Meningitis is an inflammation of the meninges, the thin layer of tissue that surrounds the brain. Bacteria and viruses cause most cases of meningitis in children. Health providers can diagnose meningitis clinically and by doing a lumbar puncture, in which a needle is introduced in the lower back, in-between the vertebra, to obtain the fluid that bathes the brain. This fluid can then be screened for the common causes of meningitis.
General symptoms
The initial symptoms of meningitis are nonspecific and can mimic other common causes of infection. Children with meningitis will feel run-down and weak and may have poor appetite, which can lead to dehydration. Fever and headache are also common early findings. Children can also have nausea and vomiting, which can also lead to dehydration and electrolyte imbalances. Most children with meningitis have a recent history of upper respiratory infections. Younger infants can also have irritability and somnolence.
Specific symptoms
There are a few symptoms that can help pinpoint meningitis as the underlying illness. Photophobia, or the inability to tolerate bright light, is a specific finding in meningitis. In infants, a bulging fontanelle, or soft spot, may be present. Also, neck stiffness and back pain are prominent features of the disease. Neck stiffness can be elicited by two physical exam tests, Brudzinski and Kernig. The Brudzinski test is positive if a patient involuntarily lifts his legs when flexing his neck. Kernig's sign is present if leg extension of a flexed leg at the hip and knee causes pain. Both of these tests can give a provider the sense that there is irritation of the meninges.
Bacterial meningitis can also present with skin manifestations like purpura, which are large bruises due to decreased platelets, the blood cells that help with clotting. Viral meningitis can present with a fine, red, raised rash throughout the body.
Symptoms of worsening disease
Patients with meningitis can become very ill. The irritability and somnolence can lead to unresponsiveness and coma. The inflammation in the brain can lead to decreased blood flow and increased pressure within the skull, which can lead to seizures, hearing loss, problems with vision and stroke. Bacterial meningitis can lead to problems maintaining blood pressure and adequate blood flow to the tissues and the extremities. Children with meningitis can present in shock, with multiple organ failure, and can die. Survivors may suffer from auto-amputation of digits due to decreased blood flow and permanent developmental disabilities.
