Meningitis (Children)

Meningitis means that the covering lining over the brain and spinal cord is inflamed. The bacterial Meningitis are less common but generally more serious, whereas the viral meningitis are more common but much less serious in its clinical course.

For viral Meningitis, most children recover completely from the acute illness. However non-specific symptoms such as malaise, tiredness, dizziness and headaches may continue weeks to months after the acute illness. Rarely there can be hearing impairment. Some have reported behavioural or learning problems years after recovery.

Bacterial Meningitis is much more serious, and death can occur due to septicemic (blood poisoning) shock from the bacterial organism. Death can also occur due to severe brain swelling that results in compression/pressure on the vital centres in the brainstem. Mortality from bacterial Meningitis is approximately 5% - 20% depending on the virulence of micro-organism involved. Other common complications in the acute illness include fluid and electrolyte abnormalities and even seizures.

Meningitis is often due to the presence of micro-organisms, which and be simply divided into those due to bacteria (Septic Meningitis) and those due to viruses (Aseptic Meningitis).

Most of the symptoms and signs are similar for both the bacterial and the viral Meningitis, and there is no one symptom or sign that is specifically indicate one or the other. The common clinical symptoms that may indicate Meningitis are fever associated with seizures, impairment of consciousness, irritability, lethargy, nausea and/or vomiting.

The important signs indicating Meningitis includes neck stiffness (pain or resistance to someone flexing the child's neck) and increased sensitivity to light (photophobia), usually in the presence of drowsiness or irritability.

For young infants where the anterior fontanel (soft spot on the top of the head) have not closed, this could be under increased pressure and bulging out of the scalp (bulging fontanel). Signs of bleeding under the skin (purpuric rash) together with other symptoms or signs indicating involvement of the brain may also suggest bacterial Meningitis.

In infant and young child with no clear source of infection for the fever present, a high index of suspicion need to maintained for the diagnosis of Meningitis. To confirm or exclude the diagnosis of Meningitis, doctors often have to perform a procedure called a lumbar puncture, to obtain cerebrospinal fluid for testing and culture for the micro-organisms.

Following prompt treatment with appropriate intravenous antibiotics, children that survive Bacterial Meningitis may also develop complications such as hydrocephalus (obstruction or impaired re-absorption of the fluid system in the brain due to scarring), which may then require an operation for relieve of the obstruction. Up to 30% of bacterial Meningitis is complicated by clinical deafness.

With two of the common bacterial organisms, this complication rate of deafness can be reduced with concomitant administration of steroid with the antibiotics at the initiation of the treatment. Potential long term sequelae will include physical and/or mental disability due to the inflammatory reaction, which can cause damage to the brain itself. These neurological abnormalities persist without complete recovery in up to 20% of the survivors.