22 March 2011

Meningitis in Children

Il-Meningite fit-Tfal (artiklu bil-malti).

Introduction
Check if a rash fades on pressure
by applying a transparent glass.


Meningitis is a rare but serious disease. There are about ten reported cases every year in Maltese children. Every effort should be made to protect our children from meningitis because it can result in permanent neurological problems, such as hearing loss and seizures, and even death in about 5% of cases.

There are two lines of defence; firstly, children can be protected by immunisation; secondly, parents should learn how to recognize the signs of meningitis so that the ill child is brought immediately to medical attention. Early treatment results in a better outcome, usually with full recovery.

Causes

Meningitis can be caused by viruses and bacteria. Viral meningitis is common, but it is usually not serious, and no vaccines are available. Bacterial meningitis is less common, but it is a more serious infection. There are three bacteria that commonly cause meningitis in infants and children after the first month of life:
  1. 1. Hib
  2. 2. Pneumococcus
  3. 3. Meningococcus
As late as the 1990’s, Haemophilus influenzae B (Hib) was a common cause of meningitis. Hib meningitis has become exceedingly rare since the introduction of the Hib vaccines in the 1990’s. Pneumococcus is a common cause of middle ear infection, pneumonia, as well as meningitis. Meningococcus is the leading cause of bacterial meningitis; it can also cause septicaemia (blood infection) which is a more serious disease than meningitis. There are several strains of meningococcus - Group B and Group C are the most common forms of meningococcus disease in our country.

Vaccines

Safe and effective vaccines are available for most, but not all, forms of bacterial meningitis.
  • HiB Included in 5-in-1 or 6-in-1 given in 3 doses in the first year of life and booster dose in the second year.
  • Pneumococcus Prevenar-13 or Synflorix, given from 2 months of age.
  • Meningococcus C NeisVac-C, given from 2 months of age; Nimenrix (also protects against other forms of meningococcus, A, C, W and Y), is given from 1 year of age.
  • Meningococcus B Baxero is given in two doses (children under 2 years need a booster dose later on).
Early Recognition

The symptoms of bacterial meningitis and septicaemia can develop rapidly, often within a few hours. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and young children may not manifest the typical signs of meningitis. An infant may simply feed poorly, dislike being handled or become very lethargic. A shrill cry or unusual moaning should alert parents to the possibility of meningitis. Check on an ill baby or child during the night.

Seizures (abnormal jerking movements and loss of consciousness) are rarely associated with meningitis and, in fact, most seizures in young children are simply the result of a high fever (‘febrile fit’).

A non-fading dark red rash is an important sign to look for when a child is unwell with fever. It may start as tiny spots that looks like small pin pricks; may spread quickly and develop into large dark red blotches. These spots do not blanch – in other words, they don’t fade if a transparent glass is pressed against the skin.

Call Doctor

Seek immediate medical advice (call you child’s doctor or take the child to the emergency department at Mater Dei) in the following circumstances:
  • Infant less than 3 months with fever even if the baby does not look unwell.
  • Infant less than 1 year of age with fever if the child looks unwell.
  • Older child with fever and signs of meningitis (as above).
  • Child of any age with fever and a non-blanching rash.
  • If the general condition of the child deteriorates even if the child had already been examined before.
Il-Meningite fit-Tfal (artiklu bil-malti).