Meningitis in Children in Low and Middle-Income Countries

Kwameghana, CC BY-SA 4.0, via Wikimedia Commons

Meningitis is a serious medical problem that many people often confuse its symptoms with common sicknesses. It can quickly become life-threatening as a result of delayed essential treatment. This article will provide information on meningitis, its common symptoms and what to do in cases of suspected infection.

What is Meningitis?

Meningitis refers to inflammation of the meninges. The meninges contain three layers of protective membranes, the pia mater, dura mater, and arachnoid mater, that cover the brain and spinal cord. These membranes provide support and maintain cerebrospinal fluid circulation.

Meningitis in children has similar symptoms to meningitis in adults. Still, the disease is more common in children under the age of one.

Neonatal and infant meningitis is often deadlier than in older children due to their immature immune systems and underdeveloped protective barriers. Infants may not exhibit typical symptoms, making diagnosis more challenging.

Rapid progression of the disease can also lead to severe complications or death if not treated quickly.

Risk factors of meningitis in children

A couple of factors have been seen to increase the chances that a child develops meningitis, and some of them include:

General Risk Factors:

Missed vaccinations: Meningitis is preventable through vaccines. Children who miss their vaccinations are at higher risk of infection.
Age: Children under 5 are particularly vulnerable, while bacterial meningitis is most common in adults under 20.
Crowded living environments: Meningitis-causing bacteria spread quickly in crowded rooms and gatherings, increasing infection rates among children.
Extreme heat and humidity: Viral and bacterial meningitis thrive in hot, humid climates, raising the risk of outbreaks.
Weak immune system: children who are not breastfed or those on chemotherapy or medications that suppress their immune systems are more susceptible to meningitis-causing organisms.

Specific Risk Factors:

Infection from Mothers: children born to mothers with infections, such as Group B Streptococcus, are at a greater risk of developing meningitis.
Neural Tube Defects: The neural tube gives rise to the future spinal cord and offers a direct channel to the brain and the meninges. Children born with neural tube defects, therefore, are at a higher risk of having meningitis.

Causes of meningitis

Meningitis is caused by germs, which could either be bacteria or viral. Hence, meningitis is grouped according to the cause. They include;

Bacterial meningitis

Escherichia coli
Streptococcus pneumonia
Group B Streptococcus
Listeria monocytogenes
Neisseria meningitides
Haemophilus influenza

Viral meningitis

Polioviruses
Herpes simplex virus
Paramyxovirus

In addition to bacteria, fungi like Candida, Aspergillus fumigatus, Cryptococcus neoformas, and Borrelia burgdoferi are other important cause of meningitis, even though fungi are not as common as viruses and bacteria.

How is meningitis transmitted

The spread of meningitis is mostly through sneezing, coughing, and kissing. Children acquire the infection when they inhale germs released by an infected person.

Once the germ enters the child's nose or throat, it spreads through the bloodstream and then makes its way to the meninges, where it causes inflammation and the accompanying symptoms of inflammation.

In low- and middle-income countries where many people live in crowded rooms, leading to overcrowding, it is much easier for these pathogens to be carried, resulting in many children coming down with meningitis.

If we take Nigeria as a case study, the country has an estimated population of 193 million people spread across 36 states, making it the most populous country in Africa. This factor has been highlighted by Nigeria being one of the countries considered the “meningitis belt.”

According to the World Health Organization, between 1 October 2022 and 16 April 2023, Nigeria reported a total of 1686 suspected cases of meningitis, including 124 deaths, for a case fatality ratio (CFR) of 7%.

How do you know that your child has meningitis

Meningitis in children usually starts with headache and fever. These two symptoms are common with many other illnesses, making it difficult to diagnose at this stage. More specific symptoms include:

Severe headache
Pain on bending the neck or neck stiffness
Sensitivity to light

The symptoms also differ depending on the patient's age.

In Infants, symptoms may include:

Fever
Being fussy and crying constantly
Extreme weakness
High-pitched cry
Arching backwards
Bulging fontanelle (a fontanelle is a “soft spot” on the head where the skull have not fused)
Seizures
Nausea and vomiting

For children older than one year, symptoms to look out for include:

Fever
Neck stiffness
Poor appetite
Stupor
Seizures
Nausea
Decreased level of consciousness

How is meningitis diagnosed in children?

The tests usually prescribed in a child showing the suspected symptoms of meningitis include:

Physical examination
Blood tests
Lumbar puncture (spinal tap)
Imaging tests (CT or MRI scan)
Polymerase chain reaction (PCR) test
Cultures of cerebrospinal fluid (CSF)
Rapid antigen tests

Treatment of meningitis in children

Symptoms of viral meningitis usually resolve within 7 to 10 days. In children, viral meningitis typically resolves at home without needing a doctor's visit, although some cases may require hospital treatment.

Treatment includes:

Rest
Fluids
Over-the-counter pain medications
Intravenous (IV) antibiotics (for bacterial meningitis)
IV fluids and electrolytes (to replace lost fluids)

What is the outlook for a child with meningitis?

The prognosis of meningitis in a child depends on several factors, such as the cause—bacterial or viral—the severity of the illness, and the child's age.

Bacterial meningitis is a medical emergency. However, most children with bacterial meningitis recover completely with no long-term complications.

The less common complications include developmental delays or learning disabilities, spastic or paralysed muscles and seizures.

Unlike bacterial meningitis, most children with viral meningitis recover with no long term complications. The symptoms of viral meningitis usually improve within a week.