Meningitis

Meningitis is a bacterial or viral infection that causes three thin layers of tissue that surround the brain and the spinal cord to swell. Doctors at Boston Children’s Hospital have been leaders and innovators in the treatment of meningitis complications for decades.

• Viral meningitis is more common and less severe
• Bacterial meningitis may cause long term complications, including death
• Vaccines help prevent some forms of bacterial meningitis
• Treatment for bacterial meningitis includes antibiotics
• There is no treatment for viral; most children recover on their own
• Early treatment can help prevent serious problems

About 3,000 people in the United States — or one in 100,000 — are diagnosed with bacterial meningitis each year, most of them infants, children, college students, and the elderly.

Incidences of bacterial meningitis usually peak in the winter or early spring. The most common cause of bacterial meningitis in children, Haemophilus influenzae b (Hib), has been almost eliminated due to a vaccine that was developed at Boston Children’s in 1990.

Several vaccines are available to prevent some of the bacterial organisms that can cause meningitis, including:

• H. influenzae type b vaccine (Hib): given as a three or four-part series during your child’s routine immunizations, starting at 2 months
• Pneumococcal conjugate vaccine (PCV7): recommended by the American Academy of Pediatrics (AAP) for all children younger than age 2 and children ages 24 to 59 months of age that are at very high risk for pneumococcal infection. PCV7 can be given along with other childhood vaccines at 2 months, 4 months, 6 months, and 12 to 15 months
• Meningococcal vaccine: for meningococcal meningitis, a very contagious form of bacterial meningitis. This vaccine is normally given during the routine pre-adolescent immunization visit (at 11 to 12 years).

Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF), the fluid within the open spaces of the brain that protect and cushion the brain and spinal cord. A fungus or parasite may also cause meningitis. More specifically:

Bacteria that can cause meningitis include:

• Group B streptococcus
• Escherichia coli (or E. coli)
• Listeria monocytogenes
• Streptococcus pneumoniae
• Neisseria meningitides (meningococcal meningitis)
• Haemophilus influenzae type b or H. influenzae
• syphilis
• tuberculosis (TB)

Viruses that can cause meningitis include:

• Polioviruses
• Mumps (paramyxovirus)
• Herpes simplex virus (HSV)

Other microorganisms that can cause meningitis are:

• Borrelia burgdorferi (Lyme disease)
• Fungi such as candida, aspergillus, or cryptococcus neoformans

Bacterial meningitis can be spread through coughing or sneezing, kissing, or sharing drinks. In addition, you increase your chances of catching meningitis by:

• Having been in close contact with someone who has bacterial meningitis (especially when it’s due to meningococcus, a type of bacteria that is more contagious than others)
• Having a compromised immune system
• Having traveled to an area of the world where meningitis is widespread (consult your doctor for the recommended vaccinations before traveling overseas)

The symptoms of meningitis vary depending on what that caused the infection and the age of your child. They also may surface several days after your child has had a cold and runny nose, or diarrhea and vomiting. Your child may not display all of the signs and symptoms, but if you think your child is sick, seek medical attention immediately.

The most symptoms common include:

• In infants (symptoms may be difficult to identify):
  • Irritability
  • Fever
  • Sleeping all the time
  • Poor feeding
  • High-pitched cry
  • Arching back
  • Cries when picked up or being held
  • Inconsolable crying
  • Bulging fontanelle (soft spot on an infant’s head)
  • Noticeably different temperament
  • Seizures
• In children older than 1 year:
  • Neck and/or back pain
  • Headache
  • Sleepiness
  • Confusion
  • Irritability
  • Fever
  • Refusing to eat
  • Decreased level of consciousness
  • Seizures
  • Sensitivity to light
  • Nausea and vomiting
  • Neck stiffness

In addition to a complete medical history, physical exam, and blood tests, your child’s doctor may need to perform other procedures to confirm that your child has meningitis, including:

Lumbar puncture (spinal tap)

• A special needle is placed into your child’s lower back into the spinal canal.
• It measures the pressure in the spinal canal and brain.
• A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems.
• We don’t recommend this if your child is very ill.

Computerized tomography scan

• Also called a CT or CAT scan
• Uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body
• Shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• More detailed than general X-rays

Early treatment with antibiotics can reduce swelling and inflammation in your child's brain. Timing is crucial. If your child has symptoms of bacterial meningitis, go to the nearest emergency room right away.

If someone is in close contact with a person who has bacterial meningitis, such as a roommate, parent, sibling, daycare worker, classmate, or boyfriend or girlfriend, they are at an increased risk and should go to the doctor for antibiotics to prevent bacterial meningitis before symptoms occur.

Traditional treatments for meningitis

Treatment depends on the type of meningitis, but can include:

Bacterial meningitis

• Intravenous (IV) antibiotics
• The earlier the treatment starts, the better your outcome
• Antibiotics can start before the results of the lumbar puncture are available
• A corticosteroid, or steroid, such as dexamethasone can decrease inflammation and reduce pressure that can build up in the brain

Viral meningitis

• Tylenol can relieve symptoms.
• With the exception of the herpes simplex virus, there are no medications to treat the organisms that cause viral meningitis.
• Most children with viral meningitis recover on their own without treatment.

Fungal meningitis

• Anti-fungal intravenous (IV) medication

Tuberculosis (TB) meningitis

• A long course (one year) of medications
• Usually involves several different medications for the first few months, followed by other medications

Boston Children’s is constantly working to prevent, identify and treat meningitis is a more effective way. Some innovations by Children’s include:

• Development of the Haemophilus influenzae b (Hib) vaccine in 1990 has practically eliminated the most common cause of bacterial meningitis in children.
• A simple algorithm developed at Boston Children’s and the University of California, Davis, Health System in 2007 helps doctors rapidly distinguish infants and children with viral meningitis from those with bacterial meningitis — potentially reducing unnecessary hospital admissions and prolonged antibiotic treatment.
• The Children’s Hospital Informatics Program created HealthMap, an online resource and smart phone app that helps track the spread of contagious diseases in real time, including meningitis.