Meningitis in Children

Meningitis is an inflammation of the meninges (thin membranes that surround the brain and the spinal cord).

Patients can be seen by Texas Children's experts in Infectious Disease and Inpatient Rehabilitation.

Causes & Risk Factors

Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF) and inflames the meninges. Cerebral spinal fluid (CSF) is the fluid within the open spaces of the brain that protects and cushions the brain and spinal cord. A fungus or parasite may also cause meningitis, but this is uncommon and usually occurs in patients with unique exposures or weak immune systems. The severity of a child's symptoms and prognosis depend on the specific organism that is causing meningitis. Meningitis can occur in infants, children, and adults. Some bacteria and viruses are more common in certain age groups than others, including the following:

Bacteria that can cause meningitis (bacterial meningitis):

In newborns and young babies, the most common bacteria include the following:

In older babies and children, the most common bacteria include the following:

• Streptococcus pneumoniae
• Neisseria meningitidis (meningococcal meningitis)

Haemophilus influenzae type b (Hib)Other bacterial infections that may cause meningitis include the following:

• Treponema pallidum (Syphilis)
• Borrelia burgdorferi (Lyme disease)
• Mycobacteria tuberculosis (Tuberculosis)

Viruses that commonly cause viral meningitis include:

• Enteroviruses (such as coxsackieviruses and echoviruses)

• Polioviruses
  
   
• Herpes simplex virus (HSV)

• Arboviruses (such as La Crosse and West Nile)

Parasites are uncommon causes of meningitis. Examples include:

• Taenia solium (cysticercosis), Trichinella spiralis, Toxoplasma gondii, Borrelia burgdorferi (Lyme disease)
• Fungi are uncommon causes of meningitis. Examples include:Candida, Aspergillus, Cryptococcus, Histoplasma, Blastomyces and Coccidioides, Cryptococcus neoformans

Meningitis caused by a virus is more common and, with the exception of herpes simplex virus infection, usually less severe. Bacterial meningitis is usually more severe and may produce long-term complications or death.

How is a meningitis infection transmitted?

The organisms that cause meningitis usually colonize in a person's respiratory tract and may be transmitted by close contact with people who may be carrying the infection, or by touching contaminated objects, such as doorknobs, hard surfaces, or toys, and then touching the nose, mouth, or eyes. The organisms may also be transmitted through respiratory secretions from a sneeze, close conversation, or by touching infected matter.

The infection usually starts in the respiratory tract and then travels into the bloodstream where it can reach the brain and spinal cord. The organism may first cause a cold, sinus infection, or ear infection (more common in children), and then travel through the sinuses into the brain and CSF, although this method of transmission is less common. A child may have no symptoms at all, but may carry the organism in his nose and throat.

Symptoms & Types

The symptoms of meningitis vary depending on the organism that is causing the infection. However, each child may experience symptoms differently. Symptoms may include:

In infants (symptoms may be difficult to pinpoint):

• Irritability
• Fever
• Sleeping more than usual
• Poor feeding
• High-pitched cry
• Arching back
• Cries when picked up or being held
• Inconsolable crying
• Bulging fontanelle (soft spot on an infant's head)
• Noticeably different temperament
• A purple-red splotchy rash

In children older than one year:

• Neck and/or back pain
• Headache
• Sleepiness
• Confusion
• Irritability
• Fever
• Refusing to eat
• Decreased level of consciousness
• Seizures
• Photophobia (sensitivity to light)
• Nausea and vomiting
• Neck stiffness
• A purple-red splotchy rash

The symptoms of meningitis may surface several days after your child has had a cold and runny nose, or diarrhea and vomiting. The symptoms of meningitis may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

Diagnosis & Tests

In addition to a complete medical history and physical examination, diagnostic procedures for meningitis may include:

• Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.
• Blood testing
• Computed tomography scan (CT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.  A CT scan is sometimes done to rule out other conditions, but cannot, by itself, diagnose meningitis. 

Treatment & Care

Specific treatment for meningitis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history
• Extent of the disease
• The organism that is causing the infection
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Bacterial meningitis. Treatment for bacterial meningitis usually involves intravenous (IV) antibiotics. The earlier the treatment is initiated, the better your child's outcome. Antibiotics work by killing bacteria. . A corticosteroid, or steroid, such as dexamethasone, is generally given for bacterial meningitis in children. Antibiotics work by killing bacteria; fragments of these dying or dead bacteria may cause inflammation. The steroid works by decreasing the inflammation and reducing pressure that can build up in the brain.
• Tuberculous (TB) meningitis. A long course (one year) of medications is recommended for children who develop TB meningitis. The therapy usually involves treatment with several different medications for the first few months, followed by other medications. Corticosteroids, or steroids, are usually given for children with TB meningitis to decrease the inflammation and pressure that build up in the brain.
• Viral meningitis. Treatment for viral meningitis is usually supportive (aimed at relieving symptoms). With the exception of the herpes simplex virus, there are no specific medications to treat the organisms that cause viral meningitis. Most children with viral meningitis recover on their own without treatment.
• Fungal meningitis. An intravenous anti-fungal medication may be administered to the child with fungal meningitis.
• Parasitic meningitis. Treatment varies and depends on the cause and extent of disease. Your child may receive oral antiparasitic medication in combination with corticosteroids.

What is supportive therapy for meningitis?

While your child is recovering from meningitis, other therapies may be initiated to improve healing and comfort and provide relief from symptoms. These may include the following:

• Bed rest
• Increased fluid intake (this may involve encouraging fluids at home or receiving intravenous fluids in the hospital)
• Medications (to reduce fever and headache)
• Supplemental oxygen or mechanical ventilation (respirator) may be required if your child becomes very ill and has difficulty breathing

How can meningitis be prevented?

Several vaccines are currently available to prevent some of the bacterial infections that can cause meningitis, including the following:

• Although pneumococcal vaccines have been used for older children and adults for many years, the American Academy of Pediatrics (AAP) now recommends a new form of pneumococcal vaccine for all children younger than age 2. This vaccine is called pneumococcal conjugate vaccine (PCV13). PCV13 can be given along with other childhood vaccines and is recommended at the following ages:

• 2 months
• 4 months
• 6 months
• 12 to 15 months

• For Neisseria meningitidis (meningococcal meningitis), a meningococcal vaccine is part of the routine immunization schedule for:

• Children 11 to 12 years of age (with a booster given at age 16) 
• Teens entering high school if they were not immunized at age 11 or 12 (with a booster at age 16 to 18, or up to 5 years later) 
• Infants and younger children at increased risk may also have this vaccine. Ask your child's health care provider about the number of doses and when they should be given.
• Haemophilus influenzae type b (Hib) is no longer a common cause of meningitis in the United States because the Hib vaccine is given as a three or four part series during your child's routine immunizations starting at 2 months of age.

If you have questions regarding prevention, please consult your child's doctor.