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Meningitis in Children

By Geoffrey A. Weinberg, MD, Golisano Children’s Hospital, University of Rochester Medical Center;University of Rochester School of Medicine and Dentistry

Bacterial meningitis is infection of the layers of tissue covering the brain and spinal cord ( meninges).

  • Bacterial meningitis in older infants and children usually results from bacteria carried in the respiratory system, and, in newborns, meningitis often comes from a bacterial infection in the bloodstream ( sepsis).

  • Older children have a stiff neck with a fever, headache, and confusion, and infants are usually irritable, stop eating, vomit, or have other symptoms.

  • The diagnosis is based on the results of a spinal tap and blood tests.

  • Some children die of meningitis even after receiving appropriate treatment.

  • Vaccination can help prevent certain bacterial infections that cause meningitis.

  • Antibiotics are given to treat the infection.

For an overview of meningitis, see Introduction to Meningitis. Also see Viral Meningitis.

Meningitis can occur at any age. Meningitis is similar in older children, adolescents, and adults (see Acute Bacterial Meningitis) but different in newborns and infants.

Although meningitis can occur in all children, children at particular risk of meningitis include those with sickle cell disease and those lacking a spleen. Children with birth defects of the face and skull may have defects in the bones that allow bacteria access to the meninges. Children who have a weakened immune system, such as those with AIDS or those who have received chemotherapy, are more susceptible to meningitis.

Did You Know...

  • Not all bacteria cause disease or infections.

Causes of Meningitis

Meningitis in newbornsusually results from an infection of the bloodstream ( sepsis). The infection is typically caused by bacteria acquired from the birth canal, most commonly group B streptococci, Escherichia coli, and Listeria monocytogenes.

Older infants and children usually develop infection through contact with respiratory secretions (such as saliva or mucus from the nose) containing causative bacteria. Bacteria that infect older infants and children include Streptococcus pneumoniae and Neisseria meningitidis. Haemophilus influenzae type b was the most common cause of meningitis, but widespread vaccination against that organism has now made it a rare cause. Current vaccines against Streptococcus pneumoniae(called pneumococcal conjugate vaccines) and Neisseria meningitidis (called meningococcal conjugate vaccines) also are making these organisms rare causes of childhood meningitis.

Symptoms of Meningitis

Symptoms of meningitis vary by age. Once children develop symptoms involving their brain (such as abnormal drowsiness or confusion), meningitis can progress very quickly. As many as 15% of children who have bacterial meningitis are unconscious (comatose) or nearly unconscious by the time they are taken to a hospital.

Newborns and children under 12 months of age

Newborns and children under 12 months of age rarely develop a stiff neck (a common symptom in older children) and are unable to communicate specific discomfort. In these younger children, important signs of illness that should alert parents to a possibly serious problem include

  • Fussiness and irritability (particularly when they are held)

  • Abnormal drowsiness (lethargy)

  • Poor feeding

  • Temperature too high or too low

  • Vomiting

  • Rash

  • Seizures

About one third of newborns who have bacterial meningitis have seizures. And about one in five infants and young children who have bacterial meningitis have seizures. Occasionally, the nerves controlling some eye and facial movements may be damaged by the bacteria, causing an eye to turn inward or outward or the facial expression to become lopsided.

In about 25% of newborns with meningitis, increased pressure of the fluid around the brain may make the fontanelles (the soft spots between the skull bones) bulge or feel firm. These symptoms usually develop over at least 1 to 2 days, but some infants, particularly those between birth and 3 or 4 months of age, become ill very rapidly, progressing from health to near death in less than 24 hours.

Rarely, certain bacteria cause pockets of pus (abscesses) to form within the brain of infants with meningitis. As the abscesses grow, pressure on the brain increases (called intracranial pressure), resulting in vomiting, head enlargement, and bulging fontanelles.

Older children and adolescents

Older children and adolescents with meningitis typically have a few days of increasing

  • Fever

  • Headache

  • Confusion

  • Stiff neck

They may have had an upper respiratory tract infection before the meningitis. Seizures, pressure on the brain, and nerve damage may also occur.

Diagnosis of Meningitis

  • Spinal tap

  • Blood tests

  • Sometimes imaging tests

A doctor diagnoses bacterial meningitis by removing a sample of cerebrospinal fluid obtained through a procedure called a spinal tap (lumbar puncture). The fluid is analyzed, and any bacteria in that sample are examined and grown ( cultured) in a laboratory for identification. Sometimes the symptoms of bacterial meningitis are caused by other infections, such as inflammation of the brain ( encephalitis) or another type of meningitis that is not caused by bacteria, so the sample is also examined to look for and rule out these other causes of the child's symptoms.

Sometimes a spinal tap cannot be done because the child has signs of increased pressure on the brain, a brain injury, or a bleeding disorder. In these instances, doctors also do blood cultures to look for bacteria in the bloodstream. These children will get a spinal tap as soon as it is safe to do it.

Ultrasonography and, more often, computed tomography (CT), are imaging tests that may be used to determine the degree of pressure on the brain and whether an abscess is present.

Prognosis

Even with timely, appropriate treatment, as many as 5 to 25% of newborns with bacterial meningitis die.

In older infants and children, mortality rates vary from 3 to 5% when the cause is Haemophilus influenzae type b, 5 to 10% when the cause is Neisseria meningitidis, and 10 to 20% when the cause is Streptococcus pneumoniae.

Of the newborns who survive, 20 to 50% develop serious brain and nerve problems, such as an accumulation of extra fluid in the normal open spaces within the brain ( hydrocephalus), hearing loss, and intellectual disability. Up to 30% have mild residual problems, such as learning disorders, mild hearing loss, or occasional seizures.

About 15 to 25% of older infants and children develop brain and nerve problems such as hearing loss, intellectual disability, and seizures.

Prevention of Meningitis

Routine vaccinations can prevent many cases of meningitis. People who have been in contact with someone who has meningitis are often given antibiotics to help prevent infection (called chemoprophylaxis).

Vaccination

Health care practitioners and parents can help prevent bacterial meningitis by ensuring that all young children receive the Haemophilus influenzae type b (Hib) vaccine and the pneumococcal vaccine and that older children and adolescents receive the meningococcal vaccine. Some infants and young children who are at high risk of Neisseria meningitidis infection may be given the meningococcal vaccine.

Chemoprophylaxis

Doctors usually give antibiotics to people who have been in close contact with someone who has meningitis caused by Neisseria meningitidis or Haemophilus influenzae. Close contacts are defined somewhat differently depending on which of these two bacteria has caused the meningitis but they typically include

  • Members of the household (especially those under 2 years of age)

  • Workers at child care centers (especially workers in the infected child's classroom)

  • Anyone who has been directly exposed to the infected child's saliva (such as through kissing or sharing toothbrushes or utensils, or health care personnel doing certain procedures)

  • Children who are not immunized or who are only partially immunized

  • Children who have a weakened immune system

Chemoprophylaxis is given to close contacts as soon as the infected child has been identified. Ideally, it is given within 24 hours.

Drugs for chemoprophylaxis include rifampin, ceftriaxone, and ciprofloxacin and are given depending on the age of the close contact.

Treatment of Meningitis

  • Antibiotics

Doctors give high doses of antibiotics by vein (intravenously) as soon as they suspect meningitis. Very sick children receive antibiotics even before a spinal tap is done. When culture results from the spinal tap become available, doctors change the antibiotics, if needed, based on the type of bacteria causing the meningitis. The child's age also helps doctors determine which antibiotics to give.

Some children older than 6 weeks may be given corticosteroids (such as dexamethasone) by vein to help reduce the risk of hearing loss.

Sometimes a second culture and spinal tap are done to determine whether the antibiotics are working fast enough.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ROCEPHIN
  • CILOXAN, CIPRO
  • RIFADIN, RIMACTANE
  • OZURDEX

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