National Science Popularization Day 2021 | Children have persistent fever and headache... Don't treat meningitis as a common cold

September 16

China Brain Health Day

On September 8, the World Health Organization's Regional Office for Africa issued a statement in Kinshasa, the capital of the Democratic Republic of the Congo, announcing an outbreak of meningitis in Tchopo Province in northeastern Congo. As of September 7, the province had reported 129 deaths from meningitis and 261 suspected cases. On September 9, the Chinese Embassy in the Democratic Republic of the Congo also issued a reminder to prevent meningitis outbreaks.

Meningitis is one of the major diseases that threaten life and health. In my country, the incidence of meningitis is highest in children under 5 years old, especially infants aged 6 months to 2 years old.

What are the symptoms of meningitis and how can it be prevented?

Meningitis is generally caused by infection with pathogenic microorganisms such as bacteria, viruses, tuberculosis, fungi and parasites. Among them, bacterial meningitis is the most serious. If not treated promptly, it may be life-threatening.

People under 5 years old are at high risk

The occurrence of bacterial meningitis is age-related and mostly occurs within 5 years of age, especially in infants and young children. It is a disease with a higher mortality rate among childhood infectious diseases, and nearly half of the survivors will have permanent neurological sequelae.

Why are children more susceptible to bacterial meningitis?

This is mainly because the baby's brain structure is not fully developed, the blood-brain barrier is not perfect, and the baby's own resistance is weak during this period. Some babies also have congenital anatomical defects (such as pilonidal sinus, cerebrospinal fluid otorrhea or nasal leakage, etc.), which makes it easy for bacteria to directly invade the brain through blood, ear or sinus infection and cause meningitis.

Initial symptoms are atypical

Meningitis has an acute onset, but the initial symptoms of infection lack specificity and are often manifested as upper respiratory tract infection symptoms, such as fever, headache, and muscle aches, which are often easily mistaken for common colds. Some babies will have some gastrointestinal reactions, such as vomiting and loss of appetite. Infants may show irritability, crying, and difficulty feeding.

As the disease progresses, special manifestations of meningitis will further appear, such as: meningeal irritation signs and central nervous system symptoms, manifested as neck stiffness (such as stiff neck and inability to lower the head), increased intracranial pressure, severe headache, projectile vomiting, and even from initial fatigue, gradually develop to confusion or delirium, and finally coma.

Clinical manifestations in infants and young children are nonspecific and may include hypothermia, convulsions, a full and tense anterior fontanelle, and altered consciousness.

Timely treatment is key

Bacterial meningitis requires emergency treatment. Any delay in diagnosis and treatment will cause permanent disability or even death. Early identification, timely and correct treatment, and long-term follow-up intervention after the disease are effective means to improve survival rate and reduce disability (mortality) rate. Therefore, if the child has a high fever that does not subside, parents should not hesitate to seek medical treatment in time.

Treatment of meningitis includes both etiological treatment and symptomatic treatment.

Cerebrospinal fluid examination (lumbar puncture) is the main basis for the diagnosis of bacterial meningitis. It can identify the pathogen as early as possible and give targeted anti-infection treatment. Antimicrobial drugs should be penicillins and third-generation cephalosporins that are easy to pass through the blood-brain barrier and safe for babies.

While treating the cause, the baby's vital signs should be closely monitored, cerebral edema and intracranial hypertension should be reduced, and water and electrolyte balance should be maintained.

5 things you can do to prevent meningitis

1. Vaccinate your baby on time, such as Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, meningococcal meningitis vaccine and Japanese encephalitis vaccine, especially for babies with cerebrospinal fluid leakage, splenectomy, and hypogammaglobulinemia.

2. Do not feed your child food that you have chewed yourself, and do not feed your child mouth-to-mouth.

3. It is recommended to eat separately and use serving chopsticks.

4. Encourage your baby to wash his hands frequently and keep his hands clean.

5. Improve your baby's immunity by ensuring adequate sleep, balanced nutrition and proper exercise.

Your baby’s “top priority” must not be taken lightly. If symptoms such as fever and headache occur, you should seek medical attention in time and actively cooperate with the doctor for treatment to avoid the occurrence of sequelae.

Author: Zhang Wei, Chief Pharmacist of Shanxi Yangmei Group General Hospital

Review expert: Ren Jianye, deputy director and pharmacist of Shanxi Yangmei Group General Hospital

Wei Guoyi, Chief Pharmacist, Beijing Anzhen Hospital, Capital Medical University