Does your child complain of a severe headache? Does he have a skin rash? Your child may have meningitis! What is meningitis? How does it proceed and how to treat it? How to prevent a terrible disease, and what measures to take to counter the virus? Is there a vaccine for meningitis? Read on to learn more about meningitis and how to protect your child. Parents try their best to keep their children healthy and safe. However, sometimes uncontrollable circumstances arise in the form of diseases that can threaten the baby. One of the childhood illnesses that many parents suffer from is meningitis. Vaccination against meningitis is required for children.
What is meningitis?
Meningitis is an inflammation of the protective membranes that cover the brain, spinal cord and brain.
Meningitis targets the lining of the brain, a group of three critical membranes (hard, arachnoid, and soft membranes) that cover the brain. These membranes, in addition to the spinal column and the skull itself, represent an additional barrier between all kinds of influences of environmental factors (trauma, infection) and the central nervous system.
In addition to these 3 membranes, cerebrospinal fluid is one of the main defenders. Especially when it comes to optimal spinal and brain function. This liquid, which is clear and colorless, helps protect the brain from damage.
In addition, the cerebrospinal fluid removes metabolic products and performs a transport function that involves the delivery of nutrients to various areas of the CNS (central nervous system).
With an immediate response, meningitis is successfully treated. Therefore, it is necessary to get regular vaccinations, be aware of the symptoms of meningitis and immediately contact a specialist if you suspect meningitis in your child.
Causes and forms of meningitis
The term meningitis is just a definition of inflammation of the meninges. There are various agents that cause disease.
Various types of meningitis have been identified, each with its own causes, risk factors, and side effects.
Bacterial meningitis
Bacterial meningitis is very serious, severe and can be fatal. Death can occur in just a few hours. Most children recover from meningitis. However, infection sometimes causes permanent damage (hearing loss, brain damage, and cognitive impairment).
Types of pathogens
There are several types of bacteria that can cause meningitis. The leading causes are the following pathogens:
- Pneumococcus. Pneumococcal meningitis can occur when a bacteria invades the bloodstream, crosses the blood-brain barrier, and multiplies within the fluid that surrounds the spine and brain. Pneumococcal bacteria do not always cause meningitis. Most often, they provoke other diseases: ear infections, pneumonia, sinusitis, bacteremia (this is when the bacteria is detected in the bloodstream).
- Group B streptococcus.Group B Streptococcus bacteria live in the throat, intestines of at least 30% of the population and up to 40% of pregnant women without causing any disease. Most infections with these bacteria occur in babies under 3 months of age, with a frequency of about 1 in 1,000 births. If the mother is a carrier, there is a 50% chance that her baby will be infected before or during childbirth. Typically, mothers are immune to the group B streptococcus serotypes they carry and transmit antibodies to the baby during the last eight weeks of pregnancy. Consequently, there are less than one percent of term infants who carry group B streptococcus and who subsequently develop associated meningitis or other severe infections. Babies born prematurely (especially those born before 32 weeks) do not receive maternal antibodies and are at significantly greater risk. Group B streptococcus infection in newborns is a serious condition, with mortality reaching 20%, while many survivors retain persistent brain damage.
- Meninogococcus. Neisseria meningitides is a meningococcal bacteria little known to most parents. But this is a significant cause of severe childhood infections. In reality, meningococcal disease is the leading cause of bacterial meningitis and can lead to outbreaks and epidemics. This sometimes leads to meningococcemia, a serious and life-threatening blood infection. Children with this infection may develop a fever and a skin rash (red or purple spots). Symptoms can worsen rapidly, often within 12 to 24 hours. The condition becomes very serious, and about 10-15% of sick children die even with proper treatment. The fact that invasive meningococcal disease often affects previously healthy children and worsens rapidly (making it difficult to diagnose) makes the disease even more dire. Risk factors include recent exposure to someone with meningococcal meningitis and recent upper respiratory tract infection.
- Haemophilus influenzae. Prior to the vaccination period, Haemophilus influenzae type B was the main causative agent of meningitis of bacterial etiology in children under 5 years of age. Since the vaccine has become available, this type of meningitis is much less common in children. Hemophilic meningitis can occur after an upper respiratory tract infection. The infection usually spreads from the lungs and respiratory tract to the blood, then to the brain.
- Listeria monocytogenes. Listeria monocytogenes are commonly found in soil, dust, water, and sewage; in unpasteurized cheeses (such as brie, mozzarella, and blue cheese) and in raw vegetables. These bacteria also enter the body through contaminated water or food. Foods contaminated with Listeria can cause meningitis outbreaks. Meningitis, caused by the bacteria Listeria monocytogenes, is most common in newborns, the elderly, and those with long-term illnesses or impaired immune systems.
Common causes of bacterial meningitis
Common causes of bacterial meningitis vary by age group:
- newborns: group B streptococcus, pneumococcus, Listeria monocytogenes, Escherichia coli;
- infants and children: pneumococcus, Haemophilus influenzae, meningococcus, group B streptococcus;
- adolescents: meningococcus, pneumococcus.
Risk factors
- Age. Babies are at increased risk of bacterial meningitis compared to children of other ages. But children of all ages can develop this form of meningitis.
- Environment. Infectious diseases often spread where large groups of people are concentrated. Surges of meningitis caused by meningococcus have been reported in preschools and schools.
- Certain medical conditions. There are some medical conditions, medications, and surgical procedures that put children at increased risk for meningitis.
Viral meningitis
Viral meningitis is the most common type of meningitis. It is often less severe than bacterial meningitis and most children get better without treatment.
It is very important that a child with symptoms of meningitis is examined by a doctor immediately, because some types of meningitis can be very serious, and only a doctor can tell if a child has a disease, what type of meningitis it is, and will prescribe optimal treatment, which is often life-saving.
Types of viral infections
Infants under 1 month of age and immunocompromised children are more likely to develop viral meningitis.
- Non-polio enteroviruses are the most common culprit in viral meningitis, especially from late spring to autumn when these viruses are most common. However, only a small number of children infected with enteroviruses actually develop meningitis.
- Mumps. Mumps is an extremely contagious viral infection of the salivary glands that most commonly affects children. The most obvious symptom is swelling of the salivary glands, which makes the patient's face look like that of a guinea pig. Sometimes the mumps virus can also cause inflammation of the testicle, ovary, and pancreas. Meningitis can occur if the mumps virus spreads to the outer protective layer of the brain. This is about 1 in 7 cases of mumps.
- Herpes viruses (herpes simplex viruses and chickenpox). The herpes virus rarely causes meningitis. But given that nearly 80% of people contract some form of herpes, meningitis is more likely than expected.
- Measles virus. The measles virus is highly contagious and lives in the mucous membrane of the throat and nose of an infected person. It can spread to others through coughing and sneezing. In addition, the virus can live for up to two hours in airspace, where an infected person coughed or sneezed. If other people breathe polluted air or touch an infected surface and then touch their eyes, nose, or mouth with their hands, they can become infected. Meningitis is one of the most serious complications of measles.
- Influenza virus. There are many different influenza viruses, and in any given year, some of them are more common than others. Influenza infections are more common during the “flu season,” which lasts from about October to May. Children under 5 years of age, especially under 2 years of age, are at risk of serious complications if they contract and develop influenza. Each year, about 20,000 children under 5 years of age are hospitalized with complications from the flu, such as pneumonia. Influenza-associated meningitis rarely develops, but still occurs.
- Arboviruses (West Nile virus). West Nile Virus is the virus most common in humans through mosquito bites. Meningitis is one of the serious diseases caused by this virus, along with encephalitis and meningoencephalitis.
At-risk groups
A child can get viral meningitis at any age. However, individual children have a higher risk. It:
- children under 5 years old;
- Children with weakened immune systems due to illness, medication (chemotherapy), or after a recent organ or bone marrow transplant.
Infants under 1 month old and immunocompromised children are more likely to suffer from severe illness.
Fungal meningitis
This type of meningitis is rare and is usually caused by a fungus that spreads through the blood to the spinal cord. Everyone can get fungal meningitis. People who are immunocompromised (HIV-infected or with cancer) are at increased risk.
The most common culprit for fungal meningitis in immunocompromised individuals is Cryptococcus.
Certain diseases, medications, and surgical procedures weaken the immune system and increase the risk of infection with the fungus, which sometimes leads to meningitis. Critically low birth weight premature babies are at increased risk of infection in the bloodstream with Candida, which can invade the brain.
Third trimester pregnant women and immunocompromised children are more likely to become infected.
Parasitic meningitis
Various parasites can provoke meningitis or can affect the brain or nervous system by other means. In general, parasitic meningitis is much less common than viral and bacterial etiology.
Certain parasites can cause a rare form of meningitis called eosinophilic meningitis, with increased levels of eosinophils (a type of white blood cell) in the cerebrospinal fluid. Eosinophilic meningitis is also triggered by other types of infections (not only parasites), and may have non-infectious causes.
The three main parasites that cause eosinophilic meningitis in infected children are listed below:
- Angiostrongylus cantonensis (neurological angiostrongyliosis)... The parasitic nematode (roundworm) that causes angiostrongyliosis is the most common culprit in eosinophilic meningitis. It is usually found in the pulmonary arteries of rats. Snails are the primary intermediate hosts where the larvae develop into an infectious form. Humans are occasional hosts and can become infected when larvae enter raw or undercooked snails, or by ingesting contaminated water or vegetables. The larvae are then transported through the bloodstream to the central nervous system, where a disease develops that is potentially fatal or permanently damages the brain and nerves.
- Baylisascaris procyonis (bayliascariasis). The infection is caused by the roundworm found in raccoons. This roundworm can infect humans as well as many other animals, including dogs. Human infections are rare but can be serious if the parasites spread to the eye, internal organs, or the brain.
- Gnathostoma spinigerum (neurognatostomyosis). Gnatostomyosis is a foodborne parasitic infection that occurs as a result of the ingestion of larvae of nematodes of the genus Gnathostoma in the third stage of life. The most common species that infects humans is G. spinigerum.
Larvae can be found in raw or undercooked protein sources (such as freshwater fish, chicken, pigs) or in contaminated water. In rare cases, the larvae can directly penetrate the skin of humans who are exposed to contaminated food sources or fresh water.
Any organ system can be involved, but the most common manifestation of infection is characterized by undulating migratory swelling in the skin and subcutaneous tissues. This swelling can be painful, itchy, and / or erythematous (reddened). Gnathostoma species usually cause parasitic eosinophilic meningitis due to larval migration into the brain.
Contagiousness of meningitis
Meningitis is a condition that does not tolerate frivolity. Because of the potential complications and pain this disease brings, it is normal to ask the question: is meningitis contagious?
The contagiousness of meningitis is determined by its type that the patient has.
Contagious meningitis
There are 2 types of contagious meningitis - bacterial and viral etiology. Viral genesis meningitis is highly contagious, as the viruses responsible for the disease are transmitted from person to person or as a result of contact with an infected surface.
Enteroviruses, which are responsible for the vast majority of cases of viral meningitis, are present in the feces, sputum and saliva of infected people. This means that touching or contacting each of these secrets can trigger viral meningitis.
As well as viral, bacterial meningitis is contagious, especially if there have been cases of prolonged contact with a sick person. However, if the child is near a sick person without close contact, the risks of infection are reduced.
The bacteria that cause bacterial meningitis are usually found in the mucus and saliva of an infected individual.
Bacteria can be transmitted through:
- kisses;
- exchange of dishes (glasses / cups);
- coughing or sneezing.
Eating food that is contaminated with bacteria increases your risk of developing bacterial meningitis.
Non-contagious types of meningitis
Fungal, parasitic, and non-infectious meningitis are not considered contagious.
Fungal meningitis does not spread from person to person. This form of meningitis develops when fungus travels through the bloodstream to the brain from another area in the body or from an infected area near it.
A child may develop fungal meningitis after taking medications that weaken his immune system. These may be steroids (prednisone), drugs used after organ transplants sometimes prescribed to treat autoimmune conditions.
Meningitis as a result of fungal infection occurs from infection spreading to the spinal cord. Unlike other fungi that are common in soil, Candida is a potential causative agent of meningitis, usually acquired in a hospital.
Parasites are more likely to infect animals than humans, and they do not spread from one person to another. People become infected by ingesting anything that contains the infectious form of the parasite.
Non-infectious meningitis is not contagious because it is usually triggered by conditions such as lupus, cancer, or brain surgery. Also, meningitis can develop due to a head injury or after taking certain medications.
Symptoms
Meningitis symptoms vary depending on age and the cause of the infection.
Common symptoms:
- increased body temperature;
- lethargy;
- irritability;
- pain, dizziness;
- sensitivity to light;
- stiffness (inactivity, stiffness) of the neck muscles;
- skin rash.
Babies with meningitis can have different symptoms. Crumbs can be very irritable and, conversely, sleepy, have a decreased appetite. You may find it difficult to calm your baby down, even if you pick him up and rock him. They may also have a fever or a fontanel that protrudes above the level of the skull bones.
Other symptoms of meningitis in infants may include:
- yellowish skin tone;
- stiffness of the muscles of the body and neck;
- temperature is below normal;
- sluggish sucking;
- a loud shrill cry.
Diagnostics
Based on the history of the disease (history) and examination, if meningitis is suspected, the doctor will suggest specific tests to further aid in the diagnosis.
Tests include evaluating the blood for signs of infection and possible bacteria, brain scans (such as CT or MRI scans), and examining cerebrospinal fluid.
A lumbar puncture is the most common way to obtain a sample of fluid (CSF) from the spinal canal for examination. It is called a "lumbar puncture" because the needle is inserted into this part of the back. The needle passes between the bony parts of the spine until it reaches the cerebrospinal fluid. Then a small amount of liquid is withdrawn and sent to the laboratory for analysis. Evaluation of cerebrospinal fluid is usually necessary for definitive diagnosis and helps make optimal treatment decisions (for example, choosing the right antibiotic).
The diagnosis is confirmed by examination of the spinal fluid and, in case of infection, by identification of the organism causing the disease.
In patients with meningitis, cerebrospinal fluid often has low glucose levels and an increased white blood cell count.
In addition, the liquid can be used to identify some viral causes of meningitis, or can be used to culture the bacterial organisms that cause meningitis.
Treatment
When a healthcare professional suspects a child has meningitis, they are likely to prescribe broad-spectrum antibacterials to treat potential non-viral types of infectious meningitis. Once the doctor determines the type of meningitis - viral, bacterial, or fungal, the doctor will provide a more specific treatment.
Treatment of viral meningitis
Antibiotic therapy will not fight the virus.
If a child is found to have viral meningitis, he will be spared any antibiotic therapy you may have used before.
There is no specific treatment for viral meningitis, which is often mild.
Typically, children recover from viral meningitis in seven to ten days. Treatment consists of rest, antipyretic / pain relieving drugs, and adequate fluid intake.
However, if your child's meningitis is caused by a herpes virus or flu, the doctor will prescribe antiviral drugs that target those specific pathogens.
For example, the antiviral drugs Ganciclovir and Foscarnet are sometimes used to treat cytomegalovirus meningitis in immunocompromised children (from HIV / AIDS or other problems), babies born with an infection, or seriously ill children.
In some cases, acyclovir is approved for use in the treatment of meningitis due to herpes simplex virus, although in most cases it has a positive effect only when administered very early.
Influenza can be treated with one of the licensed antivirals (such as Perimivir or Oseltamivir).
Treating bacterial meningitis
If a child has bacterial meningitis, he or she will be treated with one or more antibacterial drugs that target the underlying causes of that particular infection.
- cephalosporin antibiotics such as cefotaxime and ceftriaxone (for pneumococcus and meningococcus);
- ampicillin (a drug of the penicillin class) for Haemophilus influenzae type B and Listeria monocytogenes;
- vancomycin for penicillin-resistant strains of Staphylococcus aureus and pneumococcus.
A number of other antibiotics can also be used, such as Meropenem, Tobramycin, and Gentamicin.
Ciprofloxacin and Rifampicin are sometimes given to family members with bacterial meningitis patients to protect them from infection.
Treatments for fungal meningitis
Fungal meningitis is treated with long courses of high-dose antifungal drugs. These drugs are often part of the azole class of antifungal drugs such as Fluconazole, which is used to treat Candida albicans infections.
Other antifungal agents may be used depending on the type of infection. For example, Amphotericin B is a common treatment for cryptococcal meningitis caused by the fungus Cryptococcus neoformans. Amphotericin B can also be used in the treatment of a rare type of parasitic meningitis caused by Naegleria fowleri.
Alternatively, the antimicrobial agent Miconazole and the antibacterial Rifampicin can be used.
In addition to the above medications, corticosteroids can be used to reduce inflammation.
Treating other types of meningitis
Noninfectious meningitis caused by allergies or autoimmune disease can be treated with corticosteroids.
Cancer-related meningitis requires therapy for the individual type of cancer.
Prevention of meningitis
The most effective method of protecting a child from certain types of bacterial meningitis is through immunization.
Today, the meningitis vaccine for children is gaining popularity. There are three types of vaccinations for bacterial meningitis, some of which are recommended for babies 2 months and older.
Meningococcal vaccines
This vaccination protects against the bacteria Neisseria meningitidis that cause meningococcal disease.
Despite the fact that the meningococcal vaccine has existed since the 1970s, it was not very popular because its protection did not last long. Fortunately, new meningococcal vaccines are now available that offer better and longer lasting protection.
Currently, children are given two types of meningococcal vaccine:
- Meningococcal conjugate vaccine provides protection against four types of meningococcal bacteria (called types A, C, W, and Y). Recommended for all children.
- The serogroup B meningococcal vaccine protects against type 5 meningococcal bacteria. This is a fairly new type and has not yet been recommended as a routine vaccination for healthy people, but it can be given to some children and adolescents (16 to 23 years old) who are at high risk of infection with meningococcus.
Vaccination recommendations
Vaccination with meningococcal conjugate vaccine is recommended:
- children 11 - 12 years old, with a booster (increased dose) received at 16 years old;
- adolescents 13 - 18 years old who have not been previously immunized;
- those who received the first vaccine between the ages of 13 and 15. They should receive a booster dose between the ages of 16 and 18. Teens who get their first vaccine after age 16 do not need a booster dose.
A complete series of meningococcal conjugate vaccines should be provided to children and adolescents most at risk of meningococcal infection, including those who:
- lives or travels in countries where the disease is common if they are present during the outbreak of the disease;
- has certain immune disorders.
If the immune disorders are chronic, these children also need a booster dose several years after the first vaccine is given, depending on the age at which the first vaccine is given.
The sequence and dosage will depend on the age of the child.
Children 10 years of age and older with these risk factors should receive a complete series of serogroup B meningococcal vaccine. The preferred age to receive the vaccine is 16 to 18 years. Two or three doses are required depending on the brand.
Children with an increased risk of meningococcal infection (children without a spleen or with certain medical conditions) should receive the vaccine from as early as 2 months. Some of the common side effects are swelling, redness, and pain at the injection site. Headache, fever, or fatigue are also possible. Severe problems such as allergic reactions are rare.
When to postpone or eliminate immunization
The vaccine is not recommended if:
- the child is currently ill, although mild colds or other minor illnesses should not interfere with immunization;
- the child had a severe allergic reaction to a previous dose of meningococcal vaccine, DPT vaccine.
If your child has or has an episode of Guillain-Barré Syndrome (a nervous system disorder that causes progressive weakness), talk to your doctor about immunizations.
Evidence suggests that protection of meningococcal conjugate vaccines declines in many adolescents within 5 years. This underscores the importance of a booster dose at age 16 to ensure that children remain protected at the age when they are most at risk for meningococcal disease. Early data on serogroup B meningococcal vaccines suggest that protective antibodies also decline quite rapidly after vaccination.
Pneumococcal vaccine
Pneumococcal conjugate vaccine (PCV13 or Prevenar 13) and pneumococcal polysaccharide vaccine (PPSV23) protect against pneumococcal infections that cause meningitis.
PCV13 provides protection against 13 types of pneumococcal bacteria that cause the most common childhood infections. PPSV23 protects against 23 species. These vaccines not only prevent diseases in children who are immunized, but also help stop the spread.
Prevenar 13 can be given regularly to infants and children 2 to 59 months of age to protect against 13 subtypes of Streptococcus pneumoniae bacteria that cause invasive pneumococcal disease, including meningitis, pneumonia, and other serious infections.
It can also protect children from ear infections caused by these 13 subtypes of Streptococcus bacteria.
Prevenar 13 is usually given in a three-dose series (as part of a routine immunization schedule) with primary doses over two and four months and a booster dose over 12 to 15 months.
A select group of children 2 years of age and older may also need a PCV13 injection. For example, if one or more vaccinations were missed, or if there was a chronic disease (heart disease, lung disease), or something that weakens the immune system (asplenia, HIV infection). The doctor can decide when and how often the child should get PCV13.
Immunization with PPSV23 is recommended as additional protection against pneumococcus in children 2 to 18 years of age who have several chronic conditions, including heart, lung, or liver disease, kidney failure, diabetes, weakened immunity, or cochlear implants.
Pneumococcal vaccine should not be given to children with a history of hypersensitivity reactions to the vaccine. The safety of the pneumococcal vaccine for pregnant women has not yet been studied. There is no evidence that the vaccine is harmful to the mother or fetus. However, pregnant women should consult a specialist before getting vaccinated. Women at high risk should be vaccinated prior to pregnancy, if possible.
Pneumococcal vaccine usually does not cause adverse reactions. Reported adverse effects include soreness and / or redness at the injection site, fever, rashes, and allergic reactions.
Research conducted several years after PCV13 was licensed showed that a single dose of PCV13 protected 8 out of every 10 children from disease caused by the serotypes in the vaccine, and that protection was similar among children with and without risk factors. The vaccine is also effective in preventing pneumococcal disease caused by antibiotic-resistant serotypes.
Hemophilus influenza vaccine
The vaccine provides protection against a severe bacterial infection that mainly affects infants and children under 5 years of age. These bacteria can cause epiglottitis (severe swelling in the throat that makes breathing difficult), severe pneumonia, and bacterial meningitis.
Hemophilic meningitis causes death in 1 in 20 children and permanent brain damage in 20% of survivors.
Thanks to the vaccine, the incidence has decreased by almost 99%. The cases that occur are mostly in children who have not been given the vaccine or who were too small to be immunized.
The vaccine is recommended for all children under 5 years of age.
Vaccine administration is recommended in the following age groups:
- 3 months;
- 4.5 months;
- 6 months;
- 18 months.
The vaccine should not be given to children under 6 weeks of age.
Also, tell your doctor if your child has had a severe allergic reaction. Anyone who has ever had a severe allergic reaction from a previous dose or has had a severe allergy to any part of this vaccine should not be vaccinated.
For children who are moderately or severely ill, immunization should be postponed until recovery.
Studies show that almost all (93 - 100%) children are protected from hemophilus influenzae after receiving the initial series of vaccines.
After receiving the primary batch, antibody levels decrease and an additional dose is required for children 12 to 15 months of age to maintain protection in early childhood.
Most children who get the haemophilus influenza vaccine have no problem with it. Any medicine, including vaccines, has the potential for side effects. They are usually mild and go away on their own within a few days, but serious reactions are possible.
Minor problems usually do not appear after being vaccinated against haemophilus influenzae. If they do occur, they usually begin shortly after the injection. They can last up to 2 or 3 days and include redness, swelling, warmth at the injection site, and fever.
As with any vaccine, vaccines that protect against the above bacteria are not 100% effective. Vaccines also do not provide protection against all types of every bacteria. Therefore, there is still a chance that a child can develop meningitis of a bacterial etiology, even if he was vaccinated.
Prevention of viral meningitis
There are no vaccines to protect against non-polio enteroviruses, which are the most common culprits in viral meningitis.
You can take the following steps to reduce your child's risk of contracting non-polio enteroviruses or spreading them to others:
- Frequent hand washing with soap and water, especially after using the toilet, after coughing or blowing your nose.
- Do not touch your face with unwashed hands.
- Avoid close contact, such as kissing, hugging, sharing cups, or sharing utensils with sick people.
- Cleaning and disinfecting children's toys and door handles is important, especially if someone in the family is sick.
- If a child is sick, he must stay at home.
- Avoid being bitten by mosquitoes and other insect vectors that can infect people.
Some vaccines can protect against certain diseases (measles, mumps, rubella, and influenza) that trigger viral meningitis. Make sure your child is vaccinated on a schedule.
There are many other types of viral meningitis for which vaccines have not yet been developed. Fortunately, viral meningitis is usually not nearly as serious as bacterial meningitis.
Thus, despite its seriousness, meningitis is a preventable disease. And the measures taken in advance are crucial.
