Meningitis

Dr. Parang Mehta, MD.

This serious disease is an infection of the membranes covering the brain and spinal cord (the meninges).  For such a serious and life-threatening illness, it often starts with the same signs and symptoms as a number of common and innocuous illnesses.  For this reason, the diagnosis and treatment are sometimes delayed, with disastrous consequences.

The most common type of meningitis is caused by bacteria, and is known as pyogenic (pus forming) meningitis.  This type is rapidly progressive, and tardiness in starting adequate treatment can lead to permanent disability, or even death.  Less commonly, meningitis can be due to tuberculosis, viruses, or fungi.  When we talk of bacterial meningitis, we usually refer to the rapidly progresive, pyogenic meningitis.

What happens in meningitis?

The common starting point is fever.  Babies and young children refuse to feed, become irritable, and cry a lot.  These signs are common to almost any cause of fever, and are often overlooked.  Older children have more specific complaints -- headache and a stiff neck.  As the disease progresses, the child may have seizures (fits) and become unconscious.  Multiple seizures and deep coma (unconsciousness) are pointers towards a poor outcome.

What causes bacterial meningitis?

The most common cause of bacterial meningitis in childhood are Hemophilus influenzae type b, meningococcus, and pneumococcus.  Hemophilus influenzae type b is very common in babies and children below three years, and rarely affects children older than five.  The other two bacteria affect older children also.

Apart from these, some rare germs like salmonella, enterobacter, E.  coli, and staphylococcus can also cause meningitis.  These are mainly seen in newborn babies, children with immune deficiencies, and those with birth defects.

Treatment

Meningitis is a serious illness that needs intensive care, and the child must be hospitalised.  The diagnosis of meningitis is first confirmed by blood tests and a special test called a lumbar puncture (spinal tap).  If meningitis is suspected, however, antibiotics in high doses are started immediately, without waiting for the results of the tests.  A few hours can make a huge difference in the outcome of this life-threatening illness.

If the child is unconscious, admission to an intensive care unit is important.  Intravenous fluids, glucose, drugs to control seizures, and other supportive treatment are given, in addition to the intravenous antibiotics.  Children with difficulty in breathing may need oxygen inhalation, or help in breathing by a ventilator.

The antibiotics are usually given for 10-14 days, but a longer duration is needed in newborn babies, and in children with poor immunity.  The entire course must be given intravenously; there is no place for oral or intramuscular antibiotics in meningitis.

Outcome

Meningitis used to cause death in a high proportion of patients a few decades ago.  Though death rates are falling, the disease is still serious, and can never be taken lightly.  Recovery rates depend on the age of the child, the body's innate defensive strength, and how quickly treatment was started.

Survivors of meningitis often have residual problems.  These are seen more commonly in younger children and in those in whom treatment was delayed.

Last Revision: February 16, 2016

Residual problems

Meningitis in childhood often leaves a legacy of permanent disability.

Prevention of meningitis

Vaccines are available for Hemophilus influenzae type b and Streptococcus pneumoniae bacteria.  Routine use in all children in many countries in the past decade has greatly reduced the occurrence of bacterial meningitis in children.  These vaccines are not in routine use in all countries yet, because of cost issues.

Vaccines against meningococcal disease are available, but are not recommended for all children everywhere. It is often required by colleges as a pre requisite for admission.

Children who have come in contact with a child who developed meningitis should be given protective antibiotics.  These should be started soon after contact, and a few days is usually enough.  This is especially important in infections with meningococci, which can be rapidly progressive and fatal.

Contact Information

Dr.  Parang Mehta,
Mehta Childcare,
Opposite Putli, Sagrampura,
Surat, India.     Tel: +91 9429486624.
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