The meningeal coverings along with the brain and spinal cord constitute the central nervous system. The pia mater, arachnoid and the dura mater together form the meninges, which acts as shock absorbers and lubrication for the inner nervous tissues. An inflammation of any of these layers is known as meningitis.
Meningitis is a syndrome characterized by inflammation of the meninges covering the brain or spinal cord. It may affect newborns, young children or adults with a vulnerable immune system. It is preventable and curable, yet carries significance as it may lead to severe neurological complications, especially baby meningitis.
Meningitis can be categorized from the organisms which cause it:
Meningitis can affect healthy newborns and infants. Following conditions make infants and young children more prone to it.
Meningitis in infants might cause excessive irritability, poor feeding and sleepiness. Babies might have a persistent fever with bulging of the cranial fontanelles or soft spot.
Following bacteria commonly cause meningitis:
Enteroviruses are responsible for most cases of aseptic meningitis in children. They are common in summers and tropical countries.
Viral or Aseptic meningitis is also commonly caused by the following viruses other than entire group:
Meningitis can have varied manifestations depending on the age group:
Babies can have following symptoms due to meningitis. However, these symptoms in babies are not specific to meningitis and can be present due to other systemic infections.
Toddlers or children (less than 1.5 years) may exhibit the following symptoms:
Older children usually have one of the following along with neck stiffness as the main symptoms:
The Diagnosis of meningitis primarily includes the following:
Routine blood investigations:
Additional tests may include:
Tumbler test: Certain infective causes of meningitis like meningococcemia may manifest with a peculiar rash and fever. The tumbler test includes a glass tumbler being pressed against the rash and if the rash becomes clearer, the result is considered to be positive.
Following are the general treatment guidelines for meningitis:
Treatment of viral meningitis:
Herpes simplex meningitis
Since viral or aseptic meningitis can be asymptomatic, treatment may be restricted to conservative management without antiviral therapy unless associated with encephalitis. The antiviral agent Acyclovir (intravenous at 10 mg/kg 8 hourly for 1-2 weeks) is the mainstay treatment for HSV 1 & 2 meningitis.
Cytomegalovirus meningitis
Ganciclovir and foscarnet are the antivirals of choice for CMV meningitis in immune-compromised patients.
Treatment of bacterial meningitis:
Antibiotic therapy: neonates (up to age 1 month)
The most common microorganisms in neonates with meningitis are streptococci grp B or D, E.coli, and Listeria monocytogenes. Treatment comprises of a combination of ampicillin (50mg/kg 8 hourly for infants or up to 1 week and 100mg/kg 4 times daily for 7-28 days neonates) with cefotaxime (50-60mg/kg 6-8hourly for 2 weeks).
Alternative regimens include ampicillin with gentamicin (in a dose of 2.5mg/kg IV/IM 8 hourly for 2-3weeks)
Antibiotic therapy: age 1-3 months
First line treatment comprises of IV ampicillin (50-100 mg/kg IV 6 hourly) with cefotaxime (50 mg/kg 6 hourly) or ceftriaxone (50-75 mg/kg 12 hourly).
Vancomycin (15 mg/kg IV 8 hourly) should be added for drug-resistant s.pneumoniae.
Steroid cover with Dexamethasone (0.4-0.6mg/kg 2-3 times/day) should be initiated 15-20 minutes before the antibiotic course.
Antibiotic therapy: between 3 months to 7 years
Antibiotic guidelines remain the same with either ampicillin plus cefotaxime or ceftriaxone or the cephalosporins alone in high dose.
An alternative for penicillin-allergic patients is IV chloramphenicol (25 mg/kg 12 hourly) plus vancomycin (15 mg/kg IV 12hourly).
Vancomycin (15 mg/kg IV 8 hourly) should be added for drug-resistant pneumonia.
Steroid cover with Dexamethasone (0.4-0.6mg/kg 2-3 times/day) should be initiated 15-20 minutes before the antibiotic course.
In infants and children meningitis may cause the following acute complications:
Since infants and young children are in their growth phase, meningitis on a long-term may affect their neurodevelopment.
Meningitis being an infective disorder, is contagious, and may spread to close contacts and the community in general.
Pathogens like streptococcus and Hemophilus influenza are present in the nasal passage and the throat of affected patients before affecting the meninges. They may spread through coughing, spitting, sneezing and kissing too. Viral meningitis may follow childhood illnesses like measles and mumps and may similarly spread among children.
You should consult a clinician if you notice any of the following in your child:
Following are a few precautionary measures that can be followed to prevent meningitis.
Since the majority of meningitis cases are caused either by pneumococcus, meningococcus or H. influenza, vaccines available against these organisms.
Vaccination against H influenzae type B (Hib): Although HiB vaccine is not included in the national immunisation schedule as a mandatory vaccine, it is strongly recommended in susceptible populations as well as all children aged 2 months to 15 months up to 5 years for a catch-up vaccination. It is administered as Intramuscular injections 2-3 doses between 6 weeks to 12 months age as primary vaccination, while the 3rd or 4th dose or the booster is given at 12-15 months age.
Maintaining general hygiene is the best way to avoid germs. It includes habits like frequent handwashing, taking a regular bath, avoiding spitting, avoiding close contact with a known case of infectious disease. Young children and adults who are in close contacts with such infected individuals (family members or healthcare attendant) should consult a doctor for preventive prophylaxis.
Meningitis. although it is a serious health hazard, can be easily recognized and cured with awareness and healthcare services. Prevention of meningitis in infants and babies with vaccinations is vital to prevent long-term neurological complications.
Also read: Childhood Vaccinations For Various Diseases