What is Meningitis?

Meningitis is defined as swelling (inflammation) of the protective membranes (meninges) surrounding your brain and spinal cord. It can affect children of any age group, however, there is a maximum risk of infection in infants and young children.

What causes meningitis?

Meningitis is primarily caused by infection to the meninges by various infectious agents including bacteria (Streptococcus pneumonia, Neisseria meningitides and Haemophilus influenza), mycobacteria (tuberculosis), viruses (Herpes simplex virus, varicella-zoster virus, influenza virus, and enterovirus), fungi or parasites. The other causes of meningitis are chemical reactions, drug-induced or malignancy-associated.

How does infection get transmitted?

The infection can spread through various routes like bloodstream and respiratory secretions. Infected people colonizing bacteria in the nose or throat spread it by sneezing, coughing and kissing. The spread of fungal or parasitic meningitis can occur from environmental sources such as inhaling soil contaminated with birds or bats droppings or by the rodents.

What are different types of meningitis?

Bacterial meningitis: Bacterial infection is one of the most common causes of meningitis, which can occur at any age. Each age group is infected by different type of bacteria. The disease can occur in isolation or can be associated with sepsis when there is a spread of infection through the bloodstream. Bacterial meningitis can be a serious, life-threatening illness if not treated in time.

Tuberculous meningitis: Tuberculous meningitis also can occur at any age and may present at times with non-specific symptoms.
Viral meningitis: Another common type of meningitis is viral meningitis, which is a less severe illness. It mostly spreads through respiratory secretions. Viral meningitis may begin with only milder flu-like symptoms of fever, headache, myalgia and fatigability.
Other types of meningitis: Fungal meningitis, parasitic meningitis, Chemical meningitis

What are the risk factors associated with meningitis?

Children less than 5 years of age
Unvaccinated children
Immune-compromised state
Contact with infected persons.

What are the symptoms of meningitis?

The initial symptoms of meningitis are non-specific especially in the younger children and may mimic the symptoms of common flu. The symptoms may develop over hours to few days. These include:

Fever
Headache and vomiting
Behaviour changes, lethargy and irritability
Skin rash
Neck stiffness
Sleep disturbances
Photophobia
Seizures

If untreated, these children can later have altered sensorium, shock and refractory seizures. Bacterial meningitis may lead to various sequelae like hearing impairment and cognitive deficits.

Meningitis in neonates and infants usually have atypical presentation, thus making early diagnosis difficult. Therefore a high index of suspicion is always required. The symptoms may include:

High fever
Lethargy
Bulging of anterior fontanel (soft opening on anterior part of a baby’s head)
Stiffness in the body and neck
Poor feeding
Excessive irritability and crying
Seizures
Skin rash in some cases
Shock in severe cases
Bacterial meningitis is an emergency that requires immediate medical care.

What are the complications of meningitis if not treated early?

If not treated early, meningitis can cause life-threatening complications, such as:

Death
Hearing impairment
Cognitive deficits and learning disabilities
Remote symptomatic epilepsy
Behavioural issues

How is meningitis diagnosed in children?

Detailed history and Clinical examination: An idea about your child’s symptoms and health history followed by physical and neurological examination will help in formulating an appropriate diagnosis.

Laboratory tests: A battery of blood tests including complete blood count, sepsis screen and blood culture provides a clue in the diagnosis of meningitis.
Neuroimaging: MRI brain and CT scan are the most widely used radiological tests for brain imaging. MRI brain has no radiation exposure and it gives the finer details of brain abnormalities. But MRI takes a longer time to perform and thus may require anaesthesia to complete the test. CT scan uses X-rays and thus have radiation exposure. It takes less time as compared to MRI, but misses the detailed imaging findings.
EEG (Electroencephalogram): A procedure that records the electrical activity of the brain by means of electrodes attached to the scalp. It is important to know the nature, origin, and severity of epileptiform discharges to guide the further treatment of the child. The background activity in EEG gives an idea about the sensorium.
Spinal tap: In this procedure, a thin needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid for laboratory analysis. It is a very important investigations for the diagnosis of meningitis, for differentiating the various types of meningitis and for guiding the treatment.

Ophthalmological examination

What is the treatment for meningitis?

The treatment included acute symptomatic management and specific management depending on the type of meningitis

Acute symptomatic management:

It includes management of airway, breathing and circulation. Adequate fluids, maintenance of blood sugar levels, fever control, treatment of seizures, and management of increased pressure and swelling in the brain are of utmost value in the proper management of the illness.

Specific management:

Bacterial meningitis is treated with intravenous antibiotics, which vary depending on the type of organism isolated in blood or CSF PCR or blood culture and steroidal anti-inflammatory drugs to reduce the brain swelling.

Tuberculous meningitis is treated with antituberculous drugs (ATT)

Viral meningitis: Antiviral agents are helpful in the treatment of disease caused by a herpes virus. The rest of the viral meningitis are treated symptomatically. It is important to take early measure to decrease brain swelling and to control seizures.

What measures can be taken to prevent the occurrence of meningitis?

Complete vaccination against the organisms causing bacterial meningitis

Proper environment and hand hygiene

Strengthening of the immune system by healthy and proper diet

Early identification of at-risk children