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 Common Vaccinations in Children Immunization (vaccination) helps the body defend itself against diseases caused by certain bacteria or viruses. Immunity (the ability of the body to defend itself against diseases caused by... 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 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.

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. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... 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.

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.

Routine vaccinations Childhood Vaccination Schedules Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more 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.

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.