Making Sense of Meningitis

by Baylor Scott & White Staff on April 17, 2014

in Medical Information

menengitisYou walk into your child’s room to find him sweaty and shaking. Hours later he’s up at night complaining of being cold. You wonder when his fever will break and question if this fever is something more serious.

As a parent, spending nights watching over your feverish sick child can make you worry. There are many common illnesses that produce fevers, some posing severe threats.

When it comes to meningitis, fever or flu-like symptoms are common, and they merit a serious disease that needs immediate attention.

Meningitis is an inflammation of the membranes surrounding the spinal cord and brain. Viral meningitis is caused by a viral infection. It is important to know whether a virus or bacterium is causing your meningitis because viral meningitis is generally less severe than bacterial meningitis.

For these cases, children are often seen by James H. Brien, DO, a pediatric infectious disease specialist at McLane Children’s Scott & White, to assist with proper diagnosis and treatment.

Viral Meningitis

Dr. Brien says viral meningitis is caused by a number of viruses that affect the central nervous system.

“By far, the most common is a group of viruses called enteroviruses,” says Dr. Brien. “There are about 80 different types of enteroviruses and the vast majority cause little to no significant disease.”

Enteroviruses infections tend to peak in the summer months, and are spread through direct contact with another person infected.  While there are dozens of different types of enteroviruses, those that most people have heard of are the polioviruses, but thanks to polio vaccinations, this disease has been eliminated in the United States. Other, much less frequent viruses that cause meningitis are (1) herpes simplex, usually transmitted to newborns during birth, and (2) arboviruses transmitted by mosquitoes and very uncommon.

The most significant disease enteroviruses cause is meningitis. The symptoms can range from minor “flu-like” illness to severe headache, requiring admission to the hospital for management. Other symptoms may include nausea, vomiting, diarrhea and photophobia (sensitivity of your eyes to light).

If you have an illness such as this, you should see your caregiver right away to be evaluated. Your primary providers can often tell by simple history and examination if this is your diagnosis, and help you get the medications you need to feel relief from your headache and other associated symptoms.  However, you may be referred to the hospital or emergency room for further testing to get the correct diagnosis and treatment. It is important to distinguish between viral meningitis and that caused by various bacteria (see below).

“The main myth regarding viral meningitis is that they are all going to cause brain damage, when the fact is, very few cases result in any damage at all,” says Dr. Brien.

Bacterial Meningitis

Bacterial meningitis is generally much more severe because the potential for brain injury is much greater.

“While the majority of children with bacterial meningitis have complete recovery, with no lingering injury, it can be fatal,” says Dr. Brien. “It can result in severe brain injury, or even be fatal if diagnosed late or if not treated with the appropriate antibiotics, or if caused by a very virulent, rapidly progressive bacteria, regardless of other factors.”

The big risk associated with bacterial meningitis is children not getting treatment early enough. It can be hard for parents to seek medical help because symptoms may mimic a simple case of the flu, which might result in a delay in seeking care until it is clear that the child has a more severe infection.

“The progression of bacterial meningitis can be fairly rapid, further complicating decision-making,” says Dr. Brien.

He explains one dangerous scenario might be when a child has a fever with relatively minor symptoms, is put to bed, and is critically ill by morning.

Once the diagnosis is suspected, bacterial meningitis is always treated with antibiotics. Physicians will start a combination of antibiotics to cover a wide variety of different bacteria, and then, when the specific cause is determined by culturing the spinal fluid in the lab, they will target that specific bacteria with the best antibiotic based on sensitivity testing done on that bacterium.

“The outlook is usually very good, especially with early treatment, but occasionally can be devastating or fatal,” says Dr. Brien

“The outlook is usually very good, especially with early treatment, but occasionally can be devastating or fatal,” says Dr. Brien. Prevention is always better that treatment. Vaccines play a critical role in prevention of bacterial meningitis.

Importance of Vaccines

“The main thing for people to know is that bacterial meningitis is much less common today than it was just 35 years ago,” says Dr. Brien. “The sole reason for this dramatic reduction in this disease is a direct result of immunizations against the more common causes of invasive bacterial diseases.”

Children who have been immunized for the following bacteria are much less likely to contract meningitis:

  • Haemophilus influenzae type b (Hib)
  • Pneumococcus
  • Meningococcus

Dr. Brien is passionate about vaccines, as he has seen first-hand the affects of these diseases. He has a crystal-clear memory of treating many children suffering from the effects of bacterial meningitis earlier in his 37-year career, when bacterial meningitis was common.

“Parents who choose to not immunize their children with these vaccines are placing their children at risk of contracting these devastating illnesses,” explains Dr. Brien. “While all vaccines carry a small element of risk of side effects, these side effects pale by comparison with the diseases that they prevent.”

For more information about vaccines or meningitis talk to your child’s pediatrician to stay safe and worry-free.

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