Meningitis (pediatrics)

Meningitis is an inflammation of the leptomeninges (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 2 years of life.

Bacterial meningitis

 * Etiology
 * Up to 6 weeks of age: group B β-hemolytic streptococci (GBS) and E. coli, less commonly listeria, staphylococci and Klebsiella.
 * From 7 weeks of age: Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae.
 * Pathogenesis
 * 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; with 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, light gray skin color, feeding difficulties, vomiting, piercing cry, tense fontanelle, opisthotonus, increased sensitivity to touch, hyperexcitability, disorders of consciousness, convulsions.
 * From 6 weeks of age: mainly fever and vomiting, bulging of the fontanel, restlessness or lethargy, apathy, increased sensitivity to touch, convulsions.
 * After 1 year of age: fever and headache predominate, neck stiffness, vomiting, impaired consciousness, convulsions.
 * After 1 year of age: fever and headache predominate, 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.
 * Complications
 * Acute hydrocephalus, subdural hygroma, inflammatory vascular occlusions, venous sinus thrombosis, cortical defects, SIADH, Waterhouse-Friderichsen syndrome.
 * Late consequences: psychomotor retardation, hearing impairment, cerebral palsy, epilepsy, hydrocephalus.
 * Diagnostics
 * Lumbar puncture – cytological and biochemical examination of cerebrospinal fluid, culture, electrophoresis or latex agglutination examination for antigen detection, PCR.
 * The number of cells > 1000/μl, the proportion of granulocytes > 70%, protein > 1 g/l, glucose < 1.7 mmol/l, lactate > 4.5 mmol/l, the ratio of the concentration of glucose in the cerebrospinal fluid and in the blood: < 0, 4.
 * Blood tests – leukocytosis with a shift to the left or leukopenia, increased CRP, sometimes thrombocytopenia; blood culture.
 * Therapy
 * Early initiation of empiric antibiotic therapy
 * neonates and infants: cephalosporins, ampicillin and aminoglycoside iv (minimum 14 days);
 * older children: cefotaxime iv (minimum 7 days), dexamethasone (reduces the incidence of hearing defects).
 * Prognosis
 * Pneumococcal meningitis has the worst prognosis (lethality 6–20%).
 * neonates and infants: cephalosporins, ampicillin and aminoglycoside iv (minimum 14 days);
 * older children: cefotaxime iv (minimum 7 days), dexamethasone (reduces the incidence of hearing defects).
 * Prognosis
 * Pneumococcal meningitis has the worst prognosis (lethality 6–20%).
 * 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.
 * Diagnostics
 * 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.
 * Prognosis
 * Very good.

Related Articles

 * Meningitis • Meningeal syndrome
 * Viral meningitis • Serous meningitis and meningoencephalitis • Herpetic meningoencephalitis
 * Purulent meningitis (infection) • Purulent meningitis (pediatrics) • Hemophilic meningitis • Tuberculous meningitis
 * Infectious diseases of the brain• Neuroinfections, CNS/PGS inflammations • Encephalitis