Meningitis (pediatrics)

Meningitis is an inflammation of the leptomeningx (arachnoid and pia mater) caused mainly by bacteria, viruses, fungi, protozoa or parasites. About 60% of all meningitis occurs in childhood. The highest incidence is in the first two years of life. publisher = Grada |year = 2009 |pages = 155-157|isbn = 978-80-247-2525-3}}

Bacterial meningitis
Pathogenesis
 * Etiology
 * Up to 6 weeks of age: group B β-hemolytic streptococci (GBS) and E. coli, more rarely listeria, staphylococci and Klebsiella.
 * From 7 weeks of age: Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae.
 * Newborns: sepsis, bacteremia.
 * Young children: hematogenous spread of infection from the nasopharynx.
 * Secondary meningitis – by transfer of infection from the paranasal sinuses, middle ear, mastoids; in open cranial injuries and transfer of pneumococci to the cerebrospinal fluid space.
 * Clinical picture
 * Up to 6 weeks: non-specific symptoms, mostly sudden breathing disorder, then pale gray skin color, feeding difficulties, vomiting, shrill crying, tense fontanelle, opistotonus, increased sensitivity to touch, hyperexcitability, disorders of consciousness, convulsions.
 * From 6 weeks of age: mainly fever and vomiting, bulging fontanel, restlessness or lethargy, apathy, increased sensitivity to touch, convulsions.
 * After 1 year of age: fever and headache dominates, neck stiffness, vomiting, impaired consciousness, convulsions.

Meningeal symptoms
 * Brudzinski's sign: passive flexion of the neck leads to flexion of the hip and knee joints.
 * Kernig's sign: passive tension of the knee joints when the hips are bent is painful and is accompanied by strong reflex resistance.
 * Complication
 * Acute hydrocephalus, subdural hygroma, inflammatory vascular occlusions, venous sinus thrombosis, cortical defects, SIADH, Waterhouse-Friderichsen syndrome.
 * Late consequences: psychomotor retardation, hearing impairment, cranial nerve palsies, epilepsy, hydrocephalus.
 * Diagnosis
 * Lumbar puncture – cytological and biochemical examination of cerebrospinal fluid, culture, electrophoresis or latex agglutination examination for antigen detection, PCR.
 * Number of cells > 1000/μl, proportion of granulocytes > 70%, protein > 1 g/l, glucose < 1.7 mmol/l, lactate > 4.5 mmol/l, ratio of glucose concentration in CSF and blood: < 0.4.
 * Blood tests - leukocytosis with left shift or leukopenia, increased CRP, sometimes thrombocytopenia; blood culture.
 * Therapy
 * Early initiation of empiric antibiotic therapy:
 * newborns and infants: cephalosporins, ampicillin and aminoglycoside i.v. (minimum 14 days);
 * older children: cefotaxime i.v. (minimum 7 days), dexamethasone (reduces the incidence of hearing defects).
 * Prognosis
 * Pneumococcal meningitis has the worst prognosis (lethality 6-20%).

Viral Meningitis
Rarely in newborns and infants, more often in late childhood and young adulthood.
 * Etiology
 * Echoviruses, coxsackieviruses (enteroviruses), mumps virus.
 * Less often adenoviruses, parainfluenzae, tick-borne meningoencephalitis virus, lymphocytic choriomeningitis virus.
 * Clinical picture
 * Sudden onset, fever, vomiting, headache, positive meningeal signs.
 * Diagnosis
 * Lumbar puncture:
 * cell count 11–500/μl, proportion of mononuclear cells > 70%, protein < 1 g/l, glucose normal.
 * Serological tests for enteroviruses, mumps, KME and borreliosis.
 * Isolation of the virus from cerebrospinal fluid, stool, pharyngeal lavage.
 * Therapy
 * Symptomatic, fluids, bed rest.
 * Prognosis
 * Very good.

Related Articles

 * Meningitis • Meningeal syndrome
 * Viral meningitis • Serous meningitis and meningoencephalitides • Herpetic meningoencephalitis
 * Suppurative meningitis (infection) • Suppurative meningitis (pediatric) • Haemophilic meningitis • Tuberculous meningitis
 * Infectious brain disease • Neuroinfection, CNS/PGS inflammation • Encephalitis