Meningitis

One of the most respected and feared illnesses seen both in the pediatric and adult community, meningitis has made its way into the news recently and will be heard from time and again. Meningitis is an infection causing inflammation of the lining of the brain and spinal cord (meninges) and the surrounding cerebral spinal fluid (CSF). This infection can be caused generally by bacterial organisms (purulent meningitis) or by viral organisms (aseptic meningitis). The former is far more serious than the latter. Because this inflammation occurs in a closed space and the importance of the surrounding structures make this a most serious and life threatening illness.

Bacterial meningitis in the child can initially begin as many other illnesses with fever, vomiting, lethargy, irritability and headache. The illness generally worsens with the possibility of convulsion, decreased level of consciousness and/or increased irritability such that a child will not be consoled. The child may complain of or exhibit stiff neck most noticed by pain in the back of the neck on forward motion (flexion). In the case of meningococcal disease a rash may be present and sometime a rash which does not blanch with pressure (petechiae). Certainly in the younger child the diagnosis may be more difficult and the physician who is suspicious will order lab work which would include blood count and spinal tap. The examination of the spinal fluid will often identify the condition by finding increased numbers of pus cells (WBC'S) and bacteria. An astute degree of suspicion is necessary in diagnosing meningitis, as early diagnosis and treatment are essential. Even when treated properly meningitis can cause complications ranging from neurological deficits to deafness. Meningitis that is untreated or delayed can be fatal.

There are numerous causes of bacterial meningitis. The most common organisms in childhood meningitis (excluding newborns) are H. influenzae, N. meningitidis and S. pneumoniae. As most infants receive the HIB vaccine the incidence of H. influenzae meningitis has declined. The recent cases of meningitis in Rhode Island were attributed to the N. meningitidis strain also known as meningococcus. There are 13 serogroups of this organism but Group B and C cause the majority of cases.

Parents are appropriately concerned with measures to prevent this illness. Transmission of the bacteria generally occurs by person to person and droplet spread. Our best means of prevention is prompt prophylactic administration of antibiotic to close contacts of the child who developed the illness. This might include daycare and school contacts, athletic teams, baby sitters, family and friends who have been in contact with the child. Infants and children sharing toys or bottles or cups are included. The use of the meningococcal vaccine, which covers groups A, C, Y and W-135, is generally recommended when the department of public health determines that an outbreak confirmed meningococcal disease has occurred. There are defined criteria for what constitutes an outbreak and can be found at the Massachusetts Department of Public Health Web site. Remember that sporadic use of vaccine in exposed individuals should not be used in place of antibiotics as the vaccine could take 7-14 days for an immune response and secondary cases can occur within 6 days of exposure (Mass.DPH).

Ref: Pediatrics, Abraham Rudolph, and 18th Edition 1987

Meningococcal Disease: Neisseria meningitidis, Massachusetts Department of Public Health Feb.1997