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Meningitis is an inflammation of the protective membranes, covering the brain, and spinal cord.
These membranes collectively called the meninges.
Most common cause of meningitis is viral infection. And, second most common cause is bacterial infection.
Unfortunately, If bacterial meningitis left Untreated, its mortality approaches 100%.
it means Bacterial meningitis almost always causes death, in absence of adequate treatment.
In contrast with viral infection. Viral meningitis, tends to resolve spontaneously and is rarely fatal. That’s why we discuss bacterial meningitis.
Meningitis is medically emergency because it can worsen quickly. and can cause death, or permanent brain injury, within 24 hours.
Diagnosing of meningitis can be difficult among children, because they unable to describe their symptoms, and moreover, classical symptoms may not be presented. And late diagnoses means worse outcome. So, knowing Signs and symptoms of meningitis among children, is crucial for doctors and for parents too. It can save lives.
Symptoms of meningitis is difficult to identify. because most symptoms are non-specific.
But you should pay attention:
• Fever.
• Irresponsiveness and lethargy.
• Poor feeding, Vomiting and irritability.
More specific and late signs include:
Purpuric rash which means red spots on the skin. Redness will not disappear, even, if you press glass on the skin. It is sign of presence of bacteria in the blood, called septicemia.
Coma may be present and are more common in meningococcal meningitis.
These signs however are more likely to develop later in the course of the illness. around 13 to 22 hours later.
Coma is associated with a worse prognosis than a child presenting with irritability or lethargy alone.
Classical signs of Meningitis also can be presented:
Classic Symptoms include: nuchal rigidity, bulging fontanelle, photophobia, and a positive Kernig's or Brudzinski's sign.
Nuchal rigidity means neck stiffness, neck resist to passive flexion.
Bulging fontanelle means the soft spot on the top of a baby's head can bulge.
Kernig's is when examiner flex patients’ knee, and extension of the knee is painful and leading to resistance.
Brudzinski's sign means: Passive flexion of neck, causes flexion of hips and knees.
These classic signs are more common in children older than 12 to 18 months.
Seizures may be present in 20-30% of children with bacterial meningitis.
Meningitis develops, after the pathogen invades the Central Nervous System either though hematogenous route, via blood. (bacteremia). or by direct extension, secondary to sinusitis or mastoiditis and multiplies in the subarachnoid space.
The presence of bacteria in the subarachnoid space leads to activation of the immune response.
resulting in bacterial lysis. The presence of bacterial particles triggers a further inflammatory response.
Inflammation causes decreased cerebral perfusion, cerebral edema, raised intracranial pressure, metabolic disturbances, and vasculitis.
all contributing to neuronal injury and ischemia.
When bacterial meningitis is suspected, early diagnosis and prompt empirical antibiotics are paramount.
The most common organisms causing bacterial meningitis vary by age group.
Among neonates and infants Group B Streptococcus and Escherichia coli is common.
In older children, Streptococcus pneumoniae is commonest organism and it can infect healthy children. Neisseria meningitidis is second most common and it can cause epidemic or endemic outbreaks.
Bacterial meningitis has a high case-fatality rate in children, of up to 30% in developed countries fatality rate is lower.
Lumbar Puncture is necessary for the definitive diagnosis of bacterial meningitis. If lumbar Puncture is not possible, then blood culture is required.
Bacterial meningitis is a neurological emergency. and it is critical, that appropriate empirical antibiotics are administered, as soon as possible. Even before diagnosis is confirmed.
Most Common empirical Treatment is third-generation cephalosporin (such as ceftriaxone or cefotaxime) in conjunction with vancomycin as initial antibiotic therapy.
Empirical use of adjuvant dexamethasone (0.15 mg/kg/dose, 4 times a day) given before or up to a maximum of 12 hours after the first dose of antibiotics and continued for 2 to 4 days is currently recommended.
Prevention:
Vaccination is available against Neisseria meningitis and streptococcus pneumoniae.
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