Meningitis in Babies: Causes, Symptoms & Treatment

MENINGITIS IN BABIES

The meningeal coverings along with the brain and spinal cord constitute the central nervous system. The pia mater, arachnoid and the dura mater together form the meninges, which acts as shock absorbers and lubrication for the inner nervous tissues. An inflammation of any of these layers is known as meningitis.



What Is Meningitis?

Meningitis is a syndrome characterized by inflammation of the meninges covering the brain or spinal cord. It may affect newborns, young children or adults with a vulnerable immune system. It is preventable and curable, yet carries significance as it may lead to severe neurological complications, especially baby meningitis.





Types Of Meningitis

Meningitis can be categorized from the organisms which cause it:

  • Bacterial meningitis: Various bacteria can be responsible for causing meningitis in adults as well as children, like Streptococcus pneumonia, meningococcus and staphylococcus.
  • Viral meningitis: Viruses like Hemophilus influenza are known to cause meningitis in newborns and infants. Viral meningitis in infants is a serious problem in developing nations.
  • Tuberculous meningitis: Mycobacterium tuberculosis causes tuberculosis of the meninges.
  • Fungal meningitis: It is a rare type of meningitis, usually reported in who have diseases like HIV and AIDS.

Can An Infant Get Meningitis?

Meningitis can affect healthy newborns and infants. Following conditions make infants and young children more prone to it.




  • Prematurity, intrauterine growth retardation and low birth weight
  • Infections like rubella, measles
  • Tuberculosis in the mother
  • Complicated labour with assisted reproductive techniques like vacuum or forceps delivery
  • Other Congenital neurological problems
  • Poor sanitation and unhygienic living conditions
  • History of any neurosurgical intervention in the baby

What Causes Meningitis In Babies?

Meningitis in infants might cause excessive irritability, poor feeding and sleepiness. Babies might have a persistent fever with bulging of the cranial fontanelles or soft spot.

Bacterial Meningitis

Following bacteria commonly cause meningitis:





  • Streptococcus pneumonia or pneumococcus
  • H. influenza-type B (prevalent in newborns)
  • Neisseria meningitidis or Meningococcus- Meningococcal septicemia is associated with widespread petechiae and purpura.
  • E. coli
  • Group B streptococcal strains (also common in newborns)

Viral Meningitis

Enteroviruses are responsible for most cases of aseptic meningitis in children. They are common in summers and tropical countries.

Viral or Aseptic meningitis is also commonly caused by the following viruses other than entire group:




  • Cytomegalovirus or CMV
  • West-Nile virus
  • Human Herpesvirus (HHV)-2
  • Lymphocytic choriomeningitis virus

Sign & Symptoms Of Meningitis In Infants

Meningitis can have varied manifestations depending on the age group:

Babies can have following symptoms due to meningitis. However, these symptoms in babies are not specific to meningitis and can be present due to other systemic infections.





  • Irritability
  • Feeding problems
  • Continuous fever or pyrexia
  • Nausea and vomiting, mostly projectile
  • Fontanelle bulge – due to the raised intracranial tension
    Continuous Fever

Toddlers or children (less than 1.5 years) may exhibit the following symptoms:

  • Excessive crying and irritability
  • High-grade fever
  • Generalised or partial seizures
  • Drowsiness
  • Unusually lethargic
  • Projectile vomiting
  • Bulging fontanelles
  • Pain and tenderness in the neck usually discovered with passive neck movements

Older children usually have one of the following along with neck stiffness as the main symptoms:




  • Altered state of the sensorium
  • Seizures
  • Pyrexia
  • Intense headaches
  • Photophobia
  • Nausea and vomiting

Diagnosis Of Meningitis

The Diagnosis of meningitis primarily includes the following:

  • A detailed history of clinical symptoms: History of the onset and duration of symptoms like fever, neck pains or seizures along with associated symptoms if any.
  • Complete physical examination: Central nervous system examination
  • Lumbar puncture and CSF analysis: Testing the cerebrospinal fluid for routine and microscopy to identify the causative organism, CSF Protein levels and CSF sugars.
  • Neurological imaging: CT scan and MRI of the brain can detect meningeal enhancements and tubercular meningiomas.

Routine blood investigations:





  • Complete and differential blood counts
  • Electrolytes like sodium, potassium, calcium and magnesium levels.
  • Blood glucose
  • Liver function and kidney function tests
  • Erythrocyte sedimentation rate

Additional tests may include:

  • Virological studies (PCR for CSF)
  • Serological studies (VDRL for syphilis)

Tumbler test: Certain infective causes of meningitis like meningococcemia may manifest with a peculiar rash and fever. The tumbler test includes a glass tumbler being pressed against the rash and if the rash becomes clearer, the result is considered to be positive.




Treatment

Following are the general treatment guidelines for meningitis:

  • Once meningitis is clinically suspected, a CSF examination helps in determining the probable cause or organism responsible. Appropriate antimicrobial therapy is then provided.
  • Treatment should be supplemented with meningitis vaccine for babies.
  • Treatment for raised ICT: IV osmotic diuretics like mannitol infusion.
  • Therapy for seizures: Antiepileptic drugs like phenytoin and phenobarbitone.

Treatment of viral meningitis:





Herpes simplex meningitis

Since viral or aseptic meningitis can be asymptomatic, treatment may be restricted to conservative management without antiviral therapy unless associated with encephalitis. The antiviral agent Acyclovir (intravenous at 10 mg/kg 8 hourly for 1-2 weeks) is the mainstay treatment for HSV 1 & 2 meningitis.




Cytomegalovirus meningitis

Ganciclovir and foscarnet are the antivirals of choice for CMV meningitis in immune-compromised patients.


Treatment of bacterial meningitis:

Antibiotic therapy: neonates (up to age 1 month)

The most common microorganisms in neonates with meningitis are streptococci grp B or D, E.coli, and Listeria monocytogenes. Treatment comprises of a combination of ampicillin (50mg/kg 8 hourly for infants or up to 1 week and 100mg/kg 4 times daily for 7-28 days neonates) with cefotaxime (50-60mg/kg 6-8hourly for 2 weeks).

Alternative regimens include ampicillin with gentamicin (in a dose of 2.5mg/kg IV/IM 8 hourly for 2-3weeks)


Antibiotic therapy: age 1-3 months

First line treatment comprises of IV ampicillin (50-100 mg/kg IV 6 hourly) with cefotaxime (50 mg/kg 6 hourly) or ceftriaxone (50-75 mg/kg 12 hourly).

Vancomycin (15 mg/kg IV 8 hourly) should be added for drug-resistant s.pneumoniae.

Steroid cover with Dexamethasone (0.4-0.6mg/kg 2-3 times/day) should be initiated 15-20 minutes before the antibiotic course.


Antibiotic therapy: between 3 months to 7 years

Antibiotic guidelines remain the same with either ampicillin plus cefotaxime or ceftriaxone or the cephalosporins alone in high dose.

An alternative for penicillin-allergic patients is IV chloramphenicol (25 mg/kg 12 hourly) plus vancomycin (15 mg/kg IV 12hourly).

Vancomycin (15 mg/kg IV 8 hourly) should be added for drug-resistant pneumonia.


Steroid cover with Dexamethasone (0.4-0.6mg/kg 2-3 times/day) should be initiated 15-20 minutes before the antibiotic course.

Complications Of Meningitis

In infants and children meningitis may cause the following acute complications:

  • Seizure disorder
  • Cerebral abscesses
  • Sensorium problems including obtundation and coma states

Since infants and young children are in their growth phase, meningitis on a long-term may affect their neurodevelopment.

  • Hearing impairment: The auditory nerve may be commonly involved in meningitis.
  • Learning difficulties: It may affect the general IQ and cognitive skills of the child.
  • Motor affection: Meningitis in infants may involve the motor system and might result in abnormal gait.

Is Meningitis Contagious And How Does It Spread

Meningitis being an infective disorder, is contagious, and may spread to close contacts and the community in general.

Pathogens like streptococcus and Hemophilus influenza are present in the nasal passage and the throat of affected patients before affecting the meninges. They may spread through coughing, spitting, sneezing and kissing too. Viral meningitis may follow childhood illnesses like measles and mumps and may similarly spread among children.

When Should You Call A Doctor?

You should consult a clinician if you notice any of the following in your child:

  • A rash with or without fever
  • High-grade fever, usually not responding to routine medications
  • Unusual symptoms like excessive sleepiness or highly irritable
  • Neck pains or visual problems
  • Seizures
  • Close contact with meningitis at school

Prevention Of Meningitis

Following are a few precautionary measures that can be followed to prevent meningitis.

Vaccination

Since the majority of meningitis cases are caused either by pneumococcus, meningococcus or H. influenza, vaccines available against these organisms.

Vaccination

Hib (Haemophilus influenzae type b) Vaccine

Vaccination against H influenzae type B (Hib): Although HiB vaccine is not included in the national immunisation schedule as a mandatory vaccine, it is strongly recommended in susceptible populations as well as all children aged 2 months to 15 months up to 5 years for a catch-up vaccination. It is administered as Intramuscular injections 2-3 doses between 6 weeks to 12 months age as primary vaccination, while the 3rd or 4th dose or the booster is given at 12-15 months age.

Pneumococcal Vaccine

  • PCV13 (13-valent pneumococcal conjugate vaccine) 0.5ml intramuscular injections are routinely administered in a 4 dose series at 2, 4, 6 and 12 months of age.
  • Polyvalent PPSV23 (23-valent pneumococcal polysaccharide vaccine) intramuscular vaccine is advised only for children above 2 years. It is given as 0.5ml IM injection only in high-risk patients (chronic lung or kidney disorder, steroid therapy) along with routine PCV-13 vaccine.

Meningococcal Vaccine

  • The meningococcal vaccine protects against all 4 strains of Neisseria meningitides, namely A, C, Y and W-135. It is recommended only for children above 2 years. It is given as a single 0.5ml SC dose.
  • Meningococcal group B vaccine is recommended along with the routine tetravalent vaccine in a high-risk population of children more than 10 years. It is given as 0.5ml IM dose in a series at 0,2 and 6 months.

Preventing Germs

Maintaining general hygiene is the best way to avoid germs. It includes habits like frequent handwashing, taking a regular bath, avoiding spitting, avoiding close contact with a known case of infectious disease. Young children and adults who are in close contacts with such infected individuals (family members or healthcare attendant) should consult a doctor for preventive prophylaxis.

Meningitis. although it is a serious health hazard, can be easily recognized and cured with awareness and healthcare services. Prevention of meningitis in infants and babies with vaccinations is vital to prevent long-term neurological complications.

Also read: Childhood Vaccinations For Various Diseases