This is one of the most feared illnesses that worry many parents. Anytime a child complains of a headache and has a fever, the
thought goes through the parent’s mind, “Could this be meningitis?
Is it going around right now? Is my child going to have brain damage?”
Meningitis is a very serious illness, and it is important for parents to understand the
symptoms and when to seek medical attention. Here is Dr. Sears guide to meningitis.
You will learn what it is, what the symptoms are, how to tell if
your child may have it, when to worry (and when not to worry), when to seek
prompt medical attention, and how it is diagnosed and treated.
WHAT IS MENINGITIS?
It is an infection of the lining (meninges) and the fluid that cover the outside of the brain and spinal
cord. The infection can spread into the
brain tissue and cause brain damage.
WHAT CAUSES MENINGITIS?
There are two main causes:
- Viral meningitis – there are several viruses that can
cause viral meningitis. Their names are not important. It is NOT treatable with
antibiotics. It is a seasonal illness,
with most cases occurring during the summer and early fall.
It can be just as painful as bacterial
meningitis, but is usually not as serious or damaging.
- Bacterial meningitis – this is caused by several
different bacteria. Pneumococcus and E. Coli are common in infants and children.
Meningococcus is common in college students or military personnel living
in dorms. These are treatable with IV
antibiotics, but sometimes cause brain damage even if treated early.
There is a new vaccine called Prevnar that
is now given to infants to protect against Pneumococcus.
There is a vaccine for college students to
protect against meningococcus.
WHAT IS SPINAL MENINGITIS?
is really a misconception. Meningitis
affects both the brain and spinal cord at the same time.
You can’t have JUST spinal meningitis – you
simply have meningitis. Therefore,
spinal meningitis and regular meningitis are one and the same.
WHAT ARE THE MAIN SYMPTOMS OF MENINGITIS?
- Fever – will usually be high, over 103.
- Severe headache – this is not a typical headache. It
is extremely painful. It occurs because the infected lining of the
brain gets severely inflamed.
- Vomiting - the irritation in the brain triggers persistent vomiting (more than just a few times).
- Neck pain and stiffness - this does NOT apply to sore throat pain in the front of the neck. It refers to severe pain in back of the neck. Looking down at your stomach (stretching the back of your neck) will cause severe pain. Some kids will refuse to even look down at all. They will keep their neck rigidly stiff. This occurs because the lining of the spinal cord is connected to the lining of the brain. When this infected and inflamed lining is stretched by looking down, it causes severe pain.
- Photophobia - this means that light hurts your eyes. Meningitis will cause someone to refuse to look into light, especially the bright sunlight.
- In infants, you cannot determine if they have neck stiffness because they are too young to communicate this. Severe, inconsolable irritability and/or lethargy (meaning limp, lifeless, won't open eyes to focus on you) are signs of any severe infection, including meningitis.
HOW DO I DECIDE IF MY CHILD'S SYMPTOMS MAY BE MENINGITIS? - WHEN TO WORRY (OR NOT WORRY)
- If your child has all five symptoms, don't even call or page your doctor. GO STRAIGHT TO AN EMERGENCY ROOM.
- The key to meningitis is the neck pain and stiffness. So if your child has severe neck pain and stiffness, and one or more of the other four symptoms, call your doctor to be seen right away, or page the doctor after hours.
On the other hand, if your child does NOT have neck pain or stiffness, and DOES have the other symptoms, then it is less likely to be meningitis.
- If the headache is very, very severe, fever and vomiting are present, but there is no neck stiffness or pain, you should contact your doctor just to be safe.
- Additionally, fever is almost always present during meningitis. So if your child has a headache, but no fever (and no neck stiffness), then you can be reassured it is not meningitis.
- In fact, headache, fever and vomiting, without neck pain or stiffness, is probably the just a bad flu virus.
- MOST IMPORTANTLY - if you are not sure, contact your doctor.
WHAT ABOUT CASES OF MENINGITIS THAT WERE FATAL BECAUSE A DOCTOR THOUGHT IT WAS JUST THE FLU?
Unfortunately, this does occur from time to time. In the very early stages of meningitis, it can appear like the flu. Because the flu is so common, doctors can't do a spinal tap on every person with simple flu symptoms. It is important to examine closely for neck or spinal pain and stiffness.
HOW IS MENINIGITIS SPREAD?
It is spread by contact with the saliva of an actively infected person such as by coughing or sharing utensils or cups.
HOW IS MENINGITIS DIAGNOSED?
A doctor looks for several clues when examining a child for meningitis:
- Stiff neck - as discussed above.
- Photophobia - as above.
- Severe back pain when the legs and knees are pulled up to the chest - this stretches the inflamed lining of the spinal cord.
- Lethargy or extreme irritability in infants.
The doctor will consider these signs on exam and the symptoms that you are reporting, and will decide if meningitis is possible. If so, the doctor will recommend a spinal tap. There is no way to diagnose meningitis without a spinal tap.
The dreaded spinal tap
(also called a Lumbar Puncture) - no parent ever wants their child to undergo a spinal tap. The thought of sticking a needle into their child's spinal cord sounds horrible. Many parents fear it can cause paralysis. Everyone's grandmother has a story about someone being paralyzed by a spinal tap.
You can be reassured that spinal taps are actually very simple procedures from the doctor's standpoint. Every doctor performs several dozen during their training years. ER doctors perform as many as 100 or more each year. Ask the doctor how many he or she has done.
Why do a spinal tap to find an infection in the brain?
- the fluid that coats and flows through the brain also flows down into the spinal cord. So the spinal fluid reflects what is occurring in the brain.
Here is what happens during a spinal tap:
- The skin over the lower part of the spine is numbed with an injection or cream.
- The area is cleaned thoroughly so it is sterile.
- The infant or child is curled up on his side and held securely by an assistant. Older children and adults may sit up.
- A needle is passed through the skin at a large space in between two of the lower vertebrae. The needle does NOT pass through bone.
- The needle is slowly advanced until it "pops" through the lining of the spinal canal into an area of spinal fluid. THIS IS THE PART MOST PARENTS DON'T UNDERSTAND. The needle does NOT go into the spinal cord where the nerves are. The spinal cord stops about ¾ of the way down the spine. The bottom ¼ of the spine simply contains a reservoir of spinal fluid. So you don't need to worry about paralysis.
- Spinal fluid will flow out through the needle and the doctor will collect it and send it to the lab. Once the needle is pulled out, the hole seals up rapidly.
Sounds painful? Well, if numbed up properly, then there is little pain. Most of the discomfort comes from being restrained during the procedure.
TESTING TO DETERMINE THE TYPE OF MENINGITIS
The spinal fluid is tested in the lab for several things:
- Immediate results - within an hour the lab will determine if there are many white blood cells in the fluid. If there are, then it IS meningitis.
- 24 to 72 hour culture results - it takes this long for the lab to test whether or not a bacteria or a virus is causing the meningitis.
- 4-hour test results - some labs can test for the presence of viruses or bacteria within a few hours, but this type of test may not be as reliable of the 24 to 72 hour tests.
- There are several other aspects to testing the spinal fluid which are beyond the scope of this discussion.
HOW IS MENINGITIS TREATED?
- If it is viral meningitis, antibiotics won't help. Pain relief and anti-inflammatory medication is used.
- Bacterial meningitis is treated with 10 to 14 days of IV antibiotics.
- Often it is not clear whether a person has bacterial or viral meningitis until the lab runs the 24 to 72 hour culture tests. Some doctors will treat with antibiotics until this test confirms that it is NOT bacterial meningitis.
BRAIN DAMAGE FROM MENINGITIS
Most people come through meningitis with no ill effects on their brain. This is especially true of viral meningitis.
The most common ill effect is permanent hearing loss. Other effects such as weakness or loss of nerve function are less common.