Meningitis

Meningitis is a bacterial or viral infection that causes three thin layers of tissue that surround the brain and the spinal cord to swell. Doctors at Boston Children’s Hospital have been leaders and innovators in the treatment of meningitis complications for decades.

• viral meningitis is more common and less severe
• bacterial meningitis may cause long term complications, including death
• vaccines help prevent some forms of bacterial meningitis
• treatment for bacterial meningitis includes antibiotics
• there is no treatment for viral; most children recover on their own
• early treatment can help prevent serious problems

What causes meningitis?

Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF), the fluid within the open spaces of the brain that protect and cushion the brain and spinal cord. A fungus or parasite may also cause meningitis. More specifically:

Bacteria that can cause meningitis include:

• Group B streptococcus
• Escherichia coli (or E. coli)
• Listeria monocytogenes
• Streptococcus pneumoniae
• Neisseria meningitides (meningococcal meningitis)
• Haemophilus influenzae type b or H. influenzae
• syphilis
• tuberculosis (TB)

Viruses that can cause meningitis include:

• polioviruses
• mumps (paramyxovirus)
• herpes simplex virus (HSV)

Other microorganisms that can cause meningitis are:

• Borrelia burgdorferi (Lyme disease)
• fungi such as candida, aspergillus, or cryptococcus neoformans

Bacterial meningitis can be spread through coughing or sneezing, kissing, or sharing drinks. In addition, you increase your chances of catching meningitis by:

• having been in close contact with someone who has bacterial meningitis (especially when it’s due to meningococcus, a type of bacteria that is more contagious than others)
• having a compromised immune system
• having traveled to an area of the world where meningitis is widespread (consult your doctor for the recommended vaccinations before traveling overseas)

Is meningitis common?

About 3,000 people in the United States — or one in 100,000 — are diagnosed with bacterial meningitis each year, most of them infants, children, college students, and the elderly.

Incidences of bacterial meningitis usually peak in the winter or early spring. The most common cause of bacterial meningitis in children, Haemophilus influenzae b (Hib), has been almost eliminated due to a vaccine that was developed at Boston Children’s in 1990.

What are the symptoms of meningitis?

The symptoms of meningitis vary depending on what that caused the infection and the age of your child. They also may surface several days after your child has had a cold and runny nose, or diarrhea and vomiting. Your child may not display all of the signs and symptoms, but if you think your child is sick, seek medical attention immediately.

The most symptoms common include:

• In infants (symptoms may be difficult to identify)
  • irritability
  • fever
  • sleeping all the time
  • poor feeding
  • high-pitched cry
  • arching back
  • cries when picked up or being held
  • inconsolable crying
  • bulging fontanelle (soft spot on an infant’s head)
  • noticeably different temperament
  • seizures
• In children older than 1 year
  • neck and/or back pain
  • headache
  • sleepiness
  • confusion
  • irritability
  • fever
  • refusing to eat
  • decreased level of consciousness
  • seizures
  • sensitivity to light
  • nausea and vomiting
  • neck stiffness

Can you prevent meningitis?

Several vaccines are available to prevent some of the bacterial organisms that can cause meningitis, including:

• H. influenzae type b vaccine (Hib): given as a three or four-part series during your child’s routine immunizations, starting at 2 months
• pneumococcal conjugate vaccine (PCV7): recommended by the American Academy of Pediatrics (AAP) for all children younger than age 2 and children ages 24 to 59 months of age that are at very high risk for pneumococcal infection. PCV7 can be given along with other childhood vaccines at 2 months, 4 months, 6 months, and 12 to 15 months
• meningococcal vaccine: for meningococcal meningitis, a very contagious form of bacterial meningitis. This vaccine is normally given during the routine pre-adolescent immunization visit (at 11 to 12 years).

How Boston Children’s Hospital approaches meningitis

Boston Children’s is constantly working to prevent, identify and treat meningitis is a more effective way. Some innovations by Children’s include:

• Development of the Haemophilus influenzae b (Hib) vaccine in 1990 has practically eliminated the most common cause of bacterial meningitis in children.
• A simple algorithm developed at Boston Children’s and the University of California, Davis, Health System in 2007 helps doctors rapidly distinguish infants and children with viral meningitis from those with bacterial meningitis — potentially reducing unnecessary hospital admissions and prolonged antibiotic treatment.
• The Children’s Hospital Informatics Program created HealthMap, an online resource and smart phone app that helps track the spread of contagious diseases in real time, including meningitis.