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January 2017
Information for Parents with Small Children
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
Red spots in Meningitis
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