Bacterial Meningitis and Children
Recognizing bacterial meningitis, in a well-appearing infant is sometimes difficult.
Of the approximately 25,000 cases of bacterial meningitis that occur each year in the United States, children comprise two thirds of the cases. The mortality rates are 25% in adults and 5% in children, but long-term serious side effects to children occur in 25% to 40% of the survivors include permanent neurosensory hearing loss, hydrocephalus, epilepsy, and cognitive defects. The incidence of meningitis is highest between birth and 2 years of age and peaks between 3 and 8 months of age. The increased use of vaccines has significantly reduced the number of meningitis cases.
Meningitis in children usually occurs as a result of bacteremia, the inflammatory responses to the products of bacterial multiplication. This inflammation alters the blood-brain barrier and often spreads the infection and inflammation to the brain.
Symptoms and Misdiagnosis
Acute awareness for meningitis should be held by all physicians who treat children, as no single sign or symptom is always present.
There are however, clues that can point to meningitis. Usually, there are two types of progressions: a persistent fever for a number of days or rarely, an immediate septic shock, inflammation and meningitis, which happens in hours.
Symptoms depend on the age of the child. Very young infants exhibit the least symptoms and as a result infants should be carefully treated. About half of infected infants will have a fever, but many will have normal temperatures. Often the infants with meningitis will have only general symptoms including irritability, lethargy, lack of appetite, jaundice, vomiting and diarrhea. 40% of infants with meningitis may have seizures.
In older children, the initial signs may include fever, vomiting, headaches, light sensitivity, confusion, lethargy, nausea, and irritability. A marked change in the child demeanor is also an important sign of meningitis.
After the onset of the above symptoms timely medical intervention is critical. From the moment a child visits an emergency room to the to administration of antibiotics is considered as important as early treatment in heart attack cases.
A lumbar puncture or spinal tab needs to be performed, with many emergency room doctors performing lumbar punctures on any children younger than 2 years with an otherwise unexplained fever. Failure to timely perform a lumber puncture accounts for missed diagnosis of meningitis up to 35% of all cases. Doctors generally agree that not enough spinal taps are performed. The downside is that the procedure is painful and can have negative side effects.
Today, however, every child with signs or symptoms suggestive of meningitis should have a full cerebrospinal fluid evaluation.
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