Risk of Meningitis in Febrile Young Children

Introduction:

Meningitis is the inflammation of the meninges. Meninges are the outer coverings of the brain and the spinal cord. The causative agents of meningitis are bacteria or viruses, and sometimes fungi or parasites also. Noninfectious types of meningitis can also be caused due to cancers, lupus erythematosus, surgery, certain types of drugs, head injury, and brain injury.

What Is Meningitis?

Meningitis is caused when bacteria and viruses enter the CSF (cerebrospinal fluid). CSF protects the brain from shock or any other injuries. It provides a cushioning effect to the brain and the spinal cord. The symptoms of meningitis include fever, headache, and stiffness. Meningitis can be cured independently or may require urgent treatment. It could be a life-threatening condition in some cases.

What Causes Meningitis in Febrile Young Children?

Febrile seizures are the most common type seen in 2 to 5 % of children up to five years of age. The seizures may be the only presentation of bacterial meningitis in febrile children. Meningitis is often caused by a bacterial or viral infection that enters the CSF. However, the exact cause cannot be determined in some children. Still, it is usually seen in children with weak immune systems, recurrent sinus infections, serious head injuries, skull fractures, brain surgery, and cochlear implants.

The most common causes of meningitis are:

• Bacterial Infections: The most common bacteria that cause meningitis is group B streptococcus, E.coli, haemophilus influenza type B, and streptococcus pneumoniae. Syphilis, tuberculosis, and Lyme disease may also be the reasons that cause meningitis. The agents that cause meningitis usually affect the child's respiratory tract. A child may sometimes show no symptoms but still carry the agent in the nose and the throat.

The infection usually spreads by close contact with the infected person, by touching the infected objects such as doors, tables, toys, etc., and then touching other body parts like the eyes, or mouth, through droplets of sneezing, coughing, or kissing.

An infection’s occurrence is primarily seen in the respiratory tract, first causing a cold, throat, sinus, or ear infection. It can then go to the bloodstream, and then to the brain and spinal cord.

• Viral Infections: Viruses that cause viral infections include poliovirus, the mumps virus (paramyxovirus), the flu virus, and the West and Nile viruses.

• Fungal Infections: It is rarely caused due to the inhalation of fungal spores from the environment. People with certain medical conditions like diabetes, HIV, or cancer are at a higher risk of fungal meningitis.

• Other Causes: Parasitic meningitis can also affect the brain and the spinal cord in some ways. Sometimes the non-infectious type of meningitis can also be caused due to cancer or certain drugs.

What Are the Symptoms of Meningitis in a Child?

The symptoms of meningitis differ as per the causative agent. The initial symptoms may be a cold and runny nose followed by diarrhea and vomiting. The symptoms may vary from child to child and may occur suddenly or late. In babies, the symptoms include:

• Irritability.

• Fever.

• Sleeping more than usual.

• Poor feeding.

• Crying that cannot be soothed.

• Bulging soft spots on the head.

• Arch on the back.

• Abnormal body temperature.

• Vomiting.

• Seizures.

The symptoms in children over one year of age can be different, such as:

• Neck pain.

• Backpain

• Headache.

• Confusion.

• Loss of appetite.

• Fever.

• Seizures.

• Reduced level of consciousness.

• Eye sensitivity to light.

The symptoms of meningitis could be similar to other diseases, and if the baby is too young, he may not be able to explain it adequately. Therefore, it is very important to obtain a proper diagnosis of the disease.

How Is Meningitis Diagnosed?

Consult the healthcare provider immediately after noticing the first symptom. Firstly the healthcare provider takes a detailed history and conducts a physical examination. A few tests may be suggested, such as,

• Blood Test- This will help diagnose the infection that causes meningitis.

• Lumbar Puncture (LP) or Spinal Tap- In this technique, a needle is placed in the spinal canal, an area surrounding the spinal cord. The pressure around the spinal canal is measured. A small amount of cerebrospinal fluid (CSF) is obtained via a needle and is sent for testing. This is the only confirmatory test for meningitis.

• CT Scan or MRI- These tests show brain images. A CT scan is sometimes done to check for other conditions whose symptoms resemble meningitis. An MRI test is usually done to check the swelling in the meninges. This test gives more details. But meningitis cannot be diagnosed using them alone.

• Nasal, Throat, or Rectal Swabs- These tests usually helps in diagnosing the viral infections that cause meningitis.

How Is Meningitis Treated In A Child?

Meningitis is treated as per the underlying cause, whether it is caused due to bacteria, viruses, fungi, etc. The treatment protocols also depend upon the age, symptoms, general condition of the child, and severity of the disease. As per the cause, the treatment is as follows:

• Bacterial Meningitis- It is started as soon as possible. IV antibiotics are started to kill the bacteria. Corticosteroids are also suggested depending on the age of the child. Fluids are given to prevent dehydration. Steroids help in decreasing the inflammation of the meninges.

• Viral Meningitis- Usually, it gets normal on its own. There are no precise medicines to treat viral meningitis, but treatment can be provided to ease symptoms. Only the herpes simplex virus can be treated with IV antiviral therapy. Babies with weak immune systems may need to remain in the hospital for some time.

• Fungal Meningitis- It is treated by giving IV anti-fungal therapy.

• Tuberculous (TB) Meningitis- In this type of meningitis, medication can be given over 1 year. Other than this, bed rest is also suggested in some cases.

How to Prevent Meningitis?

Prevention of such diseases can be done by taking the vaccines on time. These vaccines are:

• Pneumococcal Vaccine- This is very effective in preventing meningitis caused by pneumococcal bacteria, starting at two months of age, followed by other doses at four, six, 12, and 15 months.

• Meningococcal Vaccine- It is given at 11 to 12 months of age, followed by a booster dose at 16 months.

• H-influenza Type B Vaccine- It is a 3 to 4-part series, starting at two months of age.

Conclusion:

The frequency of bacterial meningitis with febrile seizures is not too high. It is most commonly seen in children below 18 months of age. Bacterial meningitis may show the first attack of febrile seizures, loss of consciousness, etc. It could be prevented with proper vaccination. The treatment protocols differ with the causative agent and the child's age.