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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