Think Meningitis – Not just a rash

shutterstock_220765612 What is meningitis? Meningitis is a condition caused, most commonly, by viral or bacterial infection resulting in inflammation of the meningeal layer within the brain and spinal cord. Whilst viral meningitis is more common and often less severe, bacterial meningitis is a serious disease that requires fast and effective treatment.[i],[ii] Incidence and complications Iin 2017, Public Health England reported 747 lab-confirmed cases of invasive meningococcal disease in England during 2016/17, a huge reduction from the reported 2,595 cases seen in 1999/2000[iii]. The incidence of meningitis has reduced dramatically since the introduction of appropriate vaccinations.[iv] For example the introduction of the H. influenza type B vaccination in 1990 led to a 55% decrease in the incidence of meningitis associated with this bacteria, which had previously been the leading cause of meningitis in children under 5.[v] However, if left untreated, meningitis can result in hearing loss, seizures, gangrene and limb amputation, coma and death, and, despite the major impact of immunisation, remains a leading infectious cause of death and disability in children. Research looking at long-term follow up of patients showed that those who suffered from neonatal meningitis were 10 times more likely to have a moderate or severe disability compared to children who had not had meningitis[vi]. What should you look for? Non-blanching rash: Recent healthcare campaigns have significantly raised awareness of the classic ‘non-blanching’ meningitis rash, which you can monitor at home with a glass-roll test. However, in most cases, the emergence of this classical rash indicates the presence of ‘meningococcal septicaemia’; a more severe advancement of bacterial meningitis causing a more widespread infection (i.e. sepsis). The signs of more severe infection, such as the rash or signs of septic shock, often appear later in the course of the illness following other clinical signs which may be apparent earlier[vii],[viii]. Research has shown that complications are more likely to arise in patients who initially present with this rash compared to other patients,[ix] and that recognising meningitis before these signs appear (often by a GP or in a primary care setting) results in faster access to appropriate treatment.[x] Whilst some of these signs can be seen as very generic stigmata of any childhood infection, there are some more telling signs, which may be more characteristic of meningitis, and should be treated with high suspicion. Other common presenting features seen in children with meningitis:[xi]-15
  • Fever
  • Elevated heart rate
  • Tiredness
  • General muscle aches and pains
  • Irritability
  • Poor feeding
  • Vomiting
  • Altered mental state, particularly drowsiness*
  • Bulging fontanelle* (babies)
  • Light sensitivity* (photophobia)
  • Neck stiffness*
  • Leg pain*
  • Cold hands and feet
*More specific signs for meningitis; e.g. neck stiffness is seen in up to 40% children presenting with active meningitis infection. There are now vaccines available (e.g. MenACWY) and meningitis remains the subject of intense research, but if you have any concerns about your child please get them a medical review. References
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.

Bethan_Tyler Bethan Tyler Final year medical student, Kings College London

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