Bacterial meningitis in older infants and children usually results from bacteria carried in the respiratory system, and, in newborns, meningitis often results from a bacterial infection in the bloodstream ( sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more ).
Older children and adolescents have a stiff neck with a fever, headache, and confusion, and newborns and young infants are usually irritable, stop eating, vomit, or have other symptoms.
The diagnosis is based on the results of a spinal tap and blood and urine 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 Introduction to Meningitis Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space). Meningitis can be... read more . Also see Viral Meningitis Viral Meningitis Viral meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused... read more .
Meningitis can occur at any age. Meningitis in older children is similar to meningitis in adolescents and adults (see Acute Bacterial Meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid... read more ). However, meningitis in newborns (see also Bacterial Meningitis in Newborns Bacterial Meningitis in Newborns Bacterial meningitis is inflammation of the layers of tissue surrounding the brain and spinal cord (meninges) caused by bacteria. Newborns with bacterial meningitis are usually irritable, vomit... read more ) and infants is different.
Although meningitis can occur in all children, children at particular risk of meningitis include those with sickle cell disease Sickle Cell Disease Sickle cell disease is an inherited genetic abnormality of hemoglobin (the oxygen-carrying protein found in red blood cells) characterized by sickle (crescent)-shaped red blood cells and chronic... read more and those lacking a spleen Overview of the Spleen The spleen, a spongy, soft organ about as big as a person’s fist, is located in the upper left part of the abdomen, just under the rib cage. The splenic artery brings blood to the spleen from... read more . 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.
(See also Overview of Bacterial Infections in Childhood Overview of Bacterial Infections in Children Bacteria are microscopic, single-celled organisms. Only some bacteria cause disease in people. Other bacteria live inside the intestinal tract, genitourinary tract, or on the skin without causing... read more .)
Causes of Meningitis in Children
Meningitis in newborns usually results from an infection of the bloodstream ( sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more ). 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 the bacteria that cause meningitis. 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 Childhood Vaccination Schedule Most doctors follow the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC—see the schedule for infants and children and the schedule for older children... read more against that organism has now made it a rare cause. Current vaccines against Streptococcus pneumoniae (called pneumococcal conjugate vaccines Pneumococcal Vaccine Pneumococcal vaccines help protect against bacterial infections caused by Streptococcus pneumoniae (pneumococci). Pneumococcal infections include ear infections, sinusitis, pneumonia... read more ) and Neisseria meningitidis (called meningococcal conjugate vaccines Meningococcal Vaccine The meningococcal vaccine protects against infections caused by the bacteria Neisseria meningitidis (meningococci). Meningococcal infections can lead to meningitis (an infection of tissue... read more ) also are making these organisms rare causes of childhood meningitis.
Symptoms of Meningitis in Children
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
Unusual fussiness and irritability (particularly when they are held)
Abnormal drowsiness (lethargy)
Temperature too high or too low
About one third of newborns who have bacterial meningitis have seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more . 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 33 to 50% 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
They may have had an upper respiratory tract infection Overview of Viral Respiratory Tract Infections in Children Viral respiratory tract infections affect the nose, throat, and airways and may be caused by any of several different viruses. Common respiratory tract infections include the common cold and... read more before the meningitis. Seizures, pressure on the brain, and nerve damage may also occur.
Diagnosis of Meningitis in Children
Blood and urine tests
Sometimes imaging tests
A doctor diagnoses bacterial meningitis by removing a sample of cerebrospinal fluid obtained through a procedure called a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more (lumbar puncture). The fluid is analyzed, and any bacteria in that sample are examined and grown ( cultured Culture of Microorganisms Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results,... read more ) in a laboratory for identification. Sometimes the symptoms of bacterial meningitis are caused by other infections, such as inflammation of the brain ( encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more ) 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.
Other blood tests and urine tests ( urinalysis and urine culture Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more ) are also done.
Ultrasonography Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more and, more often, magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) or computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT), are imaging tests that may be used to determine the degree of pressure on the brain and whether an abscess is present.
Prognosis for Meningitis in Children
Even with timely, appropriate treatment, as many as 5 to 25% of newborns with bacterial meningitis and 5 to 10% of older infants and children with bacterial meningitis die.
In older infants and children, death 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 Hydrocephalus Hydrocephalus is an accumulation of extra fluid in the normal spaces within the brain (ventricles) and/or between the inner and middle layers of tissues that cover the brain (the subarachnoid... read more ), hearing loss Hearing Impairment in Children Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves... read more , and intellectual disability Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more . Up to 30% have mild residual problems, such as learning disorders Learning Disorders Learning disorders involve an inability to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic... read more , mild hearing loss, or occasional seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more .
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 in Children
Routine vaccinations Routine Vaccinations for Infants, Children, and Adolescents can prevent many cases of bacterial meningitis. People who have been in contact with someone who has meningitis are often given antibiotics to help prevent infection (called chemoprophylaxis). Women can be screened for group B streptococcus while pregnant and are given antibiotics at the time of delivery to prevent passing the bacteria to the newborn.
Health care practitioners and parents can help prevent bacterial meningitis by ensuring that all young children receive the Haemophilus influenzae type b (Hib) conjugate vaccine Haemophilus influenzae Type b Vaccine The Haemophilus influenzae type b (Hib) vaccine helps protect against bacterial infections due to Hib, such as pneumonia and meningitis. These infections may be serious in children. Use... read more and the pneumococcal conjugate vaccine Pneumococcal Vaccine Pneumococcal vaccines help protect against bacterial infections caused by Streptococcus pneumoniae (pneumococci). Pneumococcal infections include ear infections, sinusitis, pneumonia... read more and that older children and adolescents receive the meningococcal conjugate vaccine Meningococcal Vaccine The meningococcal vaccine protects against infections caused by the bacteria Neisseria meningitidis (meningococci). Meningococcal infections can lead to meningitis (an infection of tissue... read more . Some infants and young children who are at high risk of Neisseria meningitidis infection also may be given the meningococcal vaccine.
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)
Exposed children who are not immunized or who are only partially immunized
Exposed 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 selected depending on the age of the close contact.
Treatment of Meningitis in Children
Doctors give high doses of antibiotics by vein (intravenously) as soon as they suspect meningitis. Very sick children may 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 blood culture and spinal tap are done to determine whether the antibiotics are working fast enough.
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