25 April 2011
The early symptoms of meningitis in children can be non-specific, leading to delay in diagnosis. Therefore parents should consult doctors if infants have irritability or lethargy, repeated vomiting and fever. A high index of suspicion is required on the part of parents to seek immediate medical consultation, say experts.
The world meningitis day was observed on April 24. "Sometimes the symptoms may be very subtle in the form of temperamental changes or inconsolable crying. Some of them may go on to develop convulsions," said paediatrician Sanjay Lalwani, head of the paediatrics unit at Bharati hospital.
Meningitis in children is a dreadful condition affecting about 90,000 patients each year in India. Mortality is high due to lack of awareness of the condition, nonspecific symptoms, delay in seeking medical help and catastrophic nature of illness. It is a medical emergency which requires prompt treatment.
"It is an infection of the lining (meninges) and the fluid that cover the outside of the brain and spinal cord. The infection can spread into the brain tissue and cause brain damage," Lalwani said.
Meningitis can be caused by bacteria (40%), viruses (45-50%), tuberculosis (5%) and rarely parasites. It is important to differentiate between the two most important causes of meningitis, namely, bacterial or viral. Bacterial meningitis is more severe and, without treatment, 50% fatal. The most common organisms causing bacterial meningitis are pneumococcus, H. influenza and meningococcus. Tuberculosis is an important cause in India. Viral meningoencephelitis can be seen with a variety of viral infections like measles, mumps, and entero viruses and do not require specific treatment. Some which are caused by herpes infection or Japanese encephalitis can be extremely fatal with mortality approaching 30%.
Paediatric intensivist Shweta Naik said, "Children may contract this infection from persons who carry these organisms or environment. Sometimes infections in the ear canals, sinuses or nose can spread to brain due to proximity."
"In older children the symptoms are more specific. They develop headache, neck pain, fever, vomiting and sometimes convulsions. They may have characteristic insensitivity to light which is called photophobia. Excessive sleepiness and confusion may be the early signs and should not be ignored," said paediatrician Vijay Kalrao.
Viral meningitis also has similar features as bacterial meningitis but may be less severe. Many children have associated rash. Confusion, excessive sleepiness and convulsions are more common compared to bacterial meningitis, Kalrao said.
Whenever there is a suspicion of meningitis, a spinal tap (lumbar puncture) is done. The tapped fluid helps us to come to a rapid and definite diagnosis so that treatment can be instituted promptly, he added.
"Treatment depends on the cause of meningitis. In bacterial meningitis, antibiotics are administered for two to three weeks. In certain viral meningitis, anti-viral agents are given. But the treatment is mainly supportive," Kalrao said.
"Treatment in tuberculous meningitis cases can go on for a year and may be cumbersome for parents of patients. But adherence to treatment is required to prevent failure of treatment and future neurological sequelae. Also, treatment of other household members is required to prevent spread," Lalwani said.
Without treatment, bacterial meningitis is fatal. Even with appropriate treatment, about 10% patients can die. One in three patients can develop long-term changes like permanent hearing loss, behavioural changes, problems with vision, frequent convulsions, mental retardation, delay in acquisition of skills and focal paralysis of specific limb, he added. Meningitis contributes to widespread mortality and morbidity across the world, and prevention is the only effective measure. Vaccination against tuberculosis and measles is a part of national immunisation programme. "Vaccines against many other organisms like H. influenza, pneumococcus, meningococcus, mumps, measles, and Japanese B encephalitis are currently available. Immunisation of every child against these organisms can go a long way in decreasing mortality," said paediatrician Sharad Agarkhedkar.
A child has meningitis if it suffers from
- Excessive sleepiness or irritability
- Headache and vomiting
- Increased sensitivity to light
- Evolving rash on the body
HIB vaccine: H influenza causes 70% of meningitis in children below five years. Since its introduction in 2006, HIB vaccine has decreased the incidence of meningitis by almost 50%. It also protects against pneumonia and severe form of throat infection (epiglotitis). It is available in single as well as combination vaccine
Pneumococcal vaccine: Pneumococcal vaccine is available in India since 2006. It is a conjugate vaccine which can be used in children less than two years of age. The limiting factor for this vaccine is its high cost. Efforts are being made to reduce this cost. There are no reported side effects or contraindications
Meningococcal vaccine: Meningitis due to meningococcus is less common in India than developed countries. This vaccine is given to children who are at high risk, like teens entering boarding schools, college students, military recruits, and if there is decreased function of spleen.