Managing meningitis in children

The Nigeria Centre for Disease Control, NCDC, has confirmed the outbreak of Cerebro Spinal Meningitis, CSM, in the northern part of the country with at least 324 deaths related to the disease.

Over 2,900 suspected cases have been recorded while 109 have been confirmed and are being treated.

Cerebrospinal Meningitis is the medical term for inflammation of the tissues (meninges) that surround the brain and spinal cord. The inflammation is most commonly caused by a virus or a bacterium, which travels from an infection in another part of the body through the bloodstream to the meninges (brain).

There are two main types of meningitis — the viral and bacterial meningitis

Bacterial meningitis: There are many types of bacteria that can cause bacterial meningitis. The most likely type depends upon the child’s age, history of vaccinations, current or past medical problems. The common causes of bacterial meningitis in older infants and children are Streptococcus pneumonia, Haemophilus influenzae type b (Hib) and Neisseria meningitides. Bacterial meningitis is a medical emergency that must be treated quickly to minimise the risk of serious illness or even death.

Certain factors can increase a child’s risk of developing bacterial meningitis, including recent exposure to someone with bacterial meningitis, recent infection of the ear or sinus infection, travel to areas where bacterial meningitis is common such as sub-Saharan Africa, serious head injury, problems with the immune system, cochlear implants, and certain anatomic abnormalities.

Viral meningitis: The most common cause of viral meningitis is a family of viruses called enterovirus. Other viruses that cause meningitis can be transmitted airborne, by direct contact with an infected animal.

Signs and symptoms

Although bacterial meningitis is usually more severe, the signs and symptoms of bacterial and viral meningitis can be similar.

Newborn: They may develop a fever accompanied by non-specific symptoms (e.g, poor feeding, vomiting, diarrhoea, rash). The infant may have a stiff neck or bulging fontanel (soft spot on the skull) and may be irritable, restless, or lethargic.

Older children: They may develop a sudden fever, headache, nausea, vomiting, confusion, stiff neck, and complain that light bothers their eyes (photophobia). Meningitis can cause seizures, and decreased level of awareness. Certain types of bacterial meningitis may be associated with petechiae and purpura rash.

Diagnosis

Bacterial meningitis is a medical emergency that must be treated promptly. The following tests are generally recommended, and are usually performed in a hospital emergency department:

A blood culture – A sample of blood is cultured in the laboratory to determine if there are bacteria present (normally, no bacteria should be present in the blood). The results of the blood culture can also help determine which antibiotic is best.

Lumbar puncture – During a lumbar puncture, also known as a spinal tap, a clinician uses a needle to remove a sample of spinal fluid from the area around the spinal cord in the low back. Several tests are done on the cerebrospinal fluid to determine if a bacterial infection is present, and if so, which antibiotic treatment is best. The CSF may also be sent for viral cultures and/or molecular tests (called “PCR”) for enteroviruses.

CT scan may be recommended when and where the facility is available.

Treatment

The treatment for meningitis depends upon whether the meningitis is caused by a virus or a bacterium. However, this distinction may not be clear until the culture results are available (usually 48 to 72 hours after they are obtained).

In many cases, children are treated as if they have bacterial meningitis until bacterial meningitis is definitively excluded. The reason for this is that there is a significant risk of serious illness or even death if the child has bacterial meningitis and treatment is delayed for a prolonged period of time.

Bacterial meningitis is a life-threatening illness that requires hospitalisation and treatment with intravenous antibiotics. Depending upon the severity of the illness, the child may also need supportive treatments to aid breathing, oxygen support, maintain blood pressure, prevent excessive bleeding, and keep the child hydrated.

However, even with proper treatment, meningitis can damage the brain and cause long-term complications, including deafness, developmental delay or learning disabilities, spastic or paralysed muscles, coma and seizures. Complications are more common in children who live in developing and endemic regions.

Prevention 

Vaccines: Several routine childhood vaccines reduce the risk of developing bacterial meningitis, including the pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) vaccines. Vaccines are also available to prevent certain types of viral infections that may cause meningitis or other central nervous system infections, including polio, influenza, varicella, measles and mumps.) Preventive antibiotics are recommended for close contacts of anyone infected with meningococcal infection, even if the contact was previously vaccinated.

Families of children with meningitis should take care of them and avoid becoming infected. This includes washing hands after touching the child or changing diapers and before eating or preparing food. Utensils and cups should not be shared, the child’s mouth should be covered during a cough, and the child should not be kissed on the mouth.

Any parent who suspects that their child could have meningitis should seek medical attention immediately with their child physician. Meningitis affects all ages (the young and elderly).