Meningitis (pediatrics): Clinical sciences

Meningitis refers to the inflammation of the meninges, which are protective membranes that surround the brain and spinal cord. Meningitis commonly occurs as a result of bacterial infection. In newborns, the most frequent causative pathogens include Group B streptococci, Escherichia coli, and Listeria monocytogenes; while in children and teens, more common causes include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Finally, if there are no bacteria, consider aseptic forms of meningitis, such as viral meningitis!

Now, if your patient presents with a chief concern suggesting meningitis, perform an ABCDE assessment to determine whether the patient is unstable or stable. If unstable, stabilize their airway, breathing, and circulation. Next, obtain IV access, start IV fluids, and put the patient on continuous vital sign monitoring, including blood pressure, heart rate, and pulse oximetry. Finally, if needed, don’t forget to provide supplemental oxygen.

Now, let’s go back and take a look at stable patients. First, assess your patient’s age, since the diagnostic evaluation and management are age-dependent. The main cut-off is at age 60 days.

Let’s start with patients 60 days of age and younger. Start by obtaining a focused history and physical exam. History typically reveals non-specific symptoms, such as fussiness, inconsolability, sleepiness, weakness, or even apnea. Additionally, caretakers might report vomiting, poor feeding, and, in some cases, even seizures. The physical exam typically reveals temperature instability, poor tone, irritability when moved, and lethargy. In some cases, you might notice increased head circumference, as well as full or bulging anterior fontanelle.

At this point, you should suspect meningitis! Begin your diagnostic workup by ordering labs, including blood cultures, a CBC, and inflammatory markers, including CRP and procalcitonin. Additionally, perform lumbar puncture to obtain CSF for analysis, which includes a gram stain, culture, and cell count, as well as glucose and protein levels.