Pediatric Meningitis and Encephalitis Follow-up

  • Author: Jeffrey Hom, MD, MPH, FACEP, FAAP; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 19, 2011
 

Further Inpatient Care

  • Children with suspected bacterial meningitis should be admitted to the hospital for intravenous antibiotic therapy.
  • Adequate fluid administration is necessary to maintain perfusion, especially cerebral perfusion. Fluid restrictions (to prevent cerebral edema) may be more harmful because patients may be under resuscitated.
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Further Outpatient Care

  • Children with suspected viral meningitis who appear well may receive care as outpatients, provided follow-up care can be ensured.
  • With continued pressure to decrease hospital stays, there are occasions when patients may be discharged from the hospital to continue parenteral antibiotics at home.
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Inpatient & Outpatient Medications

  • All children with suspected bacterial meningitis should be admitted.
  • Well-appearing children with viral meningitis can be cared for as outpatients with only symptomatic treatment required.
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Transfer

  • Children with bacterial meningitis and encephalitis should be admitted to a hospital capable of managing critically ill children.
  • This may require a transfer to a pediatric hospital or large general hospital.
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Deterrence/Prevention

  • Routine childhood immunizations have been shown to effectively decrease the incidence of certain types of meningitis and encephalitis.
  • Antibiotic prophylaxis is recommended for all household contacts in those households with at least 1 unvaccinated child younger than 48 months in patients with H influenzae meningitis.
    • Treat all contacts in the household if any child is younger than 12 months.
    • Prophylaxis should be started as soon as possible.
    • Careful observation of any contacts and immediate evaluation is warranted if a fever develops.
  • Prophylaxis is recommended for all persons in contact with oral secretions of patients with N meningitidis meningitis. This includes a health care worker who performed mouth-to-mouth resuscitation, intubation, or suctioning.
    • The use of rifampin, ceftriaxone, and ciprofloxacin has been effective prophylaxis. In a systematic review, ciprofloxacin and ceftriaxone are more effective up to 4 weeks of posttreatment against resistant strains of N meningitidis.
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Complications

  • Despite early aggressive management, the complications from bacterial meningitis remain significant.
    • In the neonatal period, the mortality rate is 15-25%.
    • After the neonatal period, the mortality rate drops to about 5% with appropriate care.
    • The morbidity rate is up to 40% depending on the causative organism and delay in therapy.
    • Hib meningitis has up to 15% rate of permanent neurological sequelae.
  • Focal neurological sequelae may occur in 10-15% of patients. These problems are hemiparesis, facial palsy, visual field defects, hearing loss, and cranial nerve palsies.
    • Seizures may occur at any point of the patient's course. Seizures that continue after the fourth day of hospitalization are focal in nature or are difficult to control have a greater likelihood of neurological sequelae.
  • Most children with enteroviral meningitis have an uncomplicated course.
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Prognosis

  • The prognosis for appropriately treated meningitis has improved, but there is still a 5% mortality rate and significant morbidity.
  • The prognosis varies with the age of the child, clinical condition, and infecting organism.
  • The prognosis from viral meningitis usually is very good.
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Contributor Information and Disclosures
Author

Jeffrey Hom, MD, MPH, FACEP, FAAP  Assistant Professor, Department of Pediatrics/Emergency Services and Department of Emergency Medicine, New York University School of Medicine

Jeffrey Hom, MD, MPH, FACEP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Allan Felter, MD, FAAP, CPE, FACPE  Professor of Clinical Pediatrics, Department of Pediatrics, Georgetown University School of Medicine; Medical Director, Pediatric Emergency Medicine and Inpatient Services, Inova Loudoun Hospital

Robert Allan Felter, MD, FAAP, CPE, FACPE is a member of the following medical societies: American Academy of Pediatrics and American College of Physician Executives

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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