Neurology-Online

Meningitis in children

definition

Meningitis describes an inflammation of the Meningessurrounding the brain and its adjacent structures. The disease must be recognized quickly and treated accordingly, otherwise it will with Consequential damage or in the worst case it can be fatal.

We therefore strongly recommend the Vaccination against meningitis, which is possible from the 12th month of a child.

The classic meningitis manifests itself through headache, stiff neck, fever, vomiting and general symptoms; When brain tissue and meninges become inflamed, there is often an additional impairment of consciousness. Most meningitis is caused by viruses. In newborns, these are often herpes viruses; measles, mumps or echo viruses are more likely in small children.
A tick bite infected with the TBE virus can also lead to early summer meningo encephalitis.

Typical bacterial pathogens in newborns are enterobacteria (E.coli), which live in the intestine, as well as streptococci and listeria. In children, the most common pathogens causing meningitis are the bacterial strains Haemophilus influenza, meningococci and pneumococci. Meningococci and pneumococci are also often responsible for meningitis in adolescents and adults.

Find out more about the topic here: Meningococcal vaccination

Symptoms in the child

The symptoms of a Meningitis in children usually develop within a few hours. Typical symptoms are high fever, Neck stiffness (The child opposes the lifting and bending of the head towards the knee, too Meningism called), which in the course also becomes Pain in the neck and back can lead through the constant tension, Photophobia, Sensitivity to noise, Nausea and vomiting.

Furthermore, increased fatigue and Body aches to be added. It is also important to know whether the child may have had contact with a sick child or whether the meningitis was preceded by other diseases, such as an upper respiratory tract infection Inflammation of the parotid gland or the Sinuses, as well as a Otitis media.

In infants, meningitis often manifests itself differently than in older children, which is why caution is advised here with abnormal behavior so that the disease is not overlooked.

You can only do this Poor drinking and a increased drowsiness belong, but also abdominal pain, refusal to eat, sensitivity to touch, the bulging of the fontanel (large crack in the bone in the child's skull that has not yet overgrown) or Seizures.

infection

Meningitis in children can be over Droplet infection, so from person to person through small droplets Coughing, sneezing, or kissing, especially in places with close contact with other people (School, kindergarten) be transmitted.
Another mechanism of infection is spread via the blood from other infections (hematogenous), through other infections in the ear, nose and throat area, such as a sinus infection (per continuitatem), or after brain surgery or open Skull fractures.

Meningitis test in children

To a Meningitis in children to confirm will Nerve water (Liquor cerebrospinalis) taken from the spinal canal (Liquor or lumbar puncture) and up Viruses and bacteria examined.

Furthermore, the Pressure in the liquor space measured which at bacterial meningitis can be increased. The liquor is usually a clear one Discoloration or a cloudy appearance, also indicates a bacterial infection.
The liquor is then examined under the microscope and bacterial cultures are created, which are more reliable but take up to 48 hours to be evaluated.
Further investigation methods are the serological examination or the investigation using PCR (Polymerase chain reaction), where after the DNA of the pathogen is sought.

Imaging procedures like a CT or MRI examination or in infants the Ultrasound examination of the head can provide further information and show an increase in intracranial pressure at an early stage.

Certain physical exams can help suspect meningitis in the child.
This includes:

the test on the Neck stiffness (Meningism),
the Brudzinski sign (Tightening the legs when bending the head due to the pain of stretching the meninges and spinal cords)
and the Kernig sign (Sick people cannot straighten their legs while sitting, as this causes pain),
as well as that often examined in the case of a herniated disc Lasegue sign (Pain in the back occurs when the leg is raised while lying down).

treatment

If meningitis is suspected in the child, should swiftly traded.
A presentation in a hospital with a department for children is often useful, since all examination options are available here.

Once the nerve fluid has been sampled, a antibiotic therapy started to fight the germ quickly. Broad spectrum antibiotics are used, which cover a wide range of pathogens, as long as the exact pathogen is not known.
The antibiotics are over Infusions given.

If the results of the examination are there, the antibiotics will be adjusted if necessary.
It is not advisable to give antibiotics before the lumbar puncture, as they can falsify the results.
If bacterial infections are suspected, additional cortisone given to limit the swelling of the brain tissue.

Is one by Meningococci triggered meningitis, the patient becomes isolated, that is, placed alone in a room which is only below special protective measures how Face mask, smock and gloves, as the disease is very contagious.
For contact persons of patients with meningococcal meningitis (classmates, parents) a so-called Chemoprophylaxis given with various antibiotics and post-vaccination to prevent the outbreak of infection.
Vaccinations are available for meningococci, pneumococci and Haemophilus influenzae and are included in the Robert Koch Institute's vaccination calendar for children and people at risk.

Vaccination against the TBE virus is recommended if you live in an area where there are ticks that carry the virus.

In the case of meningitis caused by viruses, usually only the symptoms are treated, as there is no treatment against the viruses.
The measures concern that Lowering of fever and the Treatment of pain.

Consequences and long-term consequences

By Viruses caused meningitis usually have a milder course than that bacterial.

Nevertheless, meningitis can always have long-term effects.
Movement disorders such as Paralysis, Visual disturbances, Damage to the hearing organ, to the point of deafness, a development of a Hydrocephalus (also colloquially Water head called; This leads to a drainage disorder of the cerebral water) and impairments of mental development.
Bacterial meningitis can be fatal if detected too late.
There are also life-threatening complications, such as Brain abscesses (Melting down of brain tissue), Increases in intracranial pressurewhich can lead to an entrapment of the brain tissue, or that Waterhouse-Friderichsen Syndrome, which mainly affects children and adolescents if they have meningitis caused by meningococci, pneumococci or Haemophilus influenzae.

Here, toxins are released by the bacteria, which disrupt blood clotting and thus cause it to Bleeding in various organs, especially the Adrenal glands, and thus lead to their damage, which leads to septic shock can lead.
Typical signs of this are Mucosal bleeding and punctiform hemorrhages the skin, so-called Petechiae.

children under three years have the highest risk of developing bacterial meningitis, which is why the precautionary vaccination is important here.