Pediatric Meningitis (Nursing)

00:00 Hi. Welcome to our lecture on Pediatric Meningitis. We're going to start by talking about some terms and concepts; review the risk factors and causes of pediatric meningitis; talk about the signs and symptoms you might see in a neonate, infant or child; talk about how it's diagnosed, and the basics on how it's treated and prevented. Let's start with terms and concepts. Meningitis is a word that combines the words meninges and itis. The meninges are the protective covering of the brain and spinal cord. There are actually 3 layers within them. The dura is the outermost layer of the meninges. Itis means it's a suffix that means inflammation and it's usually associated with some sort of disease process. So meningitis is basically an inflammation of that protective membrane, the meninges that cover the brain and spinal cord. It's usually caused by a virus or a bacterial infection of the cerebrospinal fluid which is the fluid that's in your brain and spinal cord that's protecting it, that's delivering nutrients to it, and that's helping it rid it from some waste and toxins. Meningitis is a global public health challenge. It's still endemic in some of the underdeveloped countries especially those with low vaccination rates. There are several forms of it and we're going to actually talk just a tiny bit about each one, but we're going to focus on the main 2 which are bacterial and viral. The signs and symptoms of meningitis are similar regardless of form, but they're more pronounced in the bacterial form which is very very high risk and can be very often fatal compared to the other types.

01:52 Let's review some risk factors and causes of meningitis. Age is a risk factor, so the very young and the very old are going to be at higher risk than the rest of the population except for the adolescent population. The older adolescent, so around age 17 to age 23 or so or the college age population as they're sometimes referred to are also at a higher risk for meningitis to some strains of meningitis due to the group settings that they often live in and because they usually hang out a lot with big groups of their peers so they're just more likely to swap germs and be exposed to more illness especially if there's somebody in their group of peers that is unvaccinated. Certain medical procedures as well as certain craniofacial deformities might put somebody at risk for meningitis due to a device or an abnormality that is near the brain or has access to the brain. An example is a cochlear implant. Also, the various forms of meningitis have their own risk factors. So for example, somebody who goes swimming a lot in warm fresh water, such as a pond, might be at a slightly higher risk than the general population for an amoebic meningitis. Somebody who lives in underdeveloped country where they may not pasteurize their food, they may eat meat that is raw or is not well cooked may be at higher risk for parasitic meningitis. Those are both very rare forms but that's just an example of how pathogen specific transmission has its own set of risk factors. And finally, and even if it's not vaccinated especially against the major forms of meningitis that have vaccines is definitely at higher risk for meningitis of all types.

03:45 Despite what many people might realize, there's actually 6 forms of meningitis.

03:52 We often just talk about bacterial and viral because they are much more common than the others, but we're going to talk about all of them a little bit. Let's start with bacterial.

04:05 Bacterial is definitely most often serious and quite a bit more serious than viral.

04:11 Vaccines protect against many forms of it and it also can turn into sepsis fairly easily and fairly quickly. It's seen more often in children under age 1 than in older children and this is because first of all they do have less developed immune system but also because they often get it from either birth from their mother through the birth canal, from group B strep, or they can get it sometimes even from E. coli especially sometimes an E. coli bacteria which comes from poop can contribute to urinary tract infections in young infants and that is another fairly common cause of meningitis that has a bacterial cause. Again, we talked about another pecan incidents for around age 16 to 23 which is that college age or adolescent population. Let's go over some of the bacteria that cause meningitis in children.

05:11 The first one is Streptococcus agalactiae. This is also known as beta strep. Some infants when they're born get this form of bacteria from the mother's birth canal.

05:24 That's why pregnant mothers are tested for beta strep and they're given antibiotics usually during the birth to help prevent transmission. Streptococcus pneumonia or pneumococcus is another bacteria that can cause bacterial meningitis. And Haemophilus influenza or HIB. E. coli or Escherichia coli is a pretty well-known bacteria found in both human and animal poop. And the dreaded Neisseria meningitides otherwise known as meningococcemia. This is one of the most, probably the most serious form of bacterial meningitis. It is the only type transmitted by droplets from nasopharyngeal secretions. This bacteria actually lives in the throats and noses of some people and never causes any problem, but that's the case with many different organisms. Sometimes we have no idea why but they just all of a sudden cause an infection and this is one of them. So it's most common under age 12 months of age and then it has that secondary peak in that adolescent population and college age population. Meningococcemia is something that causes meningitis in this population and fortunately there is a vaccination for it that the adolescents are supposed to get during that age to try to prevent it.

06:52 Neisseria meningitides or meningococcus is the most dreaded form of bacterial meningitis. It's also known as meningococcal disease. When bacteria from meningococcus infects the CSF, it causes meningitis. When the bacteria from meningococcus infect the bloodstream, it's considered meningococcemia or or meningococcus in the blood, emia is a suffix for blood or in the blood.

07:22 Sometimes it can infect both the CSF and the bloodstream. This is the hallmark sign of meningococcal disease. It's a purpuric rash and purpura are basically like really big petechia so it's a rash that's caused by bleeding, not by the typical inflammation inflammatory processes that caused some other rashes. Meningococcal disease is definitely a very severe disease in anybody that has a purpuric rash especially one that is all over their body needs to be taken very seriously and precautions need to be taken assuming they have this disease until it's ruled out.

08:03 Alright, now let's talk about viral meningitis. Viral meningitis is usually much less serious than bacterial. Most people will recover from it without any treatment at all. Some don't even come to the doctor's office or to the hospital when they have it because they don't realize they have it. If they do present to a hospital for treatment or for identification of it and if they get a lumbar puncture to check the cerebrospinal fluid, it will not show any bacteria in the fluid. Now, let's go over some of the pathogens that are known to cause viral meningitis. Some of these are pretty benign most of the time but cause problems in other types of patients or in other situations where they just happen to invade. Herpes simplex virus is a virus that the infant can get during birth from the mother. Cytomegalovirus is a virus that causes some viruses of childhood that can be fairly benign usually but can also cause infection and cause viral meningitis as well. The HIV virus is another virus that can cause viral meningitis and the enterovirus which is another virus that causes fairly benign childhood illnesses can be spread through respiratory droplets and sometimes found in the GI tract. Alright, let's go over the less common forms of meningitis. Fungal meningitis is a pretty rare form and it usually just affects people who are immunocompromised for some reason or at higher risk for contracting it such as people who might have cancer or HIV. Parasitic meningitis is quite rare. It's usually only seen in underdeveloped countries where people might be eating food that has some sort of parasite in it. Amoebic meningitis is a very rare and devastating form of meningitis that's almost always fatal, is caused by an ameba that lives in warm fresh water and soil. It's only contracted when this water rushes up somebody's nose. Usually, fairly forcefully. Not many people have contracted this, but those who have have often either been jumping in water that meets this criteria or they're at a water park and they may go down a slide or some other type of ride that propels them into this water at a high rate of speed and then that water rushes up their nose. And if it has this amoeba in it, it can infect their brain. Finally, there's a few other types of meningitis that we won't go into that maybe caused, for example, by some forms of cancer.