Chapter 9

### Bacterial meningitis and meningococcus

##### What is meningitis?

Meningitis is an inflammation of the meninges, which are the thin membranes that cover the brain and the spinal cord. Infection can be caused by viruses—which is more common—or by bacteria—which is more serious and life-threatening. Bacterial meningitis is basically a childhood infection. Very young children are at the greatest risk, although it can occur in any person.

##### What is meningococcal meningitis?

A bacterium called Neisseria meningitidis, or meningococcus, can cause a particularly deadly infection, especially in children between birth and 5 years of age and in adolescents and young adults between 15 and 24 years. It is spread through close contact with saliva from activities such as kissing and sharing drink bottles, and also by nasal droplets from sneezing. This infection can take the form of meningitis or septicaemia (severe infection of circulating blood), or both simultaneously. The affected person rapidly becomes sick and may develop a rash. The red rash can be misleading because it looks like any heat rash at first but then the deadly sign of purpura (bleeding into the skin) develops. It does not blanch (turn white) on finger pressure. Early diagnosis and treatment with antibiotics is critical. Untreated cases may be fatal or result in permanent brain damage.

##### What are frequent symptoms and signs?

• Fever

• Nausea and vomiting

• Pale skin

• Skin rash

• Weakness/tiredness

• Increasing irritability with high-pitched cry

• Drowsiness

• Neck stiffness

• Sensitivity to light

• Altered state of consciousness (e.g. confusion or disorientation)

As a general rule the illness seems like the flu at first and it can be difficult for doctors to diagnose correctly in the early stages.

In infants the signs of meningitis may not be so obvious, but neck stiffness, vomiting and headache are more noticeable in children over 3 years of age. These symptoms may not be obvious if the child is on antibiotics. To arrive at the correct diagnosis, doctors usually need to do a lumbar puncture (sampling of fluid from the spinal column with a needle), blood tests or brain scans.

##### When is urgent attention necessary?

If your child develops any of the following ‘red flag’ signs, take the child immediately to your doctor or hospital emergency department:

• becomes ‘flat’ quite rapidly

• cold, pale skin especially of the limbs

• change in state of consciousness

• drowsiness, confusion or delirium

• rapid heart rate

• rapid, difficult or noisy breathing

• convulsion

• red rash, especially if it looks like flecks of blood.

Signs of meningococcal meningitis

Doctors prefer to treat people early in the illness, rather than later when the child will be very sick ...

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