Meningitis in babies and children

Meningitis refers to an acute inflammation of the meninges, which primarily endangers people with a weakened immune system, but also infants and young children. It is usually triggered by an infection with viruses or bacteria. Vaccination is possible against two of the meningitis pathogens, namely meningococcus and pneumococcus. Since 2006, the Permanent Vaccination Commission at the Robert Koch Institute has recommended vaccination against meningococci and pneumococci. This vaccination recommendation applies to children and is considered basic immunization.

If meningitis is suspected, immediate treatment is particularly important. The meninges surround the brain and have the task of protecting it from mechanical impact. In addition, blood vessels and drainage channels for the nervous fluid produced in the brain (cerebrospinal fluid) run through this area. If these meninges are inflamed, this can considerably impair the function of the brain. Temperature and water balance are disturbed. For this reason, the effects can be particularly serious for young children. In the worst case, meningitis ends lethally. Particular attention should be paid to bacterial meningitis, as this can be very serious and must therefore be treated quickly. To prevent too late detection, parents should be able to recognize the most important symptoms. These include stiff neck, fever and sensitivity to light.

During the winter and spring months, there is an increased incidence of meningitis. All in all, meningitis is nevertheless one of the rare infectious diseases in Germany. Currently, the number of cases is about 0.5 to five per 100,000 inhabitants. In countries with less good hygienic conditions, the number of diseases is considerably higher.

Bacteria:

The most common pathogens for bacterial meningitis in children include pneumococcus, meningococcus, and Haemophilus influenzae. In many people, meningococci can be found unnoticed in the nasopharynx without causing any damage. However, if the affected person suffers from a weakened immune system, the bacteria easily spread via the bloodstream and thus reach the meninges, where they can be the trigger for meningitis.

Meningitis can also develop as a complication of pneumonia, otitis media or tuberculosis. Another risk factor is a skull base fracture, which allows bacteria to easily reach the meninges or brain from the outside.

Meningococci, which are transmitted by droplet infection, are considered particularly infectious. This happens, for example, when coughing, sneezing or talking. Places where many people come together in a confined space, such as kindergartens or schools, are particularly at risk.

In newborns, it is usually safe to assume that other bacteria, such as streptococci (Streptococcos agalactiae), Escherichia coli and Proteus mirabilis, cause meningitis.

Viruses:

Early summer meningoencephalitis (TBE) is transmitted by viruses. The risk of infection is particularly high in densely wooded epidemic areas from March to November. Children should be vaccinated in any case, as they are very often victims of tick bites.

Meningitis can show full symptoms within a few days. In some cases, this can happen within hours.

The characteristic symptoms include:

• Headache
• Neck stiffness
• Sensitivity to light
• Sensitivity to touch
• Sensitivity to pain

Nevertheless, these characteristics do not necessarily have to occur. Frequently, infants show other symptomatology, which may include abdominal pain, speech difficulties, and/or vomiting.

Other signs may include:

• High fever
• Lack of playfulness, loss of appetite
• Fatigue, drowsiness, which can go as far as confusion or unconsciousness
• Epileptic seizures
• Rash, which may appear as bright to dark red spots or patches (petechiae).

In babies, other symptoms include the following:

• Sudden refusal to eat
• Jumpiness
• High-pitched and shrill crying
• Conspicuous sleepiness and apathy
• Bulging bone gap in the child's skull (fontanelle)

If these symptoms occur, a doctor should be consulted immediately.

Often there is a very clear symptomatology that suggests meningitis. These symptoms include stiff neck (meningismus) headache, sensitivity to light and touch.

Lumbar puncture:

To diagnose meningitis, the doctor removes some cerebrospinal fluid (CSF). This is done with the help of a fine needle, which is used to draw a small amount of cerebrospinal fluid from the spinal canal. This sample is then examined for bacteria, viruses and signs of inflammation. This examination may not be entirely painless. Local anesthetic patches are used to counteract the pain.

Blood test:

To also identify bacteria and signs of inflammation, a blood sample will be drawn to be tested in the laboratory. After the blood sample is taken, the immune response of the blood and CSF is compared. If antibodies to a particular pathogen are found in both fluids, the cause can be determined with certainty. For some pathogens, such as meningococci, the particularly rapid detection method of polymerase chain reaction (PCR) can also be used.

Further examinations:

If it is suspected that a child is suffering from meningoencephalitis, i.e. both meninges and brain tissue are affected, a computer tomography (CT) or magnetic resonance imaging (MRI) is also performed. This allows early detection of possible complications such as brain swelling (cerebral oedema), drainage disorders from the cerebral ventricles (hydrocephalus) or abscesses.

Bacterial meningitis:

Even if the suspicion of meningitis is not yet confirmed, antibiotic therapy should be given immediately. This should last eight to ten days. If the laboratory findings provide clear confirmation, the patient is treated in hospital for a further seven to 14 days.

If the causative pathogen has not yet been isolated, treatment is usually given with a combination of several antibiotics. Once the pathogen has been identified and its sensitivity to antibiotics has been tested, treatment can be continued with a single antibiotic that is most effective against the pathogen in question.

In most cases, one can assume a low probability of side effects with antibiotic administration. However, sometimes intolerance reactions such as itching, diarrhea, and local irritation at the site of the infusion needle may still occur.

Viral meningitis:

In general, a milder course can be assumed for viral meningitis. Therefore, it is not treated with antibiotics, since this method cannot fight viruses. Depending on the symptoms and the virus, painkillers and antipyretic drugs can be used. Nevertheless, children with viral meningitis should remain under observation in hospital in order to deal with complications at an early stage.

Bacterial meningitis:

If meningitis is detected and treated in time, there is a good chance of recovery in most cases. However, this depends on the type of pathogen, as well as the period of time from the first symptoms to the start of antibiotic therapy. Once the child has survived the meningitis, follow-up care should be provided.

In contrast to bacterial meningitis, viral meningitis is rather rare. Without treatment, bacterial meningitis often leads to death. Even with timely treatment, up to ten percent of children and adults die from this disease, as it can develop very quickly in some cases. In infants, the problem is compounded by the fact that symptoms are often not clearly identifiable, and therefore treatment does not begin until later.

Viral Meningitis:

Meningitis caused by viruses usually shows a milder course in children than bacterial meningitis.

One danger of meningitis is the transition to encephalitis (inflammation of the brain). This can leave permanent damage to the child's hearing and brain. Furthermore, it can lead to epileptic seizures and, in the worst case, to death. Permanent damage can also cause physical or mental disabilities in the child.

To counteract meningitis, as well as other infectious diseases, it is important to make sure that the child's immune system is not weakened for a long time. This can be the case, for example, with inadequate nutrition or a protracted flu infection. Therefore, it is important to eat a balanced diet rich in vitamins and to always cure minor illnesses.

Since 2006, the Permanent Vaccination Commission (STIKO) at the Robert Koch Institute has recommended meningococcal and pneumococcal vaccinations for children as basic immunisation. From the age of three, children can also be vaccinated against Haemophilus influenzae type b (Hib).

After the first year of life, vaccination against early summer meningoencephalitis (FSME), which can be transmitted by ticks, is also an option. People who live in areas where TBE is widespread should be vaccinated.

If a case of meningitis is known in the vicinity, contact with possibly infected persons should be prevented. Meningococcal infections must be reported and isolated. If meningitis has been diagnosed, parents, close family members and friends are also given antibiotics to swallow (chemoprophylaxis), such as rifampicin, which is also effective against pneumococci.