Meningitis

Meningitis is the acute inflammation of the meninges, subarachnoid space, and brain vessels caused by infection. Meningitis can be caused by a variety of infectious agents, including bacteria, viruses, fungi, and mycobacteria. Most pathogens are specific to certain age groups, seasonality, geography, and underlying host factors.

The Causes for Meningitis

• Neonatal Disease
• Neonatal streptococcal meningitis
• Neonatal gram-negative meningitis
• Neonatal herpes simplex (HSV) infection
• Neonatal lsteria meningitis
• Common Non-neonatal Bacterial Pathogens
• Streptococcus pneumoniae
• Neisseria meningitidis
• Viral, Miscellaneous Infectious, and Noninfectious Pathogens

Enteroviruses are transmitted by the fecal-oral route, and cases of meningitis are recognized most in children younger than one year of age. CNS involvement can occur with a variety of other agents, and often the clinical presentation is not restricted to meningitis; meningoencephalitis or encephalitis presentations often predominate. Pathogens such as HSV, Mycoplasma, arboviruses, Epstein-Barr virus, rabies virus, human herpesvirus-6, Ehrlichia sp, and Rickettsia rickettsii are examples of pathogens more likely to cause encephalopathic signs and symptoms. Cases of noninfectious aseptic meningitis include those that are drug-induced or are related to vasculitis in the setting of systemic lupus erythematosus or Kawasaki disease.

• Less Common Pathogens
• Non-neonatal gram-negative bacilli
• Mycobacterium tuberculosis
• Borrelia burgdorferi

Mechanisms for Development of Neonatal Meningitis

• Primary bloodstream infection with secondary hematogenous spread to CNS.
• Presence of an infectious foci with secondary bloodstream infection and hematogenous spread (e.g., osteomyelitis).
• Presence of an infectious foci with direct extension into the CNS (e.g., sinus infection).
• Primary CNS infection resulting from disruptions due to head trauma, neurosurgery, or congenital defects.

Clinical Manifestations of Meningitis

Infants younger than one month of age who have viral or bacterial meningitis can present with a constellation of constitutional, nonspecific signs, including fever, hypothermia, lethargy, irritability, and poor feeding. Similarly, infants older than one month of age and young children present with nonspecific constitutional symptoms such as fever, lethargy, and irritability. Older children and adolescents often experience malaise, myalgia, headache, photophobia, neck stiffness, anorexia, and nausea.

Diagnosis

All children who are suspected of having meningitis should have their cerebrospinal fluid (CSF) examined unless lumbar puncture is contraindicated. CSF examination should include cell count and differential count, glucose concentration, and protein measurements. These values must be interpreted based on the child’s age; normal CSF values for an infant are very different from those of an adult. Serum glucose concentration should be measured to determine the ratio between serum and CSF glucose as a percentage. A Gram stain of the CSF should be performed promptly as well as cultures of the CSF and blood. CSF culture remains the gold standard for diagnosing bacterial meningitis.

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