Meningitis Symptoms and Treatments

What Do You Need to Know About Meningitis

girl with headache
What do you need to know about meningitis in children?. JGI/Tom Grill/Getty Images

If you've heard about meningitis, and especially if your child has an unexplained fever, you might be worried. What exactly is meningitis? What are the symptoms? How is it diagnosed and how is it treated?

Since meningitis is one of the feared diseases of childhood for many parents, taking a moment to learn about the signs and symptoms of this disease is very important. Understanding these symptoms can also help you so that you don't worry needlessly.

What is Meningitis?—Definition

Meningitis is a relatively common infection in childhood in which a microorganism infects and causes inflammations of the meninges—the membranes which surround the brain. It differs from encephalitis which is an infection which primarily effects the tissues in the brain.

A stiff neck, headache, and fever are commonly found with meningitis, whereas a sore throat is not. Meningitis, especially bacterial meningitis, is much less common than in the past due to the routine immunization of children against the most common causes.

Meningitis Signs and Symptoms

Everyone is different when it comes to meningitis, but the most common symptoms are a combination of a headache and fever. For many children, the symptoms of meningitis come on rapidly within a matter of hours and around 15 percent of children are unconscious at the time of diagnosis. Other children may have the onset of symptoms a day or two before meningitis develops.

Possible symptoms of meningitis in children may include:

  • A stiff neck - A stiff neck is found in most children who have meningitis. If your child has hear head arched back or complains of pain when you try to push her head down towards her chest, you should seek medical care. Doctors often test for this stiffness which has been given names in medicine. "Kernig's sign" is considered positive if it hurts to extend the knee with a flexed hip. "Brudzinski's sign" is positive if forced flexion of the neck (moving a child's head down towards her chest) causes pain and makes a child flex her hips and knees. A stiff neck occurs due to inflammation of the meninges, which are stretched the least when the head is extended and the legs are stretched out straight.
  • A severe headache.
  • Fever - A fever can be low-grade (for example, 100.5 F) or high-grade (over 104 F) depending on the type of meningitis and other factors. Roughly 75 percent of children have a fever over 100.4 F.)
  • Nausea and vomiting.
  • Sensitivity to light (photophobia.)
  • Irritability and restlessness.
  • Fatigue or sedation.
  • Seizures - Seizures are a common symptom of meningitis but may occur with viral infections without meningitis, such as febrile seizures.)
  • Mental status changes, such as lethargy, delirium, hallucinations, or even coma. Mental status changes are common, occurring in almost 70 percent of children in one study.
  • A bulging fontanel in infants whose fontanel or soft spot hasn't closed yet.
  • A rash (a non-blanching (doesn't turn white when you press on it) rash may occur with meningococcal meningitis.)
  • Your gut instinct as a parent that something is seriously wrong. Don't underestimate your intuition as a parent, as parents often recognize that something is seriously wrong with their child even before medical providers may do so.

Unfortunately, some children do not have the classic symptoms of meningitis and at times it can be hard to diagnose.

In infants, symptoms of a stiff neck and headache are not often obvious, and the most common symptoms include fussiness, poor feeding, and lethargy.

Types of Meningitis

We often talk about meningitis as if it were one disease, but there are actually many different microorganisms that can cause meningitis, and meningitis caused by different microorganisms can have different symptoms.  Viruses, bacteria, and fungi can all cause meningitis, with viral causes being most common.

Causes of Viral Meningitis (Aseptic Meningitis)

Viruses are responsible for three to four times as many cases of meningitis as bacteria. The term "aseptic meningitis" essentially meningitis caused by something other than bacteria, and is most commonly used to describe viral meningitis.

Some viruses which may cause meningitis include:

  • Enteroviruses (the most common cause) - Meningitis caused by enteroviruses is most common between June and October. Enteroviruses are viruses that typically live in the digestive tract, and most do not cause disease.
  • Herpes viruses, including the chickenpox virus.
  • Measles virus.
  • Mumps virus.
  • Influenza virus.
  • West Nile virus - West Nile virus is a virus which is spread by the bit of a mosquito and is most common between August and October. In addition to meningitis symptoms, people with the virus often have a rash and swollen glands. West Nile virus has now been found in 46 states and about half of people who develop the disease also develop meningitis or encephalitis.
  • Lymphocytic choriomeningitis virus

Causes of Bacterial Meningitis

Bacterial meningitis is less common than viral meningitis but tends to be more severe with a greater potential for long-term problems. The particular cause of meningitis varies considerably with age.

Infants (first 3 months): The most common causes of bacterial meningitis in young infants are:

  • E. coli
  • Group B streptococcus
  • Listeria monocytogenes

Older infants and children - The most common bacterial causes of meningitis in young children has changed considerably in the past few decades due to immunizations. Most common organisms include:

  • Streptococcus pneumoniae (pneumonococcus) - Pneumococcus is the most common cause of bacterial meningitis in children.
  • Neisseria meningitides (meninogococcus) - Meningococcus is the second most common cause of meningitis in children. Meningococcal meningitis may produce signs of meningitis along with a fine petechial rash (a rash due to broken blood vessels which does not blanch when pressure is placed on the skin.)
  • Haemophilus influenzae type B (Hib) - H. Flu was the most common cause of meningitis in children until the 1990s, but the disease is now uncommon due to vaccination.

Other possible causes of meningitis include Lyme disease, syphilis, ehrlichiosis, leptospirosis, tuberculosis, and some fungal infections that affect the central nervous system such as cryptococcal meningitis (most common in children with AIDS.)

Diagnosis of Meningitis (Meningitis Tests)

After taking a brief history and physical, a lumbar puncture (spinal tap) will be recommended if your physician is concerned about meningitis. This procedure may sound terrifying as a parent, but is a very commonly performed procedure in children. The procedure is actually much more comfortable than it appears, and the worst symptoms for most children are having to be held still while the procedure is performed. With a lumbar puncture, a sample of cerebrospinal fluid is removed so that it can be analyzed under the microscope and cultured. A CT scan of the head is sometimes done before a lumbar puncture to rule out increased intracranial pressure which could cause problems with the procedure.

Fluid withdrawn from a spinal tap is looked at under the microscope, which can sometimes suggest that an infection is either viral or bacterial (based on the turbidity of the fluid and more) and what type of bacteria may be present. Cultures of the fluid are then done to grow the bacteria in order to make a precise diagnosis. Broad range antibiotics are usually started before culture results are available, and then can be changed to antibiotics that cover the specific type of bacteria. "Sensitivities" will also be run, which are tests that show which antibiotics work best for a particular strain of bacteria.

Sometimes imaging tests, such as a CT or MRI of the head are done as well, primarily to rule out other causes of neurological symptoms.

Differential Diagnosis of Meningitis—What Else Could it Be?

There are several other infections and processes which can have overlapping symptoms with meningitis. Encephalitis refers to an inflammation of the brain, rather than the meninges or membranes lining the brain and spinal cord. The key difference between encephalitis and meningitis is that encephalitis has localized symptoms (based on where in the brain the infection is) although there is a lot of overlap. Sometimes these conditions are lumped together as "meningoencephalitis."

A brain abscess due to an infection may have similar symptoms, although with a brain abscess there are often localized neurological symptoms. Sinusitis can cause a headache and fever. Almost any viral process, in fact, can lead to a headache and fever, so it's important to talk to your doctor if you have any reason at all to suspect meningitis.

Non-infectious conditions may also sometimes cause the combination of a fever and headache, for example, brain tumors.

Meningitis Treatments

Meningitis treatment depends on the type of organism causing the disease. With viral meningitis, the goal of treatment is primarily supportive care, with antivirals primarily used for diseases such as meningitis caused by the chickenpox virus.

Treatment for bacterial meningitis most often begins with a combination of intravenous broad spectrum antibiotics. The selection of antibiotics may change once the precise diagnosis is made along with "sensitivities," tests that determine the antibiotics which a specific bacteria is most susceptible.

In the first 90 days of life, a 3rd generation cephalosporin is most often used (combined with ampicillin in the first month.)

Older infants and children are usually treated with a combination of cefotaxime or ceftriazone plus vancomycin until the offending organism has been identified. Other options are available depending on what organism is thought to be the cause and for children who may have an allergy to the most commonly prescribed drugs.

Meningitis Prophylaxis

For some types of meningitis, antibiotic prophylaxis (antibiotics to prevent infection) will be recommended for contacts, such as family, friends, and medical providers who may have been exposed.

Prognosis of Meningitis

The expected outcome of meningitis varies depending on the specific microorganism which causes the disease. Viral meningitis tends to have a much better prognosis than bacteria meningitis. Prognosis of the disease is also related to how soon the disease is diagnosed, with earlier treatment resulting in a better prognosis. In general, pneumococcal meningitis has the poorest prognosis.

Long term effects related to meningitis are much more common with bacterial meningitis than viral meningitis and may include hearing loss, learning disabilities, seizures, and other neurological effects. The risk of hearing loss from meningitis depends on the type of meningitis. Recent studies, however, have found that hearing loss related to meningitis is, in many cases, reversible. Some antibiotics may also result in long-term effects such as hearing loss, but this is less common than in the past.

Meningitis, even today, remains a serious disease. Most children recover from viral meningitis, but bacterial meningitis still carries a mortality rate of 5 to 15 percent depending on the organism.

Meningitis Prevention

Meningitis prevention can take different forms.

Some types of meningitis, for example, meningococcal meningitis, are very contagious. If you have been around a person diagnosed with this disease your doctor may recommend that you take preventive antibiotics. Other types of meningitis, while contagious, do not usually result in meningitis but only less serious viral symptoms.

Many forms of meningitis in children are preventable with vaccination. As noted earlier, meningitis due to Hemophilis influenzae was the most common form of meningitis in children until just a few decades ago. Now immunization with the HIb vaccine is making this type of meningitis uncommon.

Take a moment to learn about the meningitis vaccines which are available for children, including Hib, Prevnar, and meningococcal vaccines.

You may also wish to learn about how vaccine preventable deaths including meningitis have decreased from the pre-vaccine era to our present time.

Bottom Line on Meningitis Symptoms in Children (or Adults)

Meningitis is unfortunately a relatively common disease in children, though routine immunization has greatly decreased the risk, and the long-term impact of the disease. At the current time, viral causes are more common.

Symptoms can appear rapidly, with signs of lethargy and poor feeding in infants, and a headache, fever, and stiff neck in older children. Prompt diagnosis and treatment can reduce the mortality as well as long term effects of the disease, so anyone who is concerned about their child should err on the side of caution and seek medical treatment.

Effective antibiotic treatment can be started as soon as a lumbar puncture (spinal tap) or other labs suggest the illness is present. Determining the exact cause is crucial in treatment, so it's important not to give your child a dose of medication at home before seeking help as this could interfere with the accuracy of tests. While meningitis is relatively common in health, it can be terrifying as a parent. Ask questions and make sure you understand what is happening with your child. Many pediatric hospitals now provide support people who can help you cope emotionally while your child is being treated.

Sources:

Centers for Disease Control and Prevention. Viral Meningitis. Updated 06/15/16. https://www.cdc.gov/meningitis/viral.html

Janowski, A., and J. Newland. Of The Phrensy: An Update on the Epidemiology and Pathogenesis of Bacterial Meningitis in the Pediatric Population. F1000Research. 2017 Jan 27. (Epub ahead of print).

Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.

Lundbo, L., and T. Benfield. Risk Factors for Community-Acquired Bacterial Meningitis. Infectious Diseases (London). 2017. 49(6):433-444.

Ouchenir, L., Renaud, C., Khan, S. et al. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics. 2017 Jun 9. (Epub ahead of print).

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