Meningitis

Meningitis can be caused by several different bacteria and viruses, and it's often a serious condition.

Key points

• A range of bacteria and viruses can cause meningitis.
  
• Signs and symptoms include fever, restlessness, headache, vomiting, stiff neck and sensitivity to light.
  
• Duration varies depending on cause and treatment; some bacterial infections can rapidly progress from minor symptoms to death within hours.
  
• Can cause brain damage or death if bacteria enters the blood stream (septicaemia).
  

Meningitis refers to an inflammation of the coverings of the brain and spinal cord – the meninges. A range of bacteria and viruses can cause the condition.
Meningitis is always serious, but it can be particularly bad if caused by certain types of bacteria. For example, meningococcal meningitis can rapily overwhelm a person, with death occurring within hours of the first symptoms appearing.
In general, testing is needed to determine the exact cause of meningitis.
Signs and symptoms
The signs and symptoms of meningitis vary with the age of the child.
For babies and younger children, you may notice:

• fever
  
• difficulty waking your child
  
• bulging of the fontanelle (the soft spot on the top of the head in very young babies)
  
• restlessness
  
• a moaning high pitched cry
  
• disinterest in feeding
  

For older children, as well as a fever they may have:

• a severe headache
  
• vomiting
  
• a stiff neck
  
• sensitivity to light
  

Later on, your child may become confused and even lose consciousness.
If your child has meningococcal meningitis a skin rash may appear. If you apply pressure to the rash, you will notice that it does not go pale and it does not disappear. You should seek help immediately.
Course and duration

The nature of the disease varies greatly depending on what is causing the inflammation, and whether your child receives treatment. Without treatment, some bacterial infections can quickly become fatal.
Spread of infection
The bacteria and viruses that cause meningitis are usually spread by droplets from the respiratory tract when we cough and sneeze. Approximately 10% of the community can carry the organisms that cause meningitis without experiencing any symptoms.

Infectious period
Again, the infectious period varies greatly depending on the organism. Public health authorities treat meningococcal infection as a serious community condition until they are certain no more new infections are occurring.
Complications
When early treatment is given, most cases of meningitis resolve without ongoing problems.
However, meningitis is a serious disease and can cause brain damage or death through septicaemia (blood stream infection). Other complications include deafness and epilepsy in severe cases of bacterial meningitis.

Treatment
Antibiotics are a life-saving treatment for bacterial meningitis. In viral conditions generally treatment of symptoms and fluid replacement are the most important actions.
A lumbar puncture is needed to definitively diagnose meningitis. This involves inserting a long needle through the lower back into the spinal canal. Some spinal fluid is taken and then analysed in the pathology laboratory.
Antibiotic treatment is indicated based on the appearance of the spinal fluid and may be changed if necessary when the germ causing the infection is identified. This allows treatment to be much better targeted.
However, antibiotics may be given immediately if meningococcal disease is suspected based on symptoms and signs such as – rapid progression of severe illness, neck stiffness, fever, alternate conscious state and non-blanching rash.
It may be necessary to take drugs to control seizures ('fits') and to reduce brain swelling in bacterial meningitis.
With some bacteria, particularly meningococcal, doctors will treat people living closely with an infected person in case they are unknowingly carrying the organism but are susceptible to the illness.

Prevention
Vaccination is routinely given for the three most common bacteria that cause meningitis (the types of meningitis are haemophilus (hib), meningococcal and pneumococcal).
Mumps, a virus, can also cause this type of infection and is included in the routine MMR vaccine.
Additionally, paying attention to good hand hygiene when it comes to coughing, sneezing and hand washing will reduce the spread of some agents that cause meningitis.



Special notes
Vomiting, a bit like fever, is a very non-specific symptom in children, especially young children and infants. If your child is vomiting it doesn't always mean the problem is with their gut.
Reviewed by Dr Peter Vine. A former rural paediatrician with more than 20 years experience, Dr Vine is head of campus and senior lecturer, UNSW Rural Clinical School, Albury Wodonga.
Your story: meningitis
Naomi Terblanche, and Aiden
Aiden while in hospital (Photo: Naomi Terblanche)


My son, Aiden, was born four months premature and after spending the next five months in hospital, we brought him home. One day, after about two weeks at home, I noticed he was cold, lethargic and feeding poorly. When I went to change his nappy, he would squeal and become very stiff. He was hooked up to a monitor to watch his oxygen saturation levels, as he had chronic lung disease, and this kept going up and down.
I called our paediatrician who suggested I do kangaroo care (by placing him on my chest with a blanket on top) to raise Aiden's temperature. While this helped a little, his other symptoms persisted. On the second day, I took him to the GP, where the doctor immediately rang for a paediatric ambulance to take us from our country town to Royal Melbourne Hospital.
Meanwhile, Aiden was given oxygen therapy in the local hospital to get him breathing properly. By the time the ambulance arrived he had become quite big and puffy as his body had filled with fluid. When the ambulance arrived, he suffered a cardiac arrest (his heart stopped) and the paramedics had to resuscitate him.
When we arrived at Royal Melbourne Hospital, they made a preliminary diagnosis that he was suffering from bacterial meningitis, based on his symptoms. They took a sample of his cerebral spinal fluid to find out the exact cause. In the meantime, he was intubated (a tube was inserted through his mouth and into his airway) and he was placed on a ventilator (a machine to move air into and out of his lungs). He was also given antibiotics and sedated.
The next day, after the results of the spinal fluid test came back, we got the diagnosis of enteroviral meningitis (i.e. it was a viral infection, not bacterial). As antibiotics don't help with viral infections, they were discontinued. He improved after 48 hours and no longer required intubation. He also started taking breast milk from me.
We spent one week in hospital during which my husband and I were emotionally drained. I stayed with Aiden but my husband would drive the six-hour round trip from home to Melbourne almost every day as he had to work and care for our one-year-old daughter.
Aiden had completely recovered from the meningitis infection when he was discharged and is now a happy and healthy four year old, with no sign of any damage.
Never delay getting medical attention if you feel something is wrong with your child and push for treatment if you feel your child's case is urgent.
http://www.abc.net.au/health/library/stories/2012/03/21/3421652.htm