Bacterial meningitis in children

Of all the infections in infants and children, acute bacterial meningitis (bacterial infection of the coverings of the brain and spinal cord) is one of the most serious and potentially fatal.

Fortunately it is less common compared to other infections. It can occur at all ages starting from newborn to adolescents.

There are a few conditions, which predispose a child to meningitis– ear infections involving the middle ear and dermal sinus (an opening on the skin over the spine leading to the spinal canal).

Meningitis can also occur following head injury. But often it occurs without any of these conditions due to invasion of the meninges through blood.

Clinical manifestations: In the newborn baby the symptoms and signs of meningitis are vague and nonspecific. There may not be any fever. The baby simply looks unwell, may have a different type of cry and does not feed well.

Sometimes convulsions occur but are usually limited to a few parts. Generalized convulsions generally do not occur in newborns. At a later stage the soft spot over the head may be bulging due to increased pressure inside the head.

In older infants and children meningitis causes fever that is usually high, vomiting, irritability and occasionally convulsions. Older children almost always complain of severe headache.

Another common feature is inability to tolerate bright light a condition called photophobia. In meningococcal meningitis caused by bacteria called meningococci rashes may be seen in some children and shock can occur.

Once a doctor suspects bacterial meningitis based on the history and physical examinations he wastes no time in performing lumbar puncture-a procedure in which a needle is inserted through the lower back into the spinal canal to withdraw small quantity of cerebrospinal fluid which surrounds the brain and spinal cord.

Laboratory examination of this fluid including culture confirms the diagnosis. This also helps to distinguish between meningitis and febrile seizure whenever there is any doubt. The latter is much more common. Sometime even the appearance of the fluid suggests meningitis.

The normal cerebrospinal fluid is crystal clear but may become cloudy in bacterial meningitis. Usually no other investigation is required. However if any complication like brain abscess is suspected a CT scan may be required.

Treatment: If diagnosed and treated early complete recovery may be expected. Antibiotics have to be administered intravenously. Supportive treatment consists of intravenous fluids if the child is not able to take orally, anticonvulsants if the child has fits, drugs to bring down fever and reduce the inflammation and swelling of the brain.

Any delay in starting treatment can result in complications like abscess in the brain and hydrocephalus-a condition in which excess fluid accumulates in the ventricles of the brain.

Permanent damage to the brain manifesting as impaired hearing, weakness of limbs, recurrent fits, decreased intelligence or memory can also occur. Hearing evaluation is recommended for children treated for meningitis.

Prevention: Not every type of meningitis can be prevented. Vaccine is available against Haemophilus influenza B an organism that is known to cause severe infection often resulting in complications and is now routinely recommended for infants.

The vaccine can be given as early as two months. Three doses should be administered at monthly intervals followed by a booster dose between 15 and 18 months of age. Today combination vaccines are available and are very convenient as multiple pricks can be avoided. Visit childhood vaccination for more information.

Vaccines are also available against Meningococci and Pneumococci other bacteria known to cause meningitis. They are not recommended routinely but are recommended for those who have undergone splenectomy (removal of spleen).

Close contacts of patients suffering from meningococcal meningitis are at increased risk of getting the infection. Hence such people are advised to take a drug called rifampicin to prevent it if culture of cerebrospinal fluid yields meningococci.

Page last reviewed on 19th November 2009

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