Meningitis is the inflammation of the protective membranes covering your child’s brain and spinal cord, collectively known as the meninges. Meningitis is potentially life-threatening and has a high mortality rate if untreated; delay in treatment has been associated with a poorer outcome and sequelae (a long-term consequence of a disease or an injury). Thus any child with suspected meningitis should be promptly hospitalized for timely management and treatment.

In India, meningitis is one of the top causes of death of children below five years of age. To treat meningitis at the right time, it is important for you to know its causes, symptoms, transmission, and diagnosis.   

Causes of Meningitis

Meningitis is usually caused when a bacterium (bacterial meningitis), a virus (viral meningitis), fungus (fungal meningitis), or a parasite (amoebic meningitis) invades the cerebral spinal fluid (CSF). Cerebral spinal fluid (CSF) is the fluid within the open spaces of the brain that protect and cushion your child’s brain and spinal cord (a long, fragile tubelike structure that begins at the end of the brain stem and continues down almost to the bottom of the spine).

Meningitis can occur at all ages, especially in infants and children less than 5 years of age. Meningitis caused by a virus is more common and usually less severe. Bacterial meningitis is usually more severe and may produce long-term complications or death. 

  • Bacterial Meningitis:

    • Common bacteria causing meningitis in neonates (newborns) and young infants are Group B streptococcus, Escherichia coli (or E. coli), and Listeria monocytogenes

    • In older infants and children, bacteria like Haemophilus influenzae type b (H.influenzae), Mycobacterium tuberculosis (tuberculous meningitis), Neisseria meningitides (meningococcal meningitis), Streptococcus pneumoniae usually cause meningitis. The severity of your child's symptoms and prognosis (likely course of a medical condition) depends on the specific organism that is causing meningitis. 

  • Viral Meningitis

    • Viruses that can cause meningitis include poliovirus, mumps (paramyxovirus), and herpes simplex virus (HSV).

  • Other microorganisms that can cause meningitis:

    • Borrelia burgdoferi (Lyme disease)

    • Fungi such as candida, aspergillus, or cryptococcus neoformans

  • Meningitis can also be caused by other severe infections such as an ear infection or a sinus infection (sinusitis, which is the inflammation of your child’s sinuses).

  • Sometimes, cancer, head injury, brain surgery, etc. also cause meningitis.

How is Meningitis Transmitted?

The organisms that cause meningitis usually colonize (settle among) in your child’s respiratory tract (includes your child’s nose or nostrils, nasal cavity, mouth, throat, and voice box). These may be transmitted by close contact or respiratory secretions from persons, who may be carrying the infection, or by touching infected objects. The infection usually starts in the respiratory tract and then travels into your child's bloodstream where it can reach the brain and spinal cord. 

Symptoms of Meningitis

Common symptoms in infants: 

  • Irritability 

  • Fever 

  • Sleeping more than usual 

  • Poor feeding 

  • High-pitched cry 

  • Aching back 

  • Inconsolable crying

  • Bulging fontanelle (soft spot on an infant's head) 

  • Noticeably different temperament

In older children, the symptoms are: 

  • Fever 

  • Neck and/or back pain 

  • Headache 

  • Sleepiness 

  • Confusion 

  • Irritability 

  • Refusing to eat 

  • Decreased level of consciousness 

  • Seizures (sudden uncontrolled changes in your child’s brain activity) 

  • Photophobia (sensitivity to light)

  • Nausea and vomiting

  • Neck stiffness 

Diagnosis of Meningitis

A complete medical history and physical examination of your child is very important to diagnose meningitis. Diagnostic procedures for meningitis usually are: 

  • Lumbar puncture. Known as a spinal tap, this is a medical procedure in which a needle is inserted into the lower back to collect cerebrospinal fluid (CSF) for diagnostic testing. The pressure in the spinal canal and brain is measured. Culture is done for the spinal fluid (CSF) to detect the organism causing meningitis.

  • Complete blood count and blood cultures. Blood testing to check for other infections. 

  • Nasal, throat, or rectal swabs. These help to diagnose the viral infections which can cause meningitis.

  • CT (Computerized Tomography) or MRI (Magnetic Resonance Imaging) scan. CT scan is done to identify other conditions that can cause similar symptoms as meningitis. An MRI may identify other complications, if any.

Treatment of Meningitis

Treatment of meningitis depends on the symptoms, age, and clinical condition of your child and is usually done in a hospital setting. Antibiotics, IV (Intravenous) fluids, anticonvulsants, antipyretics, and other supportive medications, etc., are usually given. 

  • Bacterial Meningitis:

    • Treatment is started immediately on diagnosis. IV antibiotics, steroids are the mainstay of treatments. Steroids help in reducing the swelling (inflammation) in the brain and also decreases the pressure build-up in the brain, hence preventing brain damage.

  • Viral Meningitis:

    • Usually, no treatment is required, except in the case of herpes simplex virus which is treated with IV antiviral medication.

    • A child gets better with rest and symptomatic treatment.

  • Fungal Meningitis:

    • IV antifungal medicine is required

  • Tuberculous Meningitis:

    • Your child will be given a course of antituberculous drugs for over a period of 1 year with other medications.

In the recovering phase, your child will also require:

  • Bed rest

  • Increased fluid intake (by mouth or IV)

  • Medicines to reduce fever (antipyretics)

  • Oxygen supplementation or ventilator (breathing machine), if required 

Complications of Meningitis 

Bacterial meningitis usually causes long-term complications in children like seizures, brain damage, hearing loss, disability, and sometimes even death.

Prevention of Meningitis

  • Vaccines: Several vaccines are available to prevent meningitis. These are:

    • H. influenzae type b vaccine (Hib)

    • PCV13 pneumococcal vaccine

    • PPSV23 pneumococcal vaccine (for children at higher risk of pneumococcal disease)

    • Meningococcal vaccine

    • Vaccines that protect against viruses like measles, mumps, chickenpox, and flu can also prevent viral meningitis

  • Other Measures

    • Make sure your child washes his/her hands often, especially after eating, using the toilet, or after coming back from public places.

    • Do not share items like your child’s toothbrushes, or eating utensils.

    • Teach your child to cover his/her mouth and nose while coughing or sneezing.

    • Give your child a healthy diet, encourage him/her to get plenty of exercises, and rest at night.

    • Keep your child away from ill/sick household members to avoid the spreading of infected droplets.

Meningitis is a serious infection that can cause various complications in your child, if not treated on time. Talk to your paediatrician if you notice any of the symptoms and seek guidance on the next steps.

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.