Better be safe
If your child has meningitis, determining the specific cause of his infection, as well as effective treatment, could be a matter of life and death.
MENINGITIS is an inflammation of the protective membranes surrounding the brain and spinal cord (called the meninges).
It can occur as a response to infection (bacteria, viruses, parasites or fungi) or due to physical injury, cancer or the body’s reaction to certain drugs.
Although meningitis is not restricted to any one particular age group, children below two years face the highest risk.
Meningitis has been found to be much more common in developing countries. Environmental factors such as exposure to smoke, as well as medical conditions and immunodeficiencies can make one more susceptible to the disease.
Types of meningitis
These include bacterial meningitis, viral meningitis, parasitic meningitis, fungal meningitis and non-infectious meningitis.
Bacterial meningitis can be a life-threatening infection and is caused by bacteria such as Haemophilus influenza b (Hib), Neisseria meningitidis and Streptococcus pneumoniae.
These organisms are not as contagious as the common cold or flu, but they can be spread through activities such as kissing, sharing of utensils/cups/cigarettes, close proximity (e.g. childcare centres), or activities in close quarters (e.g. colleges, universities, national service camps, dormitories).
According to the World Health Organization (WHO), bacterial meningitis is responsible for an estimated 170,000 deaths worldwide.
Death or disability can happen in as little as 24 hours from the first symptom.
In the case of meningococcal meningitis, survivors can be left with serious medical problems, including amputation of limbs/ fingers/toes, severe scarring, brain damage, hearing loss, kidney damage and psychological problems.
Bacterial meningitis:
Viral meningitis:
Viral meningitis is caused by enteroviruses, herpes simplex virus and varicella-zoster virus (responsible for chickenpox and shingles). It can spread through respiratory secretions or faecal contamination.
It can affect any age group, but usually occurs in children below five years of age. It is serious, but rarely fatal in people with normal immune systems.
Fungal and parasitic meningitis:
Fungi and parasites that cause meningitis are quite rare. The most common fungal meningitis is caused by cryptococcus.
Parasitic meningitis is a very rare form of meningitis, but is often fatal. The parasite is an amoeba called Naegleria fowleri that can be found in bodies of warm fresh water (lakes or rivers) and poorly maintained swimming pools.
Other causes of non-infectious meningitis include cancers, lupus, certain drugs, head injury, and brain surgery.
Signs and symptoms
The most common symptoms of meningitis in infants include fever, bulging fontanelle, nausea and vomiting, irritability (babies may cry when you pick them up), poor appetite, or drowsiness.
Older children may also have a sudden onset of fever or complain of headache or a stiff neck.
Other symptoms include nausea, vomiting, sensitivity to light (photophobia) and altered mental state (confusion or delirium).
Meningococcal meningitis is often accompanied by the classic symptom of a haemorrhagic purpuric rash (rashes that do not blanch on pressure).
While these are some of the more common symptoms, not everyone gets every symptom. Bear in mind that different kinds of meningitis may cause different symptoms. Hence, it is important to be alert and get immediate medical attention.
If you suspect that you or someone in your family has symptoms and signs suggestive of meningitis, seek medical attention immediately.
Early treatment of meningitis can prevent
serious complications.
Determining the cause of meningitis
The best means to determine whether it is meningitis and its specific cause, is by drawing a sample of blood, or cerebrospinal fluid (CSF), with a procedure called a lumbar puncture (LP).
The LP procedure involves collecting CSF from the lower spine with a carefully inserted needle. The entire process will take less than half an hour.
A local anaesthetic is injected over the tail end of the back to prevent pain. A small spinal needle is then inserted into the lower back area, and your paediatrician will collect the CSF sample before withdrawing the needle.
The CSF sample will be analysed and tested at a lab to find the specific cause of meningitis. The result will help your child’s paediatrician to determine the most appropriate treatment for your child. In the case of bacterial meningitis, antibiotics can help prevent severe illness and reduce or stop the infection from spreading into the blood stream.
Some types of bacterial and viral meningitis can be prevented. Protecting your children with early immunisation is the key to preventing the disastrous consequences of the disease.
Some of the germs which cause meningitis that can be prevented by immunisation are tuberculosis, polio, Hib, measles, mumps, chicken pox, pneumococcus and meningococcus.
Meningococcal meningitis can now be prevented with the Meningococcal Conjugate Vaccine (MCV), which is now available in Malaysia. Four strains of Neisseria meningitides (A, C, W, and Y) are included with the quadrivalent MCV4.
The World Health Organisation (WHO) recommends MCV4 for infants at two doses between the ages of nine and 23 months (with at least a three month interval between doses), and one dose for children older than two years.
The Centres for Disease Control and Prevention (CDC) advocates vaccinating preteens and teens at age 11, with a booster dose by 18 years of age.
MCV4 vaccines have been shown to be safe and efficacious in children aged nine months and older.
Currently, vaccination against other more common causes of meningitis, which include Hib, measles and mumps, are included as part of the Malaysian National Immunisation Programme.
Unfortunately, MCV4 is not included in the schedule.
Maintaining good personal hygiene may lower your chances of getting infected or spreading the disease to others. However, the best option is still to make sure that you and your child are vaccinated.
Datuk Dr Musa Mohd Nordin is a consultant paediatrician and neonatologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.