Meningitis in Infants & Children Meningitis is a serious medical emergency particularly when it affects infants and children. It is a serious infection involving the brain and spinal cord. If suspected immediate medical check is necessary as delay in treatment can cause permanent damage to the brain. When infection is highly likely, treatment should be started promptly. Cause: Viruses and bacteria are the main causes for the infection. Viral meningitis is not as serious as bacterial meningitis. However it will be difficult to distinguish between the two. Therefore the child should be admitted, observed and investigated before bacterial meningitis can be ruled out. The bacteria that cause the infection are found in the nose and throat of 10 percent of the population. Sometimes they enter the blood stream and reach the brain. They can also spread from a sinus or ear infection. Coughing and sneezing is one other way it spreads. Bacterial infections cause the maximum damage and most fatalities are due to that. Bacteria that cause infection include Pneumococcus, Meningococcus, Haemophilus and Listeria. Among these pneumococcus is the commonest infection affecting infants and children. In infants it is more common during the first month than at any other time. Meningococcus more often affects teenagers and young adults. Pathology: Infection reaches the covering of the brain and spinal cord through the blood stream. The toxins that are released during the infection cause Brain damage. Symptoms & Signs: It is often difficult to distinguish between ordinary flu and meningitis in the early stages. Cold and cough usually accompanies influenza. In meningitis symptoms and signs appear much worse and the mother will usually suspect that there is something seriously wrong. Neck stiffness, severe headache, aversion to bright light and sickness are more often seen in meningitis. Symptoms are more pronounced in infants and young children. Meningitis remains a devastating disease in new born infants Symptoms & Signs in Infants: Constantly crying at a high pitch Not feeding properly Lethargic and often drowsy Sometimes cough and difficulty breathing T he soft spot on top of the head (Fontanelle) may be tense or bulging Fever may not always be present when the child is under 3 months Generalised rash or tiny red spots Red spots are difficult to see on a dark skin. It will be more easily seen on the palm and sole of that child. Symptoms & Signs in Older Children: ( In addition to the above) Sudden high fever with cold hands and feet Headache Stiff Neck Nausea and Vomiting Sensitive to bright light (Photophobia) Skin Rashes Fits at later stages. Not all symptoms will be present in every child but once infection gets in to the system the child would become seriously ill rapidly. If you are very worried about your child who is ill, don’t wait for symptoms to get worse or a rash to appear – get medical help promptly. But if a rash is already present do the “Tumbler Test”. When you press a clear glass on the spot or rash the spot will normally disappear. If it does not fade and you can still see it through the glass get medical help immediately. If you have any doubt do not hesitate to consult a paediatrician and ask him or her to rule out Meningitis . Investigations: Blood culture: As soon as the child is seen by a doctor Blood will be taken for culture to identify the organism causing the infection. Lumbar Puncture: This is an important investigation where fluid that surrounds the spinal cord and brain will be withdrawn for tests. It will be done by inserting a needle through the spine. CT or MRI Scan: The scan is done to check for inflammation of the meninges (covering of brain and spinal cord). If there is delay in getting the scan done, do not wait. Start antibiotics before the scan (as soon as the lumbar puncture is done). Treatment: The child should be admitted to hospital for close monitoring Fluids and appropriate antibiotics given through an intravenous drip (as soon as Spinal fluid is sent for analysis) Steroids may sometimes be given to reduce inflammation at the subarachnoid space (layer surrounding the brain) Complications: Most patients will make full recovery with prompt treatment. Complications from meningitis result mainly from delay in recognising the condition and starting treatment late. Delayed treatment increases the risk of permanent brain damage or even death. The child could lose fingers, toes or even part of a limb. Any complication that follows later is directly related to the degree of brain damage. It may be constant headaches, loss of memory, problems with hearing, fits, difficulty walking or performing co-ordinated movement of arms or legs. Prevention: Avoid taking your infant or child to very crowded places. It has been shown that the risk of getting infected increases in overcrowded and smoky places. Meningitis spreads mainly through the respiratory route. Meningitis can be prevented by routine immunisation during childhood. Every parent must make sure that their child is up to date with immunisation. It is particularly important to do this before the child starts school. If by chance your child comes in contact with someone who has meningitis, you must contact your doctor. He may suggest antibiotics as a preventive measure. Remember Meningitis is a serious infection affecting the Brain. If treated promptly the child will recover fully. Delay or Neglect in treatment would cause permanent brain damage. If you have the slightest doubt get the child checked by a paediatrician K. Badrinath This topic was discussed in greater detail in the “Forum” under Paediatrics