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meningitis in infants and children

Alternative Names
paediatric meningitis

The meninges are the membranes that line the outer surface of the brain and spinal cord. Meningitis is an acute inflammation of these areas. It is usually caused by infection.

What is going on in the body?
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). This is the fluid that circulates within the brain and over its surface. This process results in a set of symptoms known as meningitis.

Meningitis is more common in infants and children than adults. It can result in permanent long-term effects, such as deafness.

What are the signs and symptoms of the infection?
Meningitis may cause the following in infants and children:
  • fever, or sometimes in infants a temperature that is lower than normal
  • headache
  • stiff neck, which may make the child unwilling to move his or her head
  • irritability
  • decreased alertness or level of consciousness, so that a child may appear "glassy-eyed" or "out of it"
  • decreased appetite
  • nausea and vomiting
  • seizures or convulsions, which can cause rapid twitching of the muscles in the arms and legs
  • bulging of the soft spot on top of a child's head, usually in children less than 2 years old
What are the causes and risks of the infection?
The main cause of meningitis is an infection, usually with a bacteria or virus. The following children are more likely to develop this condition:
  • sick newborn infants who need intensive care
  • children who live in poor or crowded conditions
  • children who go to daycare or preschool, because they have more contact with other children
  • children who do not get standard vaccines
  • children with certain other medical conditions. These include conditions that weaken the immune system, such as cancer, leukaemia or HIV. Sickle cell disease and problems with the spleen also increase the risk of meningitis.
What can be done to prevent the infection?
The most important prevention is routine childhood immunisations. Vaccines that prevent cases of meningitis include Hib, mumps, and polio, among others. Some vaccines to prevent this condition are used only in children with other medical problems. Breast-feeding may provide some protection to infants. When there is an outbreak of meningitis caused by certain bacteria, children may be given antibiotics, such as rifampicin, to prevent an infection with the bacteria. Parents should call their child's doctor if the child has been exposed to someone with this condition.

How is the infection diagnosed?
A history and physical examination of the child often lead the doctor to suspect this condition. The diagnosis is confirmed by examining the cerebrospinal fluid (CSF). 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 subarachnoid space, where the CSF surrounds the spinal cord. This procedure is called a lumbar puncture or spinal tap.

Once a sample of CSF is obtained, it is sent to the laboratory for analysis. Children with this condition have abnormal CSF that indicates the presence of an infection. In many cases, the bacteria or virus can be identified so that the proper antibiotic can be given.

What are the long-term effects of the infection?
Meningitis is quite serious, with a fairly 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. Long-term effects may include:
  • seizures
  • mental retardation
  • paralysis
  • deafness
  • vision loss
  • hydrocephalus, an increase in CSF inside the brain
  • learning disabilities
  • behaviour problems
What are the risks to others?
People with this condition are often contagious and may spread the infection to other children or adults. Parents should call their child's doctor if the child has been exposed to anyone who develops meningitis.

What are the treatments for the infection?
The main treatment is antibiotics, such as ampicillin, gentamicin, and cefotaxime, given through a vein, or intravenously. The results of the CSF and blood tests help decide which antibiotic to use. Some cases are caused by a virus and cannot be treated with antibiotics. This condition is usually treated in the hospital, preferably one that can provide intensive care for infants and children.

Other treatments that may be given include:
  • paracetamol to reduce fever
  • corticosteroids, such as dexamethasone, to reduce inflammation
  • intravenous fluids to prevent or treat dehydration
  • medications 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.

What are the side effects of the treatments?
All medications can have side effects. Antibiotics may cause allergic reactions, kidney damage, or liver damage. Corticosteroids may increase the risk of bleeding in the gut or worsen the infection. Medications to stop seizures may cause low blood pressure or allergic reactions. Other side effects are possible, and depend on the drugs used.

What happens after treatment for the infection?
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 be severely mentally retarded.

How is the infection monitored?
Because this condition affects the brain, children need to have check ups for years after the illness to look for problems with vision, hearing, or movement. Mental functioning is also monitored to detect mental retardation, learning disabilities, or problems with judgment or impulse control.

Author: Adam Brochert, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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