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Meningitis is an inflammation of the leptomeninges, tissues that cover the brain and spinal cord. Untreated bacterial meningitis has a mortality of nearly 100%, so treat suspected bacterial meningitis promptly. Unfortunately, even with rapid antibiotic treatment, long-term neurologic sequelae occur. Viral meningitis has a range of severity: mild cases resolve without sequelae; however, some viruses, such as herpes virus, can cause severe infections. Meningoencephalitis is an inflammation of the brain as well as the meninges. It is less common than meningitis but can be devastating.

The most common causes of bacterial meningitis vary with the child’s age (Table 120-1). Vaccination programs have had a huge impact on the epidemiology of bacterial meningitis in developed countries. For instance, Haemophilus influenzae vaccine has almost eliminated H. influenzae meningitis in countries where the vaccine is utilized and has decreased overall bacterial meningitis rates by 55%.1 The introduction of the polyvalent vaccinations for Streptococcus pneumoniae (PCV7 in 2000 and PCV13 in 2010) has markedly decreased meningitis caused by that organism, although it remains the most frequent cause of pediatric meningitis.2 Neisseria meningitidis remains an important cause of meningitis in children, and vaccines against serotype B have recently been introduced. Other important causes of bacterial meningitis in children include Mycobacterium tuberculosis and Borrelia burgdorferi, the causative agent of Lyme disease.

TABLE 120-1Causes and Treatment of Bacterial Meningitis by Age Group

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