Bacterial meningitis american academy of pediatrics. May 06, 2020 a cohort study of infants bacterial meningitis by ouchenir et al reported that e coli 33% and gbs 31% remain the most common causes of bacterial meningitis in the first. Some bacteria and viruses are more common in certain age groups than others. Department of pediatrics, division of pediatric infectious diseases. In this study, we evaluated 5 childrens for symptoms of meningitis, diagnosis tests, therapy and also some comorbid diseases related to abm. The clinical symptoms and signs of bacterial meningitis in children vary depending on the age of the child and duration of disease. Mar 29, 2020 pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Lp is recommended before antibiotics for most cases.
Untreated, its mortality approaches 100%, and even with current antibiotics and advanced paediatric intensive care, the mortality rate of the disease is approximately 510%. Practice guidelines for the management of bacterial meningitis. Aseptic meningitis has multiple etiologies with viral infection being the most common. Meningitis can occur in infants, children and adults. Bacterial meningitis is a medical emergency characterised by inflammation of the meninges in response to bacterial infection. Bacterial meningitis and septicemia in sickle cell disease. Chqgdl60008 meningitis emergency management in children 2 in the older child, the rates of meningitis are much lower with an estimated incidence of 1 per 5,901 febrile children aged 2 to 24 months.
The meninges of the central nervous system cns include 3 membranes that support, protect, and nourish the brain and spinal cord. In 2010, a conjugated vaccine, menafrivac became available that is highly efficacious even in young children and also increases herd immunity. Meningitis is an inflammation of the membranes meninges surrounding your brain and spinal cord. The reason for this is that there is a significant risk of serious illness or even death if the child has bacterial meningitis and treatment is delayed for a prolonged period of time.
In addition to antibiotics, dexamethasone a steroid may also be given to children over six weeks of age who have acute bacterial meningitis. Prevention and treatment of bacterial meningitis in resource. Meningitis encephalitis meningitis is an inflammation swelling of the protective membranes meninges covering the brain and spinal cord. If tb meningitis in differential diagnosis refer to nice tb ng33 for appropriate antibiotic treatment consider herpes simplex meningoencephalitis. Paediatric bacterial meningitis is a neurological emergency which, despite advances in medical management, still has a significant morbidity and mortality. Acute bacterial meningitis in infants and children.
Pediatric bacterial meningitis surveillance african. If tb meningitis in the differential diagnosis, refer to nice ng33 before administering steroids. Routine neuroimaging is not necessary for the initial medical evaluation of children with suspected bacterial meningitis who do not have clinical signs of brain. Sequelae include deafness, seizures, learning difficulties, and blindness. However, permanent disabilities such as brain damage, hearing loss, and learning disabilities can result from the infection. However, the symptoms and signs depend on the age of the child, the duration of illness, and the host response to infection.
Diagnosis and management of bacterial meningitis in the. Streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae type b hib are the predominant causative pathogens in both adults and children. To summarize salient features on diagnosis and treatment of bacterial meningitis in children and identify challenges currently faced in the. After completing this article, the reader should be able to. Meningitis american academy of pediatrics textbook of. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Diagnosis, initial management, and prevention of meningitis. Bacterial meningitis is a serious inflammation of the meninges caused by various bacteria.
Pediatric bacterial meningitis is a medical emergency requiring immediate initiation of treatment. Pdf pediatric bacterial meningitis is a medical emergency requiring immediate initiation of treatment. Consider tb meningitis if raised csf wcc and risk factors for tb. The epidemiology of bacterial meningitis in children is changing. May 17, 2016 the bacterial meningitis score bms may be used to determine the likelihood of bacterial and nonbacterial meningitis in infants and children older than 2 months. Pediatric bacterial meningitis differential diagnoses. Prevalence of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection. Because bacterial meningitis in the neonatal period has its own unique. Outcomes of bacterial meningitis in children sciencedirect. Meningitis about bacterial meningitis infection cdc. In general, there are no medications to fight the germs that cause viral meningitis, so treatment is usually aimed at easing the symptoms.
Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid csf. Acute bacterial meningitis in infants and children the lancet. A 6yearold previously healthy, fully immunized hispanic american boy was admitted to the hospital during spring with a 2week history of headache, vomiting. Routine neuroimaging is not necessary for the initial medical evaluation of children with suspected bacterial meningitis who do not have clinical signs of brain herniation. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era.
During this period, 53 episodes of septicemia or meningitis occurred, indicating a risk of 12. Dec 01, 2015 bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Meningococcal meningitis is the most common bacterial meningitis worldwide and group a was the most common epidemiccausing meningococcus. A total of 422 patients with sickle cell disorders have been observed for 3,442 patient years. The clinical features of bacterial meningitis in infants and children can be subtle, variable, nonspecific, or even absent. Bacterial meningitis requires early diagnosis and empirical antimicrobial treatment.
Management of bacterial meningitis in children and young. Diagnosis and management of bacterial meningitis in the paediatric. Diagnostic and statistical manual of mental disorders 5th edition. Endorsed by management of bacterial meningitis in children and young people incorporates nice bacterial meningitis and meningococcal septicaemia guideline cg102. Recognize the common acute complications of meningitis. All patients with bacterial meningitis and many with viral meningitis will be treated in the hospital.
Listeria monocytogenes in immunocompromised patients. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. The meningitis diagnosis was based on the association of a meningeal syndrome with fever and a positive cerebrospinal fluid csf bacterial culture, andor the presence of positive soluble antigens in csf, andor a positive bacterial pcr in csf, andor a positive blood culture associated with pleocytosis in csf. Important for bacterial one should know which type of bacterial is causing meningitissome antibiotics can prevent some type from spreading and infecting other people. What are causes of pediatric bacterial meningitis in neonates. Professor, departments of pediatrics and microbiology, school of medicine, university of washington. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons. Hospitalists should recognize atypical features suggestive of an alternative etiology. Nov 01, 2004 the objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. No data were obtained in children aged 1 month1 year. In many cases, children are treated as if they have bacterial meningitis until bacterial meningitis is definitively excluded. Bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space, that occurs in response to infection with bacteria andor bacterial products.
Tuberculosis meningitis american academy of pediatrics. Contributing factors to such mortality and morbidity include our incomplete knowledge on the pathogenesis of how meningitis causing bacteria penetrate the blood brain barrier, emergence of antimicrobial resistance, and difficulty in early diagnosis of meningitis. Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. In contrast, other studies suggest that pmns can be the most prevalent cell in early aseptic meningitis followed by a shift to mononuclear cells within 24 hours. Viral meningitis is the most common form of meningitis in the uk, but bacterial meningitis continues to be important, with a high mortality clinical features are poor discriminators for meningitis, so urgent investigations, starting with lumbar puncture, are key.
Different incidences of acute bacterial meningitis in children of. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the inflammation of the brain parenchyma, presents as diffuse andor focal. Febrile neonates with utis and their risk of bacterial. Management of bacterial meningitis clinical practice guideline local protocols are in place in all hospitals and facilities likely to be required to assess or manage paediatric patients with bacterial meningitis ensure that all staff treating paediatric patients are educated in the use of the locally developed paediatric protocols. Over recent decades new vaccines have led to a change in epidemiology of the disease. The outermost layer, the dura mater, is a tough, inelastic, connective tissue layer that sheaths the brain and spinal cord and terminates caudally at the first coccygeal vertebra. Sep 01, 2015 neonatal bacterial meningitis continues to be an important cause of mortality and morbidity. Even with appropriate treatment, morbidity and mortality can be substantial. Division of infectious diseases, childrens mercy hospitals and clinics, kansas city, mo. In children in the uk, bacterial meningitis is most commonly caused by one of three bacteria. Nigrovic le, kuppermann n, malley r, bacterial meningitis study group of the pediatric emergency medicine collaborative research committee of the american academy of pediatrics. The earlier the treatment is initiated, the better your childs outcome. In the past, hib was the most common cause of meningitis in children under five years of age.
Morbidity and mortality rates are high, especially in the neonatal period. Bacterial meningitis is very serious and can be deadly. The etiology of acute meningitis and encephalitis syndromes in a. If dexamethasone is utilized for meningitis, then rifampin 1020 mgkgday, max 600 mgday should also. Management of bacterial meningitis in children and young people. Subsaharan africa has one of the worlds greatest disease burdens of haemophilus influenzae type b hib, streptococcus pneumoniae, and neisseria meningitidis infections. Bacterial meningitis is a serious, relatively common childhood disease that affects approximately 1 in 500 children who are younger than 2 years. Acute meningitis and encephalitis syndromes ames is a severe neurological infection. If only patients with ss hemoglobinopathy sickle cell anemia. Meningitis powerpoint 2009 warren hills regional school.
In newborns and young babies, possible bacteria include. We aimed to describe the cerebrospinal fluid csf profiles of infants. Practice guidelines for bacterial meningitis cid 2004. Bacterial meningitis symptoms, diagnosis and treatment.
Most cases of meningitis in the united states are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Bacterial meningitis is one of the most important medical emergencies, a lifethreatening condition that leads to death in. May 14, 2009 pediatric bacterial meningitis surveillance african region, 20022008. The hib vaccine is given to all children as part of their immunization routine. The severity of a childs symptoms and prognosis depend on. The type of treatment depends on the germ that caused the meningitis. Jan 16, 2019 pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae.
Group b streptococcus, enteric gram negatives in young infants. Meningitis background general presentation meningitis is an important infectious disease to rule out in the pediatric population because it can have serious medical and social complications. Neonatal bacterial meningitis american academy of pediatrics. To study the changes in the epidemiology, clinical and bacteriological profiles of bacterial meningitis in the era of the haemophilus influenzae type b hibvaccine and pneumococcus resistance. Dexamethasone should be administered 1020 min before antimicrobial therapy for maximal efficacy and continued for 24 days. It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and prevention. Cerebrospinal fluid findings in aseptic versus bacterial. Aseptic meningitis is often reported to be characterized by a mononuclear cell predominance in the cerebrospinal fluid csf, whereas bacterial meningitis is characterized by a polymorphonuclear pmn cell predominance. Pediatric bacterial meningitis clinical presentation. Treatment for bacterial meningitis usually involves intravenous iv antibiotics. This is a retrospective study of children aged 6 weeks old, consider. The beginning of this millennium has witnessed the virtual disappearance of haemophilus invasive disease in some countries, emergence of pneumococcal strains that are. The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. Cerebral spinal fluid csf is the fluid within the open spaces of the brain that protect and cushion the brain and spinal cord.
619 565 96 1218 938 1369 1578 56 1187 1301 1544 93 951 67 413 1407 1627 795 1460 1562 1425 31 1520 1509 1399 1492 985 281 464 133 266 121 689