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Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People

Children’s Services Colchester Hospital

Children’s Ward 01206 746208 or 746209

Children’s Assessment Unit 01206 746200

Children’s Emergency Department 01206 742847

What do I need to know?

This digital leaflet is about the care and treatment of children and young people under 16 years of age with bacterial meningitis and / or meningococcal septicaemia.

Bacterial meningitis and meningococcal septicemia are life-threatening diseases that require urgent emergency treatment. They are not very common but when they happen they can be very serious and quickly lead to complications such as brain damage, skin damage, amputation and even death, although most children and young people make a full recovery if they are treated early.

Bacterial meningitis occurs when bacteria infect the lining of the brain (the meninges) and the spinal cord. Meningococcal septicemia (blood poisoning) occurs when bacteria in the blood multiply uncontrollably. Meningococcal disease can appear as meningococcal meningitis, meningococcal septicaemia or a combination of both. There may be many types of microbes that cause both conditions.

More Information

  • Fever/Vomiting 
  • Headache 
  • Stiff neck 
  • Dislike of bright lights 
  • Very sleepy/vacant/difficult to wake 
  • Confused/Delirious 
  • A rash that doesn’t fade when pressed with a glass tumbler (but in some kinds of meningitis there may be no rash).

This is called blanching 

  • Seizures Babies may also refuse feeds, be irritable with a high-pitched cry, have a stiff body and bulging soft spot on the top of their head. 

Not everyone has all of these symptoms though.

Non-blanching rash plus: 

  • fever 
  • vomiting / nausea 
  • lethargy 
  • muscle ache/joint pain 
  • cold hands/feet 
  • leg pain
  • pale/mottled skin 
  • rapid breathing/breathlessness 
  • confusion 
  • very sleepy/vacant/difficult to wake.

Not everyone has all of these symptoms. In the early stages there may not be a rash or the rash may fade when pressure is applied (blanch).

If your child has a non-blanching rash and fever or has previously had a fever, they may need to have a blood test.

If results of the blood tests are not normal, your child may be given antibiotics and admitted to hospital. If they are normal your child’s condition will be monitored for several hours. If the doctor thinks there is a possibility they may have meningitis or septicaemia, despite normal tests, they will be given antibiotics and admitted to hospital.

If your child has a non-blanching rash but no fever, and they do not look unwell, they probably do not have meningitis or septicaemia, so the doctor may consider a different diagnosis.

Almost all children with suspected meningitis will need to have a lumbar puncture to confirm the diagnosis. This is a routine test in paediatrics and should not alarm you.

During this procedure, a sample of cerebro-spinal fluid (the fluid surrounding the brain and spinal cord) is taken from the lower part of the spinal canal using a hollow needle inserted into the lower part of the back. The fluid taken is then tested in a laboratory. A patient information leaflet on lumbar puncture is available. Please ask a nurse if you would like one.

If the blood tests or lumbar puncture tests are abnormal and indicate a bacterial infection, your child will need antibiotics.

The tests may also show which types of bacteria are causing the infection. The doctor will use this information to decide which type of antibiotic to use.

Babies will sometimes need to have a second lumbar puncture during the course of treatment if they have a persistent fever or a fever that has returned. their condition gets worse, they have new symptoms or blood tests show continuing infection.

If your child is having problems staying conscious or has signs of brain injury or brain inflammation (these are known as focal neurological signs), your child might need to have a computerised tomography (CT) brain scan to see if there is an another problem.

Your child will normally have blood tests if septicaemia is suspected. If the results are abnormal this may indicate a bacterial infection and your child will usually be given antibiotics.

If your child is dehydrated (due to either excessive loss of water from the body or reduced feeding), they will be given fluids. The fluids may be given intravenously through a needle or thin tube inserted directly into a vein. Alternatively, the fluids can be given directly into the stomach or small intestine using a thin tube, which is usually inserted through the nose.

Depending on the results of the lumbar puncture, your child may be given a drug called corticosteroid to reduce the inflammation in the brain. This does not have marketing authorisation for use at the dose recommended nationally by NICE (National Institute for Health and Clinical Excellence), so you will be asked to sign a consent form indicating you are willing for your child to receive it. If you have any concerns or worries about the drug, you can discuss them with the doctor at the time.

If your child is suspected of having septicaemia the doctor will look for signs of clinical shock. This is when blood does not circulate around the body properly, which means the body’s tissues and organs cannot function correctly. If your child is in shock they will be treated with fluids and then re- assessed. Severe shock eventually causes low blood pressure, so they may need drugs urgently to help improve their circulation quickly to stabilise their condition.

If your child has suspected or confirmed septicaemia they may need some help to breathe. This could involve using a special face mask or a machine called a ventilator to help them breathe in more oxygen. If your child needs a ventilator or their condition is very serious, they may need to be transferred to a paediatric intensive care unit.

Most children recover well but some will take a while to return to normal. The doctor will discuss with you the potential long term effects of the disease, as well as likely patterns of recovery. The circumstances will be different for each child but the after-effects of meningitis may include emotional and psychological problems or minor learning difficulties, which may mean they will need extra help or support at school.

Very severe cases can cause hearing loss and damage to the brain or other parts of the nervous system, perhaps causing learning impairment, epilepsy and problems with movement and coordination. Septicaemia can cause scarring to the skin and lead to amputation and other damage to bones. The kidneys may also be affected. These problems should be obvious very early in the course of the illness.

All children who have had bacterial meningitis or bacterial septicaemia will be offered an appointment to see a paediatrician a few weeks after discharge from hospital.

Meningitis Now Tel: 0808 801 0388 (24-hour freephone helpline) Web: www.meningitisnow.org Meningitis Research Foundation Tel: 0808 801 0388 (24-hour freephone helpline) Web: www.meningitisnow.org NICE Quality Standards – June 2012 Information for people who use NHS services for bacterial meningitis and meningococcal septicemia in children and young people.

If you have any further concerns or worries, please do not hesitate to speak to the doctor or nurse caring for your child.

When your child attends hospital you will be asked for his or her NHS number and other information, such as your address.

Please be patient with this procedure as it is to ensure our records are kept up to date and to protect your child’s safety.

If you do not know his or her NHS number, please don’t worry, he or she will still receive care.

To find out how to give us feedback on your visit or healthcare experience, please visit www.esneft.nhs.uk and search for PALS’, or speak to a member of staff on the ward or department you are in.