Meningitis Infections in Infants and Children

Meningitis is defined as any inflammation of the protective membranes, called meninges, which surround the brain and spinal cord. It can be caused due to various infectious agents like bacteria, viruses, fungi, and parasites. While meningitis can affect people of any age, infants and young children are at a higher risk. Given the immature state of their immune system, they are more susceptible to infection and its complications. Let’s explore types of meningitis more commonly seen in infants and children, symptoms, causes, treatment, and preventive measures.

What is infant meningitis?

Meningitis in infants, also known as infantile meningitis, refers to the inflammation of the protective membranes covering the brain and spinal cord – the meninges – in babies and infants less than one year of age. When an infectious agent enters the normally sterile cerebrospinal fluid surrounding the brain and spinal cord, it triggers an inflammatory response leading to meningitis.

Types of meningitis in infants

The major types of meningitis seen in infants are:

1. Bacterial meningitis: Bacteria like Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Group B streptococcus are the most common causes. Without timely treatment, it can progress rapidly and become life-threatening.
2. Viral meningitis: Common viruses causing meningitis include enteroviruses (coxsackievirus A16), mumps virus, herpes simplex virus, varicella zoster virus, and human herpesvirus 6. Most viral meningitis is seldom life-threatening and resolves on its own with rest and supportive care.
3. Naegleria fowleri: This ameba normally found in warm freshwater can cause a very rare but devastating infection of the brain called primary amebic meningoencephalitis if contaminated water enters the body through the nose.
4. Parasitic meningitis: Parasitic infections like toxoplasmosis are usually seen in infants born with weakened immunity.
5. Fungal meningitis: Fungal infections like cryptococcosis or histoplasmosis are very rare causes, often seen in immunosuppressed infants.

What are the causes of meningitis in infants?

The causes of meningitis vary with the type and predominant agents include:

1. Bacterial meningitis is commonly spread through respiratory droplets from the nose/throat of an infected person via close contact. Perinatal transmission from an infected mother is also possible. Risk factors include lack of immunization.
2. Viral meningitis is often spread through the fecal-oral route or respiratory droplets. Enteroviruses are a common cause.
3. Naegleria fowleri multiplies in warm freshwater and may infect via contaminated water entering the nose during swimming or bathing.
4. Parasitic meningitis occurs when infants are exposed to parasites like toxoplasma from undercooked meat, cat litter, or contact with infective oocysts in soil.
5. Fungal meningitis occurs due to opportunistic infections among infants with weak immunity.

Signs and symptoms of meningitis in babies and children

The signs and symptoms of meningitis vary with the age of the child but may include:

Meningitis in newborns:

• Fever
• Refusal to feed
• Abnormally high or low tone or movements
• Poor activity, lethargy
• Vomiting

Infants and young children:

• Fever
• Irritability, poor appetite
• Vomiting, nausea
• Stiff neck and sensitivity to light (photophobia)
• Bulging fontanelle (soft spot) in infants
• Seizures

Older children:

• Fever, chills
• Headache
• Stiff neck
• Sensitivity to light
• Nausea, vomiting
• Confusion, irritability
• Sleepiness or difficulty waking up

Children at higher risk of meningitis

Some children are predisposed to infection due to intrinsic or extrinsic factors:

• Babies under one year of age
• Children with weakened immunity due to HIV/AIDS, cancer, organ transplant etc
• Children with cochlear implants or brain shunts
• Travelers to tropical areas where parasitic meningitis is endemic
• Unvaccinated or partially immunized children
• Children exposed to adults/siblings carrying infectious meningitis-causing pathogens
• Children with recurrent ear infections or sinusitis

When to get immediate medical care

A parent should seek emergency care if the child shows any signs of meningitis. It is a medical emergency and prompt evaluation and treatment is critical for a positive outcome. Do not wait for the symptoms to worsen. Some red flag signs necessitating urgent evaluation include:When to get immediate medical care

• Fever along with neck stiffness, headache, vomiting or any other symptom
• High fever (over 103°F/39.4°C) or low temperature below 95°F
• Seizures
• Lethargy, irritability difficult to console
• Newborn with fever

Vaccines to protect against bacterial meningitis

Vaccines play an important role in preventing potentially life-threatening infections. Recommended vaccinations for infants and children against some common causes of bacterial meningitis include:

• Pneumococcal vaccines (PCV13, PPSV23) protecting against Streptococcus pneumoniae
• Hib vaccine targeting Haemophilus influenzae type b
• Meningococcal vaccines (MenACWY, MenB) protecting against Neisseria meningitidis serogroups
• Rotavirus vaccine indirectly protecting against Group B streptococcus

Timely vaccination as per the recommended schedule can help build immunity against preventable bacterial causes. However, protection is not guaranteed against all causes, so it is important to watch for symptoms and seek prompt medical care if suspected.

Treatment and management of infant meningitis

Once meningitis is diagnosed through examination, spinal fluid analysis and identification of the causative organism, prompt treatment is started. The mainstay of treatment depends on the identified cause and involves:

• Antibiotics: For bacterial, fungal or parasitic meningitis, intravenous broad-spectrum antibiotics are given for at least 7-10 days. Antiviral drugs may also be used for specific viral cases.
• Antifungals: Medications like amphotericin B are used for fungal infections.
• Antiparasitics: Medications like albendazole, sulphadiazine/pyrimethamine are used for parasitic meningitis.
• Corticosteroids: They help reduce inflammation and complications in specific bacterial/viral types when given alongside antibiotics.
• Supportive care: Managing fever, maintaining hydration and nutrition, monitoring for raised ICP are also important aspects of care.
• Potential long term impacts: Even after clinical recovery, some infants may need further management for sensorineural hearing loss, developmental delays or other disabilities due to the initial infection and inflammation. Early intervention therapies improve long term prognosis.

Overall, prompt recognition of red flag symptoms, seeking immediate care and administering appropriate treatment maximizes chances of survival without impairment in infants with meningitis. Prevention through immunization, hygiene practices and avoiding contaminated environments also play a huge role. With high index of suspicion, early care and preventive strategies, the impact of this disease can be greatly reduced.
Meningitis remains a significant threat in infants and young children due to their developing immune system. Timely vaccination as per recommendations and hygienic practices can help prevent many infectious causes. However, parents and caregivers must be vigilant about symptoms of meningitis and not delay seeking emergency care when concerns arise. Prompt treatment is key to optimize outcomes and minimize long term impacts. Adhering to public health guidelines and creating awareness about this disease can help address the risks in the vulnerable pediatric population. With multidisciplinary care and a focus on prevention, the devastating effects of meningitis can be effectively managed in most infants.