Viral aseptic meningitis is a serious, but not usually fatal with people with healthy immune systems. For suspected bacterial meningitis in children 6 weeks old, consider. Fluid management of bacterial meningitis in developing. Outcomes of bacterial meningitis in children sciencedirect. The etiology of acute meningitis and encephalitis syndromes in a. The figure above shows countries trained to conduct surveillance for the pediatric bacterial meningitis surveillance network, by performance level. Methods acutely ill children admitted to a district general hospital in england were included in this casecontrol study between 2000 and 2005. Pdf pediatric bacterial meningitis is a medical emergency requiring immediate initiation of treatment. Tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. Other rare causes of meningitis in neonates include staphy lococci, enterococci, and viridans streptococci. The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis.
The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. Sign in or purchase a subscription to access this content. You acknowledge that the recommendations and information in the materials do not indicate an exclusive course of treatment or serve as a standard of. Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid csf.
Pediatric bacterial meningitis surveillance african region, 20022008. Bacterial meningitis is life threatening, and must be distinguished from the more common aseptic viral. In infants and young children worldwide, streptococcus. Prevention and treatment of bacterial meningitis in resource. Dexamethasone should be administered 1020 min before antimicrobial therapy for maximal efficacy and continued for 24 days. However, permanent disabilities such as brain damage, hearing loss, and learning disabilities can result from the infection. Sequelae include deafness, seizures, learning difficulties, and blindness. Bacterial meningitis causes more than 100 000 deaths worldwide each year in infants and young children.
Meningitis caused by bacteria, fungi, and mycobacteria is classified as septic and characterized by fever, altered mental status, and purulent cerebrospinal fluid csf. Meningitis meninjahytis is inflammation of the meninges mininjeez, a protective tissue that covers the brain and spinal cord. Risk factors associated with the outcomes of pediatric. Dexamethasone for the treatment of tuberculous meningitis. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. However, the use of conjugate vaccines has reduced the incidence of bacterial meningitis in children and adults. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges. Meningococcal meningitis is the most common bacterial meningitis worldwide and group a was the most common epidemiccausing meningococcus. This is normally caused by infection but can also have noninfectious causes. In 2010, a conjugated vaccine, menafrivac became available that is highly efficacious even in young children and also increases herd immunity.
Shenzhen childrens hospital sch was chosen as the sentinel hospital. The meninges of the central nervous system cns include 3 membranes that support, protect, and nourish the brain and spinal cord. Routine neuroimaging is not necessary for the initial medical evaluation of children with suspected bacterial meningitis who do not have clinical signs of brain. Nov 01, 2004 the objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. It serves as a referral center in the field of pediatric diseases and treats over 60% of. Meningitis in children symptoms, warning signs, treatment. This is normally caused by infection but can also have non. A long course one year of medications is recommended for children who develop tb meningitis. Pediatric bacterial meningitis is a medical emergency, and its appropriate treatment depends on the causative organism. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcareassociated ventriculitis and meningitis, including the following. Recognize the common acute complications of meningitis. The infectious diseases society of america idsa standards and practice guidelines committee collaborated with partner organizations to convene a panel of 10 experts on healthcareassociated ventriculitis and meningitis.
Meningitis is an inflammation of the membranes meninges surrounding your brain and spinal cord. This podcast presents an approach to the diagnosis and management of meningitis in children. You get it when a virus enters the body through the nose or mouth and travels to the brain. Pneumococcal and meningococcal conjugate vaccines have been implemented, use of enteroviral polymerase chain reaction pcr has become routine in most. Prevention and treatment of bacterial meningitis in. Diagnosis, initial management, and prevention of meningitis aafp.
Management of bacterial meningitis in children and young people. Meningitischild care and schools pediatric patient education. The booster dose provides protection during the ages when adolescents are at highest risk of meningococcal disease. Most patients do not need brain imaging before lumbar puncture. The reason for this is that there is a significant risk of serious illness or even death if the child has bacterial meningitis and treatment is delayed for a prolonged period of time. Aseptic meningitis and encephalitis are most often the result of viral infection but less frequently result from infection by parasites, spirochetes, rickettsia, and prions. Most cases of meningitis in the united states are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. Tuberculous meningitis is the severest form of infection with mycobacterium tuberculosis, causing death or severe neurologic deficits in more than half of those affected in spite of.
We conducted a retrospective study and included 34 children 3 months15 years who had been hospitalized for bacterial meningitis in the pediatric department of a university hospital between january 1st, 2001 and december 31st, 20. In many cases, children are treated as if they have bacterial meningitis until bacterial meningitis is definitively excluded. Hearing impairment in childhood bacterial meningitis is. Newer tests like nuclei acid amplification tests naats. You get it when a virus enters the body through the nose or mouth and travels.
Viral meningitis is the most common form of meningitis in the uk, but bacterial meningitis continues to be important, with a high mortality. Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. May 30, 2018 meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. The clinical symptoms and signs of bacterial meningitis in children vary depending on the age of the child and duration of disease. Clinical features are poor discriminators for meningitis, so urgent investigations, starting with lumbar puncture, are key.
We compared dexamethasone andor glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels. However, the increased rate in some ethnic groups american indian, inuit, and black people and some families, and the observation that siblings of patients with meningitis can have deficient antibody synthesis against. Analysis of the risk associated with the causative organism of bacterial meningitis was difficult, because most studies included patients with laboratory and clinical findings suggestive of meningitis, but lacked isolation of the etiologic agent using either microbiological or molecular tests. Pharmacists should be aware of the signs and symptoms to assist in the timely diagnosis of meningitis in pediatric patients. Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. One hundred seventynine pediatric files were studied. Meningitis is the medical term for inflammation of the tissues meninges that surround the brain and spinal cord. If meningitis is suspected, an examination of the csf via lp should be performed in eligible patients to determine the organism involved. Meningitis, especially bacterial meningitis, is a potentially lifethreatening condition that can rapidly progress to permanent brain damage, neurologic problems, and even death. Aseptic meningitis and encephalitis are most often the result of viral infection but less frequently result. It is usually caused by a bacterial bakteereeuhl or viral vahyruhl infection of the fluid found in between the meninges and the brain and spinal cord. The epidemiology of bacterial meningitis in children is changing.
The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. During 20012002, clinical, laboratory, and data management staffs in 26 of the 46 countries in the african region were trained to conduct hospitalbased pbm sentinel surveillance. Bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children throughout the world. Bamberger, md, university of missourikansas city school of medicine, kansas city, missouri a cute meningitis is a medical emer. Most children with viral meningitis recover on their own without treatment. Feigin and cherrys textbook of pediatric infectious diseases, 7th, cherry jd, harrison gj, kaplan sl, et al eds, elsevier saunders, philadelphia 2014. Meningitis home pediatric care online aap pointofcare. Nov 05, 2018 meningitis is a term used to describe an inflammation of the membranes that surround the brain or the spinal cord. Meningitis powerpoint 2009 warren hills regional school. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons.
Management of bacterial meningitis in children and young. Pneumococcal and meningococcal conjugate vaccines have been implemented, use of enteroviral polymerase chain reaction pcr has become routine in most children s hospitals. Jan 16, 2019 pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Bacterial meningitis is very serious and can be deadly. Pediatric bacterial meningitis differential diagnoses. We examined the diagnostic accuracy of individual clinical signs and 6 cprs, including. Meningitis about bacterial meningitis infection cdc. Because bacterial meningitis in the neonatal period has its own unique epidemiologic and etiologic features, it will be discussed separately in this article as necessary.
Diagnosis, initial management, and prevention of meningitis david m. Meningitis is a severe acute infectious disease caused by several microorganisms, including viruses, bacteria, parasites, and fungi. Fatality rates associated with this disease can be as low as 2% in infants and children, and as high as 2030% in neonates and adults. The inflammation is most commonly caused by a virus or a bacterium, which travels from an infection in another part of. Acute bacterial meningitis in infants and children the. All 11 to 12 year olds should receive a meningococcal conjugate vaccine. Adolescents and young adults 16 through 23 years old may also receive a serogroup b. Routine neuroimaging is not necessary for the initial medical evaluation of children with suspected bacterial meningitis who do not have clinical signs of brain herniation.
Dec 07, 2017 tuberculous meningitis tbm develops in 2 steps. Consult a paediatric intensivist, anaesthetist, or intensivist. Jun 30, 2016 this podcast presents an approach to the diagnosis and management of meningitis in children. Dec 15, 2010 acute meningitis is a medical emergency with a potential for high morbidity and mortality. Since protection wanes, cdc recommends a booster dose at age 16 years. In children in the uk, bacterial meningitis is most commonly caused by one of three bacteria. Clinical outcomes and risk factors of meningitis among. Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. Diagnosis and management of bacterial meningitis in the paediatric. Listeners will learn the etiology and epidemiology of meningitis in different age groups, explore the clinical presentation, pertinent investigations and understand the management of bacterial and viral meningitis according to the most recent guidelines. Pediatric bacterial meningitis surveillance african.
Chqgdl60008 meningitis emergency management in children 2 in the older child, the rates of meningitis are much lower with an estimated incidence of 1 per 5,901 febrile children aged 2 to 24 months. Morbidity and mortality rates are high, especially in the neonatal period. The severity of a childs symptoms and prognosis depend on. Meningitis background general presentation meningitis is an important infectious disease to rule out in the pediatric population because it can have serious medical and social complications.
The material discussed in the materials is not intended to present the only or necessarily the best pediatric method or procedure, but rather presents the approach or opinion of the discussant. May 17, 2016 pediatric bacterial meningitis is often fatal if treatment is delayed. Division of infectious diseases, childrens mercy hospitals and clinics, kansas city, mo. In neonates children 5 cellsl or 1 neutrophill if lower cell count, still consider bacterial meningitis if other symptoms and signs suggest the diagnosis especially in neonates. Subsaharan africa has one of the worlds greatest disease burdens of haemophilus influenzae type b hib, streptococcus pneumoniae, and neisseria meningitidis infections. American academy of neurology, american association of neurological surgeons aans, congress of. The inflammation is most commonly caused by a virus or a bacterium, which travels from an infection in another part of the body through the bloodstream to the meninges. Division of infectious diseases, children s mercy hospitals and clinics, kansas city, mo. In persons who develop tbm, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or. The introduction of the protein conjugate vaccines against haemophilus influenzae type b, streptococcus pneumoniae, and neisseria meningitidis has changed the epidemiology of bacterial meningitis. Bm6 repeat lp in neonates after starting treatment if. The outermost layer, the dura mater, is a tough, inelastic, connective tissue layer that sheaths the brain and spinal cord and terminates caudally at the first coccygeal vertebra. An intravenous antifungal medication may be administered to the child with fungal meningitis.
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