Meningitis
Basics
Description
Inflammation of the membranes of the brain or spinal cord, usually caused by viruses or bacteria and, rarely, fungi or parasites
Epidemiology
- Bacterial meningitis
- Most common agents in children of all ages include Streptococcus pneumoniae and Neisseria meningitidis.
- Underlying host factors, age, exposure, and geographic location alter incidence and pathogen.
- Viral meningitis
- Most common agent in all age groups
- Most common isolated viruses are enteroviruses that tend to occur in outbreaks in summer and early fall.
- Fungal meningitis
- Cryptococcus neoformans is a budding encapsulated yeast-like organism found in soil and avian excreta; associated with immunocompromised patients (especially AIDS), rare cases in healthy children
- Candida species occurs in immunocompromised patients and ill premature infants.
- Tuberculous meningitis
- Mycobacterium tuberculosis (TB) meningitis occurs in 0.5% of untreated primary TB infections.
- Most common in children aged 6 months to 4 years
- In ~50% of cases, miliary TB is accompanied by meningitis.
General Prevention
- Haemophilus influenzae type b (Hib) vaccine has significantly reduced the incidence of meningitis and other invasive Hib infections by up to 99%.
- 13-valent pneumococcal conjugate vaccine (PCV13) for use in all infants given at 2, 4, 6, and 12 to 15 months of age
- Quadrivalent meningococcal vaccine for serogroups A, C, Y, and W is recommended for all patients ≥11 years of age and select at-risk populations <11 years. A booster dose is recommended for all patients who receive the first dose of the vaccine between 11 and 15 years of age.
- Children with anatomic or functional asplenia or persistent complement deficiency should be considered for meningococcal serogroup B vaccines.
Etiology
- Bacterial
- Cause differs depending on age:
- <1 month old: group B Streptococcus, gram-negative pathogens (Escherichia coli, Citrobacter koseri, Cronobacter sakazakii, Serratia marcescens, and Salmonella species), Listeria monocytogenes, S. pneumoniae
- 1 to 3 months old: group B Streptococcus, E. coli, S. pneumoniae, Hib
- 3 months to 5 years old: S. pneumoniae, N. meningitidis, Hib
- >5 years old: S. pneumoniae, N. meningitidis
- Consider Hib in unvaccinated patients of any age.
- Cause differs depending on age:
- Viral
- Herpes simplex virus (HSV) in the neonatal population
- Enteroviruses: ∼70 different strains that include polioviruses, coxsackie A, coxsackie B, and echoviruses. Recently discovered enteroviruses are not placed in these four groups but are numbered (e.g., enterovirus 68).
- Other, less common: arboviruses (e.g., West Nile virus), mumps
- Fungal
- Fungi most commonly isolated include Candida species, Coccidioides immitis, C. neoformans, and Aspergillus species.
- Aseptic meningitis
- Agents not easily cultured in the viral or microbiology laboratory can cause meningitis and include Borrelia burgdorferi (Lyme disease) and Treponema pallidum (syphilis).
- Tuberculous meningitis
- Unusual pathogens more likely in immunocompromised patients
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Citation
Cabana, Michael D., editor. "Meningitis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617110/all/Meningitis.
Meningitis. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617110/all/Meningitis. Accessed October 11, 2024.
Meningitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617110/all/Meningitis
Meningitis [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 October 11]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617110/all/Meningitis.
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