  • Mumps (paramyxovirus)
  • Herpes simplex virus (HSV)

Other microorganisms that can cause meningitis:

  • Borrelia burgdorferi (Lyme disease)
  • Fungi such as candida, aspergillus, or cryptococcus neoformans

Meningitis caused by a virus is more common and usually less severe. Bacterial meningitis is usually more severe and may produce long-term complications or death. 

How is a meningitis infection transmitted?

The organisms that cause meningitis usually colonize in a person's respiratory tract and may be transmitted by close contact with persons who may be carrying the infection, or by touching infected objects such as doorknobs, hard surfaces, or toys and then touching the nose, mouth, or eyes. The organisms may also be transmitted through respiratory secretions from a sneeze, close conversation or by touching infected matter. The infection usually starts in the respiratory tract and then travels into the bloodstream where it can reach the brain and spinal cord. The organism may cause a cold, sinus infection, or ear infection (more common in children), and then travel through the sinuses into the brain and CSF, although this method of transmission is less common. A child may have no symptoms at all, but may carry the organism in his/her nose and throat.

What are the symptoms of meningitis?

The symptoms of meningitis vary depending on the organism that is causing the infection. However, each child may experience symptoms differently.

In infants (symptoms may be difficult to pinpoint):

  • Irritability
  • Fever
  • Sleeping more than usual
  • Poor feeding
  • High-pitched cry
  • Arching back
  • Cries when picked up or being held
  • Inconsolable crying
  • Bulging fontanelle (soft spot on an infant's head)
  • Noticeably different temperament

In children older than one year:

  • Neck and/or back pain
  • Headache
  • Sleepiness
  • Confusion
  • Irritability
  • Fever
  • Refusing to eat
  • Decreased level of consciousness
  • Seizures
  • Photophobia (sensitivity to light)
  • Nausea and vomiting
  • Neck stiffness

The symptoms of meningitis may surface several days after your child has had a cold and runny nose, or diarrhea and vomiting. The symptoms of meningitis may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How is meningitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for meningitis may include:

  • Lumbar puncture (spinal tap)
  • Blood testing
  • Computed tomography scan (Also called a CT scan)

Treatment

Specific treatment for meningitis will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Organism that is causing the infection
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Opinion or preference

Treatment may include:

  • Bacterial meningitis. Treatment for bacterial meningitis usually involves intravenous (IV) antibiotics. The earlier the treatment is initiated, the better your child's outcome. 
    • In addition to antibiotics, dexamethasone (a steroid) may also be given to children over six weeks of age who have acute bacterial meningitis. Dexamethasone helps to decrease the inflammatory response caused by the breaking down of the bacteria, resulting in less fever and a reduction in hearing loss caused by the infection. While the use of dexamethasone has been shown to be more effective in H. influenzae type b meningitis, it may also be considered for use in other types of bacterial meningitis.
  • Viral meningitis. Treatment for viral meningitis is usually supportive (aimed at relieving symptoms). With the exception of the herpes simplex virus, there are no specific medications to treat the organisms that cause viral meningitis. Most children with viral meningitis recover on their own without treatment.
  • Fungal meningitis. An intravenous anti-fungal medication may be administered to the child with fungal meningitis.
  • Tuberculous (TB) meningitis. A long course (one year) of medications is recommended for children who develop TB meningitis. The therapy usually involves treatment with several different medications for the first few months, followed by other medications.

What is supportive therapy for meningitis?

While your child is recovering from meningitis, other therapies may be initiated to improve healing and comfort, and provide relief from symptoms. These may include the following:

  • Bed rest
  • Increased fluid intake (this may involve encouraging fluids at home or receiving intravenous fluids in the hospital)
  • Medications (to reduce fever and headache)
  • Supplemental oxygen or mechanical ventilation (respirator) may be required if your child becomes very ill and has difficulty breathing
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