Meningitis has a high fever

Meningitis

What is meningitis?

Meningitis is an inflammation of the meninges and neighboring structures. It is a serious condition that develops in hours and can affect anyone, children as well as adults. Despite drug treatment, a fatal outcome or permanent consequential damage cannot always be prevented.

According to the Federal Statistical Office, 124 people died of meningitis in 2019, including 3 children under 15 years of age.

Various pathogens such as bacteria (e.g. Borrelia, meningococci), viruses (e.g. herpes, chickenpox, mumps and measles virus), protozoa (single cells) and fungi can cause the disease, but autoimmune processes, malignancies or poisons can also be triggers.

causes

Meningitis can be caused by viruses or bacteria. Frequent pathogens of bacterial meninigitis are mainly Haemophilus influenzae type b (Hib), meningococci and pneumococci.

Pathogens can migrate through the mucous membranes of the respiratory tract, but also from an adjacent focus of inflammation (e.g. in the case of otitis media) or an injury site (e.g. open skull fracture). In spring and summer there is a risk that a tick bite will transmit the so-called early summer meningo encephalitis or bacterial meningitis caused by borrelia.

Certain pathogens / triggers can predominate in different age groups. Herpes viruses are frequent triggers of viral meningitis in newborns, while measles, mumps or echoviruses are often the cause of an illness in small children. Bacterial meningitis in infancy is usually due to an infection with group B streptococci, Escherichia coli or Listeria. In infancy and toddlerhood, hemophilus, meningococci and pneumococci, among others, are named as the main responsible for meningitis.

Symptoms & clinical picture

In addition to fever, an important symptom of meningitis is stiff neck. The child puts up resistance to the movement of his head, so that it is hardly or not at all possible to bring the head to the child's bent knee (meningism). Other typical symptoms are headache, tiredness, vomiting and photophobia. If the brain is also inflamed, it can lead to drowsiness or even a coma. The symptoms can develop within a few hours.

Infants usually experience other, more general symptoms such as abdominal pain, tenderness, refusal to eat or even seizures. The fontanel can be bulging. Caution: Especially with infants, there is a risk that meningitis will initially be overlooked, as it is sometimes very uncharacteristically manifested only in weak drinking and slackness.

If you notice such symptoms in your child, you should immediately consult a pediatrician so that treatment can be initiated immediately if necessary.

Effects

In general, the meningitis caused by viruses are not as dangerous as those caused by bacteria, e.g. B. meningococcal or pneumococcal meningitis. In severe cases, meningitis can cause permanent damage, such as movement disorders, hearing damage, deafness or impaired intellectual development, or even death. Children in the first three years of life have a particularly high risk of developing bacterial meningitis.

diagnosis

If there is a suspicion, the doctor will puncture the spinal canal (lumbar puncture) and take nerve fluid (liquor) from it and examine it. This is the only way he can reliably determine whether meningitis is present and whether it is a viral or bacterial infection.

therapy

Meningitis often requires hospital intensive care treatment. If bacteria are the culprit, the child is given antibiotic infusions. But the family members of the sick child must also take antibiotics as a preventive measure to protect themselves.

Viral meningitis can only be treated symptomatically, but it is generally not a serious condition.

Vaccination protection

Some meningitis pathogens can be vaccinated preventively:
For example, vaccinations against the bacteria Haemophilus influenzae type b (Hib), pneumococci and meningococci in babies are possible. It is not uncommon for meningitis to be the result of a mumps infection. You can also vaccinate against this infectious disease, as well as against the causative agent of early summer meningo encephalitis (TBE).

Pneumococcal vaccination

Pneumococci are feared as meningitis pathogens. Beyond the neonatal period, 20% of meningitis is caused by pneumococci. Pneumococcus causes 70% of all deaths from meningitis. Vaccination against pneumococci is recommended by the STIKO for children from the age of 2 months and up and adolescents with underlying diseases or with an increased health risk. The underlying diseases include, for example, the condition after spleen removal or spleen disease, diabetes mellitus, chronic heart and lung diseases, kidney damage and immune deficiency diseases. There is an increased health risk for premature babies (<38 weeks), children with a birth weight of less than 2500 g, as well as for infants and children with failure to thrive or neurological diseases.

Infants can receive the pneumococcal conjugate vaccine in parallel to the 6-fold vaccine (a total of three times - with the exception of premature babies - up to the age of 23 months): at the age of 2, 4 and 11 months (so-called 2 + 1 vaccination scheme, two basic immunizations plus a booster). The Standing Vaccination Commission (STIKO) recommends the 3 + 1 scheme for premature babies (born before the 37th week of pregnancy). You should receive four doses of the vaccine at ages 2, 3, 4 and 11 months.

Meningococcal vaccination

In addition to Haemophilus influenzae type b and pneumococci, bacterial meningitis is also triggered by meningococci. Today, meningococcal infections are the most common cause of bacterial meningitis, especially since meningitis caused by Haemophilus influenzae type b and pneumococcal infections have now decreased due to vaccinations.

The vast majority of meningococcal infections in Europe and Germany is caused by Meningococci of serogroups B and C triggered (there are a total of 13 subgroups in meningococci). Up to 350 people develop meningococci annually in Germany. Meningococcal C diseases make up only about 20% of them, but are very feared due to their severe and complex course. Rapidly progressing sepsis (Waterhouse-Friderichsen syndrome) is particularly dangerous.

The Standing Vaccination Commission has recommended one for all children since July 2006 Vaccination against meningococci C in the 2nd year of life. A missing vaccination should be made up for by the 18th birthday.

Against Meningococcal B. A completely newly developed vaccine has been available since the end of 2013. The first vaccination can be given to babies from two months and must be repeated twice at an interval of four weeks for immunization up to the age of five months. Another vaccination in the second year of life (age 12 to 15 months) completes the vaccination cycle (a total of four vaccinations). Two doses are sufficient for older children. This vaccination probably protects against up to 80% of the meningococcal B strains that occur in Germany. The duration of this protection cannot yet be estimated with certainty. The new meningococcal B vaccination has so far only been reimbursed by some health insurance companies as a statutory benefit.

For certain Children at risk or for children who have long stays abroad ahead of them, the STIKO recommends vaccination from the age of 1 year A-C-W135-Y conjugate vaccine. This conjugate vaccine against meningococcal ACWY has been approved in the EU since March 2010 and is effective against the four serogroups at the same time (namely against A, C, W135 and Y).

Since August 2015, the STIKO has been advising certain children at risk, such as children without a spleen or who have had a spleen removed or with certain immunodeficiencies, to be vaccinated against Meningococcal B.

Addresses & links

Consultative laboratory for early summer meningoencephalitis (TBE)
Institution: Robert Koch Institute
North bank 20
13353 Berlin
Contact person: Prof. Dr. M. Low
Dr. H. Ellerbrok
Tel .: 030/18 754-23 70 / -23 21
030 /18 754-23 87
Fax: 030/18 754-26 25 / -23 90
Email: [email protected] or [email protected]

National Reference Center for Meningococci and Haemophilus
influenzae
at the Institute for Hygiene and Microbiology
of the University of Würzburg
(Head: Prof. Dr. M. Frosch, Prof. Dr. U. Vogel)
Josef-Schneider-Straße 2, building E1
97080 Wuerzburg
Tel .: 0931 - 31-81423 (inquiries to medical and scientific staff)
0931 - 31-46006 (query of findings, inquiries to technical staff)
Fax: 0931 - 4 64 45
Email: [email protected]
[email protected]
Internet: www.meningococcus.de
www.haemophilus-online.de

National Reference Center for Staphylococci and Enterococci
at the Robert Koch Institute (Wernigerode area)
Dept. 1 Infectious Diseases
Research group Infectious agents and antibiotic resistance
Burgstrasse 37
38855 Wernigerode
Tel .: 03018 - 754-42 10
Fax: 03018 - 754-43 17
Internet: www.rki.de
Head of PD Dr. G. Werner
Contact person: Staphylococci: Dr. Layer (Tel .: -42 49)

National Reference Center for Streptococci
at the Institute for Medical Microbiology
of the University Clinic Aachen
Pauwelsstrasse 30
52057 Aachen
Tel .: 02 41.80-8 99 46
Fax: 02 41.80 82-483
Email: [email protected]
Internet: www.nrz-streptococcus.de
www.pneumococcus.de

Robert Koch Institute
P.O. Box 65 02 61
D-13302 Berlin
Tel .: 030 - 18754-0
Fax: 030 - 18754-2328
Internet: www.rki.de

swell

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  • Cause of death statistics 2019. Federal Statistical Office (Destatis), 2020. Accessed: 02/26/2021 / 14:06:21

Author: äin-red

Technical support: Dr. Ulrich Fegeler

last change: 02/26/2021