How to diagnose meningitis in a child

Meningitis (for Parents) - Nemours KidsHealth

What Is Meningitis?

Meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord.

People of any age can get meningitis. But it can spread easily among those living in close quarters, so teens, college students, and boarding-school students are at higher risk for infection.

If dealt with quickly, meningitis can be treated successfully. So it's important to get routine vaccinations, know the signs of meningitis, and get medical care right away if you think that your child has the illness.

What Causes Meningitis?

Most cases are caused by bacteria or viruses, but some can be due to certain medicines or illnesses.

Many of the

bacteriaand virusesthat cause meningitis are fairly common and cause other routine illnesses. Both kinds of meningitis spread like most other common infections do — someone who's infected touches, kisses, or coughs or sneezes on someone who isn't infected.

Bacterial Meningitis

Bacterial meningitis is rare, but is usually serious and can be life-threatening if not treated right away.

In some cases of bacterial meningitis, the bacteria spread to the meninges from a severe head trauma or a severe local infection, such as a serious ear infection (otitis media) or nasal sinus infection (sinusitis).

Many different types of bacteria can cause bacterial meningitis. In newborns, the most common causes are group B strep, E. coli, and less commonly, Listeria monocytogenes. In older kids, Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are often the causes.

Viral Meningitis

Viral meningitis (also called aseptic meningitis) is more common than bacterial meningitis and usually less serious.

Many of the viruses that cause meningitis are common, such as those that cause colds, diarrhea, cold sores, and the flu.

What Are the Signs & Symptoms of Meningitis?

Meningitis symptoms vary, depending on the person's age and the cause of the infection. The first symptoms can come on quickly or start several days after someone has had a cold, diarrhea, vomiting, or other signs of an infection.

Common symptoms include:

fever
lack of energy
irritability
headache
sensitivity to light
stiff neck
skin rash

Meningitis in Infants

Infants with meningitis might have different symptoms. Babies might be cranky, feed poorly, and be sleepy or hard to wake up. It may be hard to comfort them, even when they're picked up and rocked. They also may have a fever or bulging fontanelle (soft spot on head).

Other symptoms of meningitis in babies can include:

jaundice (a yellowish tint to the skin)
stiffness of the body and neck
a lower-than-normal temperature
a weak suck
a high-pitched cry

How Is Meningitis Diagnosed?

Bacterial meningitis can be very serious. So if you see symptoms or think that your child could have meningitis, it's important to see the doctor right away.

If meningitis is suspected, the doctor will order tests, probably including a lumbar puncture (spinal tap) to collect a sample of spinal fluid. This test will show any signs of

inflammationand whether the infection is due to a virus or bacteria.

How Is Meningitis Treated?

Most cases of viral meningitis end within 7 to 10 days. Some people might need to be treated in the hospital, although kids usually can recover at home if they're not too ill. Treatment to ease symptoms includes rest, fluids, and over-the-counter pain medicine.

If bacterial meningitis is diagnosed — or even suspected — doctors will start intravenous (IV) antibiotics as soon as possible. Fluids may be given to replace those lost to fever, sweating, vomiting, and poor appetite.

What Problems Can Happen?

Complications of bacterial meningitis might need extra treatment. Someone with shock or low blood pressure might get more IV fluids and medicines to increase blood pressure. Some kids may need extra oxygen or mechanical ventilation if they have trouble breathing.

Bacterial meningitis complications can be severe and include neurological problems, such as hearing loss, vision problems, seizures, and learning disabilities. Because impaired hearing is a common complication, those who've had bacterial meningitis should have a hearing test after they recover.

The heart, kidneys, and

adrenal glandsalso might be affected, depending on the cause of the infection. Although some kids develop long-lasting neurological problems, most who get a quick diagnosis and treatment recover fully.

Can Meningitis Be Prevented?

Vaccinations

Routine immunization can go a long way toward preventing meningitis. The Hib, measles, mumps, polio, and pneumococcal vaccines can protect against meningitis caused by those germs.

Kids also should get the meningococcal conjugate vaccine (MenACWY) when they're 11 or 12 years old, with a booster shot at age 16. Kids older than 11 who haven't been vaccinated also should be immunized, particularly if they're going to college, boarding school, camp, or other places where they'll live in close quarters with others.

Kids 2 months to 11 years old who are at higher risk for infection also should get MenACWY. This includes kids who:

live in or travel to countries where infection is common
have some types of immune disorders
are present during an outbreak

A newer type of meningococcal vaccine called MenB protects against a type of meningococcal bacterium not covered by the older vaccine. Kids 10 years and older who have a higher risk for infection should get this vaccine. Others who are not at increased risk may also get it between the ages of 16 and 23 (preferably between 16 through 18, which is when the risk of getting infected is highest). The decision to get the MenB vaccine should be made together with their parents and the doctor.

Avoiding Germs

Kids and adults should wash their hands well and often, particularly before eating and after using the bathroom, and if they work closely with kids (as in a daycare). Avoid close contact with someone who looks ill and don't share food, drinks, or eating utensils.

In some cases, doctors may give antibiotics to anyone who has been in close contact with a person who has bacterial meningitis to help prevent infection.

When Should I Call the Doctor?

Get medical care right away if you think that your child has meningitis or you see symptoms such as:

vomiting
headache
tiredness or confusion
neck stiffness
rash
fever

A baby who has a fever, is cranky, and isn't feeding well should be seen right away by a doctor.

If your child has been near someone who has meningitis, call your doctor to ask about preventive medicine.

Meningitis - Diagnosis and treatment

Diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and skin along the spine.

You or your child may undergo the following diagnostic tests:

Blood cultures. A blood sample is placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide and stained (Gram's stain), then studied under a microscope to see whether bacteria are present.
Imaging. Computerized tomography (CT) or magnetic resonance imaging (MRI) scans of the head may show swelling or inflammation. X-rays or CT scans of the chest or sinuses also may show infection that may be associated with meningitis.
Spinal tap (lumbar puncture). For a definitive diagnosis of meningitis, you'll need a spinal tap to collect cerebrospinal fluid (CSF). In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein.

CSF analysis may also help your doctor identify which bacterium caused the meningitis. If your doctor suspects viral meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification or a test to check for antibodies against certain viruses to determine the specific cause and proper treatment.

More Information

CT scan
Lumbar puncture (spinal tap)
X-ray

Treatment

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis

Acute bacterial meningitis must be treated immediately with intravenous antibiotics and sometimes corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.

The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis.

Your doctor may drain any infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear.

Viral meningitis

Antibiotics can't cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild cases of viral meningitis usually includes:

Bed rest
Plenty of fluids
Over-the-counter pain medications to help reduce fever and relieve body aches

Your doctor may prescribe corticosteroids to reduce swelling in the brain, and an anticonvulsant medication to control seizures. If a herpes virus caused your meningitis, an antiviral medication is available.

Other types of meningitis

If the cause of your meningitis is unknown, your doctor may start antiviral and antibiotic treatment while the cause is determined.

Treatment for chronic meningitis is based on the underlying cause. Antifungal medications treat fungal meningitis, and a combination of specific antibiotics can treat tuberculous meningitis. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal.

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids. In some cases, no treatment may be required because the condition can resolve on its own. Cancer-related meningitis requires therapy for the specific cancer.

Request an Appointment at Mayo Clinic

Preparing for your appointment

Meningitis can be life-threatening, depending on the cause. If you've been exposed to bacterial meningitis and you develop symptoms, go to an emergency room and let medical staff know you may have meningitis.

If you're not sure what you have and you call your doctor for an appointment, here's how to prepare for your visit.

What you can do

Be aware of any pre- or post-appointment restrictions. Ask if there's anything you need to do in advance, such as restrict your diet. Also ask if you may need to stay at your doctor's office for observation following your tests.
Write down symptoms you're having, including changes in your mood, thinking or behavior. Note when you developed each symptom and whether you had cold- or flu-like symptoms.
Write down key personal information, including any recent moves, vacations or interactions with animals. If you're a college student, your doctor likely will ask questions about any similar signs or symptoms in your roommates and dorm mates. Your doctor will also want to know your vaccination history.
Make a list of all medications, vitamins or supplements you're taking.
Take a family member or friend along. Meningitis can be a medical emergency. Take someone who can help remember all the information your doctor provides and who can stay with you if needed.
Write down questions to ask your doctor.

For meningitis, some basic questions to ask your doctor include:

What kinds of tests do I need?
What treatment do you recommend?
Am I at risk of long-term complications?
If my condition is not treatable with antibiotics, what can I do to help my body recover?
Am I contagious? Do I need to be isolated?
What is the risk to my family? Should they take preventive medication?
Is there a generic alternative to the prescription medicine you're recommending?
Do you have any printed information I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

When did you begin experiencing symptoms?
How severe are your symptoms? Do they seem to be getting worse?
Does anything seem to improve your symptoms?
Have you been exposed to anyone with meningitis?
Does anyone in your household have similar symptoms?
What is your vaccination history?
Do you take any immunosuppressant medications?
Do you have other health problems, including allergies to any medications?

What you can do in the meantime

When you call your doctor's office for an appointment, describe the type and severity of your symptoms. If your doctor says you don't need to come in immediately, rest as much as possible while you're waiting for your appointment.

Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever and body aches. Also avoid any medications that may make you less alert. Don't go to work or school.

By Mayo Clinic Staff

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Meningitis in children. What is important for parents to know?

February 08, 2016

There are a lot of infections that can cause meningitis, so it is important to know the features of the manifestation of this disease, its treatment and prevention.

What is meningitis?

Meningitis is an inflammatory disease affecting the meningeal membranes of the brain. There are many pathogens that can cause meningitis. Depending on the pathogen, infectious meningitis is divided into bacterial and viral. It is very important to understand as early as possible what exactly the pathogen is associated with the disease. Bacterial meningitis is more often severe and leads to significant damage to the nervous system, and sometimes death. Viral meningitis usually proceeds more favorably and often does not cause severe complications.

Symptoms of meningitis

Persistent increase in body temperature from 39C
Headache
Tension in the neck, inability to bend the head to the chest (so-called meningeal symptoms)
Nausea and vomiting
Disorders of consciousness (drowsiness, confusion, loss of consciousness)
Photophobia

In neonates, meningitis may have the following features :

Feeding difficulties (sluggish sucking, regurgitation).
Diarrhea.
Bulging fontanel.
Unusual lethargy, drowsiness.
Blurred clinical picture, absence of significant meningeal symptoms.

The course of bacterial and viral meningitis may differ. For example, bacterial meningitis is often accompanied by seizures and a specific dark "star-like" rash on the skin. Viral meningitis can develop against the background of common colds - a runny nose, cough, as well as infections with a rash of a different nature - red or pink.

What if a child suspects meningitis?

Meningitis is an emergency, you should immediately consult a doctor and be treated in a hospital.

Meningitis diagnostics

Blood test.
A lumbar puncture is a procedure in which a small amount of cerebrospinal fluid (CSF) surrounding the brain and spinal cord is removed through a small incision in the lower back. The composition of this fluid changes with meningitis and the doctor determines the cause of the disease by the characteristic changes.
Computed tomography. In meningitis, some changes in the brain are only diagnosed with a CT scan.

The EMC Children's Clinic has all the facilities for fast and high-quality diagnostics of meningitis: its own round-the-clock clinical diagnostic laboratory, a round-the-clock tomography complex, where, if necessary and under the supervision of experienced anesthesiologists, small patients are examined under medical sleep. If hospitalization is necessary for examination and treatment, the clinic has its own hospital. Comfortable wards for the joint stay of mother and child, modern original preparations, individual nutrition, round-the-clock nursing post, creation of a friendly and comfortable atmosphere during the stay in the hospital (play areas, outdoor playground) - all this contributes to a quick recovery.

Treatment of meningitis

Bacterial meningitis is treated with antibiotics, usually given intravenously. Additionally, drugs are used to maintain vital functions, for example, to normalize blood pressure. In many cases, hormones are used to prevent permanent hearing loss after bacterial meningitis.

Viral meningitis is not treated with antibiotics because antibiotics do not work on viruses. Treatment consists of rest, plenty of fluids (or intravenous fluids) and symptomatic therapy (headache medications).

It may take several days to determine the exact nature of the illness. This is a forced delay, so the doctor usually prescribes an antibiotic immediately, without waiting for the results of the diagnosis. This is done based on the possible presence of bacterial meningitis, which will not wait until the diagnosis is confirmed.

Is it possible to catch meningitis?

Bacteria and viruses can be transmitted from person to person, so this danger exists.

Prevention of meningitis

Vaccination. Meningitis caused by meningococci (Neisseria meningitidis) and Haemophilus influenzae (Haemofilus influenza type b), pneumococci, etc. is very widespread. EMC Children's Clinic uses certified European vaccines to create reliable protection against meningitis. In particular, for the prevention of meningitis caused by meningococci, the "MENACTRA" vaccine manufactured by Sanofi Pasteur (USA) is used - a modern conjugated 4-valent meningococcal vaccine with 10 years of clinical experience, the only reliable and safe protection against meningococci A, C, Y and W used in children over the age of 9months and adults.

Prevention of infection: avoidance of contact with the sick, hand hygiene, use of individual utensils, cutlery and personal hygiene products.

Antibiotics may sometimes be prescribed for prophylaxis in case of contact with a sick person. This is done only by a doctor and only if necessary. Self-medication and uncontrolled medication can be more dangerous than the disease itself.

Meningitis in children: types, symptoms, signs, treatment

The most severe course in bacterial meningitis. Such meningitis can damage the nervous system and sometimes be fatal. Viral meningitis usually proceeds more favorably and rarely leads to complications.

Symptoms of meningitis in children

The cause of the development of the inflammatory process in the meninges can be various viruses (enteroviruses, Coxsackie viruses, poliomyelitis, mumps, etc. ), as well as bacteria (meningococci, pneumococci, staphylococci, hemophilic bacilli, etc.). The infection can enter the human body through airborne droplets, through unwashed hands, contaminated food and water.

Some children are at higher risk of developing meningitis. These include:

Premature babies, since these babies have very weak immunity;
Newborns whose mothers had a severe course of pregnancy and childbirth, as well as fetal hypoxia, infections;
Children at an early age, if they have other foci of infection (sinusitis, otitis media, tonsillitis, endocarditis), acute respiratory viral infections, intestinal infections;
Children with disorders of the nervous system;
Children with brain and spinal cord injuries.

The development of meningitis is accompanied by:

Increasing temperature to 39°C or more;
Headache is the main symptom of meningitis. It usually increases with sudden movements, in bright light;
Tension in the neck muscles, preventing the child from bending his head to his chest;
Nausea and severe vomiting;
Convulsions
Confusion;
Photophobia.

In newborns, the symptoms of the disease are more subtle. Diarrhea, lethargy, lack of appetite, regurgitation may occur. If any of these signs appear, you should immediately contact your pediatrician.

Incubation period

Symptoms of meningitis usually develop rapidly and at the first suspicion of illness, the child should be hospitalized immediately. In some cases, an incubation period of 2 to 10 days is possible. During this period, the symptoms of the disease are not yet so pronounced.

Rash

The characteristic "star" rash occurs in about a quarter of all meningitis cases. She says that meningitis is caused by a meningococcal infection. Meningococcus, entering the body, begins to secrete a toxin that damages the wall of blood vessels. This leads to hemorrhages in the form of a red-purple skin rash.

Types of meningitis in children

Serous

Serous meningitis is usually caused by a viral infection and has a more favorable course. Such meningitis is characterized by muscle pain, fever, conjunctivitis, redness of the throat, rash. As a rule, the patient complains of a sharp headache, vomiting.

Purulent

Purulent meningitis is caused by bacteria - meningococci, streptococci, staphylococci, Haemophilus influenzae, etc. The infection enters the child's body through the mother's placenta, if she has such diseases as pyelitis, cystitis, etc. Purulent meningitis is the most dangerous and in 50-60% of cases leads to death. Newborn babies do not fully recover. Often the nervous system is so affected that the child has a mental retardation, paralysis of the limbs and other serious complications.

Viral

Viral meningitis is usually more benign. Its causative agents can be viruses of various types. At the same time, along with headache, neck muscle tension, and vomiting, the child has signs of a viral infection, such as redness of the throat, conjunctivitis, lacrimation, etc.

Treatment of meningitis in children

analyze the cerebrospinal fluid. The diagnosis of meningitis can be confirmed if there are certain changes in it. Additionally, a bacteriological examination of blood, a smear from the throat, etc. is carried out.

After the diagnosis is confirmed, treatment is prescribed. It allows:

Eliminate bacterial, viral infection;
Reduce cerebral edema and normalize intracranial pressure;
Reduce body temperature;
Eliminate oxygen starvation, convulsions, reduce headache.

Consequences

If meningitis is not treated promptly and adequately, severe consequences can develop in children. There may remain disorders of the psyche, speech, hearing, lesions of the facial nerves (paresis and paralysis), dementia.

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