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Quick reference medical handouts used by Pediatric offices


The Facts about Meningitis


When two reports surfaced last month of college students contracting an infectious disease known as meningitis, many parents were greatly alarmed by the dramatic and frightening news coverage. Judging by the numerous phone calls received in pediatric offices and at the health department, there is considerable confusion in parent’s minds about this illness. When parents read about a case of meningitis or are told that their child’s classmate has this infection, how much do they really have to worry? Of the different infectious diseases of childhood, meningitis is probably the most respected by physicians and feared by parents. What exactly is this dreaded disease?

We have three layers of tough protective linings surrounding our brain and spinal cord. The term "meningitis" simply means inflammation of the meninges. These infections arises from a number of sources, the most common cause being viruses. Even though it occurs less frequently, bacterial meningitis often results in more serious illness since bacterial cause more inflammation and scarring.

The less worrisome viral form of meningitis usually arises from an ordinary viral infection. The symptoms of viral (sometimes called "aseptic") meningitis are generally mild and similar to those of other viral ailments such as influenza or the common cold. Viral meningitis is rarely fatal and recovery is usually complete.

Bacterial meningitis remains one of the most important infectious diseases encountered by physicians who care for children.The responsible organisms can severely damage or kill nerve and brain tissue, sometimes inflicting permanent neurological injury if left untreated. The names of the bacteria that cause the most cases of bacterial meningitis in children are the pneumococcus, Hemophilus influenzae type b (nothing to do with the organism that causes the flu!), and meningococcus, the latter being the organisms respnsible for last month’s widely publized cases. Since the meninges are well insulated from the outside world, most cases of bacterial meningitis arise from germs which enter the blood stream from the respiratory tract and then spread to the meninges. These bacteria are transmitted from person to person in nasal droplets and by sharing food and eating utensils. The incubation period is usually two to 10 days after exposure and over 75% of those who will develop the illness do so within a few days after they come in contact with an infected person. Therefore, by the time parents read about a case of meningitis in the paper or learn that one of their child’s classmates has been hospitalized with this infection, the danger to their child has probably passed.

The symptoms of meningitis occur slowly or hit suddenly, depending on the cause and the individual child’s age and susceptibility. Since the early signs of meningitis -- fever, irritability and headache -- may be similar to those of the flu or common cold, the diagnosis may be delayed while meningitis is still in an early stage. This is why parents need to become familiar with its symptoms in order to judge when prompt medical attention is needed.

As a general rule, the younger the child, the less specific the symptoms. In infants, meningitis usually begins slowly. Irritability, restlessness, an unusual high pitched cry, displeasure at being handled and poor feeding may be the only symptoms. In toddlers and young children, additional symptoms correspond to signs of meningeal inflammation- vomiting, drowsiness, sensitivity of the eyes to light, severe headache and stiff neck. By far the most distinctive feature of meningitis is the stiff neck, although in children below the age of one this symptom may not be present until very late in the illness. In older children with meningitis, any neck movement is so painful that the child tends to lie still with their neck straight. Since children frequently complain of a stiff neck during the course of an upper respiratory disease, a good test is for parents to ask their child to "kiss a knee." If the child can bend their neck forward and flex their knee so that the knee can be "kissed," the neck pain is probably not due to meningitis. This can be done either with the child sitting or laying down position. Temperature may be high or even normal, and in about 30 percent of cases convulsions occur. Bacterial meningitis is characteristic in that symptoms progress rapidly and there is usually no period when the child seems to "get better."

When a physician suspects meningitis, blood samples are drawn and a lumbar puncture or "spinal tap" is done to obtain cerebrospinal fluid (the liquid that bathes the brain and spinal cord). A needle is inserted into the child’s lower back so a small amount of fluid can be withdrawn for analysis. Although the very thought of a "tap," may alarm parents, the procedure is safe and causes only minimal, if any discomfort to the child. Normally clear, the cerebrospinal fluid becomes cloudy when bacterial meningitis is present because of an accumulation of disease fighting white blood cells and disease causing bacteria. A medical laboratory will often contribute to the diagnosis by identifying the causitiv organism from the fluid obtained.

When bacterial meningitis is the presumed diagnosis, a child must be admitted to the hospital for the administration of intravenous antibiotics and fluids, as well as observation for complications. Should the tests of the spinal fluid eventually prove negative, then the antibiotics are discontinued. However, if bacterial meningitis is indeed confirmed, then the antibiotics will have been the most important intervention in the youngster’s life.

Household and other close contacts of people with certain kinds of bacterial meningitis may be given an antibiotic called Rifampin to protect them against the development of meningitis. Taken as soon as possible (within 48 hours of contact) it can usually forestall illness. Rifampin may also be used during outbreaks in daycare centers or nursery schools. Antibiotics are not effective against viral forms of meningitis

A important step in the prevention of bacterial meningitis was the development of the Hemophilius influenzae type B vaccine. Administered at 2,4,6 and 15 months of age, the HIB vaccine has dramatically decreased the incidence of hemophilius influenzae type B meningitis in children Since meningitis in older children and adults is usually due to different bacteria, the Hib vaccine is not useful at later ages. Vaccines available against meningococcal bacteria are of limited usefulness, their effectiveness hampered by the need for an immunization that would protect against all the different forms of this bacterium.

Despite medical advances, meningitis still lingers as a dangerous disease for the pediatric population. Through knowledge of the disease and recognition of its symptoms, parents can play a crucial role in its early recognition since immediate treatment goes a long way towards preventing neurologic complications and saving lives. Hopefully, the development of new vaccines in the future will do much to even further reduce the incidence of this serious illness.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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