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

Neisseria meningitidis

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.

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%).

 For more information see Purulent meningitis (pediatrics), Purulent meningitis (infection), Hemophilic meningitis, Tuberculous meningitis.

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.

 For more information see Serous meningitis and meningoencephalitis , Viral meningitis, Herpetic meningoencephalitis .

Links

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