Infection
Meningitis in children can be transmitted via droplet infection, i.e. from person to person through small droplets when coughing, sneezing or kissing, especially in places with close contact to other people (school, kindergarten). Another mechanism of infection is the spread via the blood from other infections (hematogenic), from other infections in the ear, nose and throat area, such as sinusitis (per continuitatem), or after brain surgery or open skull fractures.
Test for meningitis in children
To confirm meningitis in children, cerebrospinal fluid (CSF) is taken from the spinal canal (CSF or lumbar puncture) and examined for viruses and bacteria. Furthermore, the pressure in the cerebrospinal fluid space is measured, which can be increased in bacterial meningitis. The cerebrospinal fluid is normally clear, a discoloration or a cloudy appearance also indicates a bacterial infection.
The CSF is then examined under a microscope and bacterial cultures are prepared, which are more reliable, but take up to 48 hours to evaluate. Other examination methods are serological examination or examination by PCR (polymerase chain reaction), where the DNA of the pathogen is searched for. Imaging methods such as CT or MRI scans or, in infants, ultrasound examination of the head can provide further clues and show an increase in intracranial pressure at an early stage. Certain physical examinations can confirm the suspicion of meningitis in children. These include:
- The test for neck stiffness (meningism),
- The Brudzinski sign (tightening of the legs when bending the head due to the stretching pain of the meninges of the brain and spinal cord)
- And the Kernig’s sign (a sick person cannot stretch the leg while sitting, as this causes pain),
- As well as the Lasegue sign, which is often examined in the case of a herniated disc (when lifting the leg while lying down, pain occurs in the back).
Treatment
If there is a suspicion of meningitis in the child, prompt action should be taken. A presentation in a hospital with a department for children is often useful, as all examination facilities are available here. If the sample of the cerebrospinal fluid has been taken, antibiotic therapy is started immediately to quickly combat the germ.
Broad-spectrum antibiotics are used here, which cover a wide range of pathogens, as long as the exact pathogen is not yet known. The antibiotics are given via infusions. Once the results of the examination are available, the antibiotics are adjusted if necessary.
The administration of antibiotics before the lumbar puncture is not recommended, as they can falsify the results. If bacterial infections are suspected, cortisone is given additionally to limit the swelling of brain tissue. If meningococcal meningitis is suspected, the patient is isolated, i.e. placed alone in a room which may only be entered under special protective measures such as mouth protection, gowns and gloves, as the disease is highly contagious.
Contact persons of patients with meningococcal meningitis (classmates, parents) are given a so-called chemoprophylaxis with various antibiotics and the subsequent protective vaccination to prevent the outbreak of an infection. Protective vaccinations are available for meningococcus, pneumococcus and Haemophilus influenzae and are scheduled in the vaccination calendar of the Robert Koch Institute for children and persons at risk. Vaccination against the TBE virus is recommended if you live in an area where there are ticks carrying the virus. If meningitis is caused by viruses, usually only the symptoms are treated, as there is no treatment against the viruses. The measures include lowering fever and treating pain.
