The clinical features seen in neonatal meningitis are usually indistinguishable from those of neonatal sepsis. The most prevalent clinical signs include temperature instability, irritability or lethargy and poor feeding or vomiting [1]. Neurological manifestations are more commonly seen after a bacterial attack. Meningitis caused by group B streptococci may initially present with features of respiratory distress, accompanying a systemic illness. These findings become less common with an earlier age of onset.

Temperature instability presents either as fever or hypothermia and is the most commonly reported clinical feature.

Neurologic signs may include irritability, lethargy, hypotonia, muscle twitches, tremors and seizures. A more specific feature is paradoxical irritability, wherein consolation by parents irritates rather than comforts the affected neonate. Findings of a full or bulging fontanelle are not uncommon. Some patients may present with nuchal rigidity or hydrocephalus [2]. Cranial nerve lesions, especially involving the oculomotor, abducens and facial nerve may be seen in a few children.

Ventriculitis is seen accompanying neonatal meningitis in a few children, especially in those afflicted with gram negative bacilli [3]. Certain organisms (C. diversus, Cronobacter (previously Enterobacter) sakazakii) responsible for causing vasculitis along with meningitis may lead to brain cysts and abscesses. Brain abscesses may have raised intracranial tension as one of its first manifestations, thereby leading to an increase in head size and non-projectile vomiting.

• Fever

  The symptoms were fever and seizures. The culture of cerebrospinal fluid showed to be positive for Neisseria meningitidis B. culture blood was negative. Antibiotic therapy was started at admission and maintained for 3 weeks. [ncbi.nlm.nih.gov]

  The mother usually experienced a flu-like illness late in the third trimester of pregnancy, characterized by low-grade fever, myalgias, malaise, and backache. [labce.com]

  Symptoms include sepsis, fever, irritability, and dyspnea. It can be caused by Escherichia coli (E. coli), and in rare cases, listeria monocytogenes (listeria). [imedpub.com]

• Cerebral Palsy

  Brain damage Cognitive impairments Cerebral palsy Edema (fluid buildup in the brain) Brain abscesses (pus-filled pockets) Cerebral palsy Developmental delays Seizure disorders Learning disabilities What Are the Signs and Symptoms of Neonatal Sepsis and [michigancerebralpalsyattorneys.com]

  Pre-term infants with sepsis are noted to have higher rates of cognitive deficits, cerebral palsy, and other neurological disabilities. [abclawcenters.com]

• Epilepsy

  Complications of cerebral palsy, mental retardation and epilepsy occurred in 3 patients (23%). None of the patients died during the study period. [ncbi.nlm.nih.gov]

  One in three youngsters who are treated for the disease will suffer mental health problems, epilepsy or learning difficulties, the study found. [theguardian.com]

  A 2015 study demonstrated that central nervous system complications associated with late-onset GBS meningitis, such as hydrocephalus, epilepsy, subdural empyema, and ischemia, may be underestimated. 3 [acepnow.com]

  Twenty five per cent of those who survive, can face devastating challenges like hearing loss, epilepsy, cerebral palsy or losing a limb. There are different types of bacteria that can cause meningitis and blood poisoning. [action.org.uk]

  Some 25-50% have significant problems with language, motor function, hearing, vision, and cognition [18, 3] ; 5-20% have future epilepsy. [19, 20] Survivors are also more likely to have subtle problems, including visual deficits, middle-ear disease, and [emedicine.medscape.com]

• High Fever

  Clinical history The prototype history for this organism is either a still birth or a neonate with death ensuing within two or three days post-partum due to high fever, sepsis, and respiratory distress. [labce.com]

  Neonatal meningitis can proceed rapidly and result in symptoms such as vomiting, a high fever, a bulging or pulsing soft spot, a rash, jaundice, shivering and difficulty breathing. Some babies with meningitis develop seizures. [livestrong.com]

  A high fever, stiff neck, and severe headache are the hallmark signs. [babycenter.com]

• Acutely Ill Patient

  Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness. [patient.info]

• Pneumonia

  Klebsiella pneumoniae (31%) and Serratia marcescens (21%) were the main pathogens. The incidence of concurrent septicemia among these infants was 58%. Klebsiella pneumoniae appears to dominate in both early and late onset infections. [ncbi.nlm.nih.gov]

  Resumen Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. [repositorio.uchile.cl]

  Home » Science » Groups Genomics of Pneumonia and Meningitis (and neonatal sepsis) | Parasites and Microbes Home » Science » Groups Genomics of Pneumonia and Meningitis (and neonatal sepsis) | Parasites and Microbes Our Research and Approach We study [sanger.ac.uk]

• Sneezing

  Your baby can get viral meningitis when the virus is transferred into the air when someone coughs or sneezes nearby. It's also spread by poor hygiene, such as not washing your hands after going to the toilet. [babycenter.ca]

  Viral meningitis is spread, just like other viruses, from person to person, some by coughing and sneezing and others by poor hygiene, such as not washing your hands after going to the toilet. [babycenter.com.au]

  Wash your hands after coughing, sneezing, or blowing your nose, or after going to the toilet or changing nappies (Meningitis Now 2017). Try to make sure anyone who comes into close contact with your baby does the same. [babycentre.co.uk]

• Abdominal Distension

  On the fourth day, the baby developed lethargy, refused to feed, and developed abdominal distension. The baby was referred to the neonatal intensive care unit at Sir Ganga Ram Hospital on the sixth day of life. [journals.lww.com]

  Fever, irritability, seizures and a bulging fontanel were significantly more frequent among newborns whose birth weight was > " 2500g, whereas abdominal distension, apnea, jaundice and blood count abnormalities were predominant among low-birth weight [scielo.br]

• Hypotension

  […] pathogens include E. coli and Listeria monocytogenes. 1 The cumulative incidence of meningitis is highest in the first month of life and is higher in preterm neonates than term neonates. 2 Patients may present with difficulty feeding, apnea, bradycardia, hypotension [acepnow.com]

  The recognition and treatment of hypotension is particularly important to avoid complications such as cerebral ischaemic... Read more... [health.vic.gov.au]

  Meningococcal meningitis and/or septicaemia may also present with capillary refill time more than two seconds, unusual skin colour and hypotension. [patient.info]

• Purpura

  We report the case of neonatal meningitis in a 20-day-old girl without shock or purpura. The symptoms were fever and seizures. The culture of cerebrospinal fluid showed to be positive for Neisseria meningitidis B. culture blood was negative. [ncbi.nlm.nih.gov]

  […] meningococcal meningitis Pathophysiology : coagulopathy triggered by endotoxins, which often leads to hemorrhagic necrosis of the adrenal glands Clinical features Myalgia Non-blanching, petechial rash (mostly on trunk and legs) ; in severe cases even purpura [amboss.com]

  Number of participants with bleeding diatheses at one month post treatment (external bleeding including oozing from puncture sites, purpura and petechiae, as well as evidence of internal bleeding such as haematuria and haematemesis occurring during hospitalisation [cochranelibrary.com]

• Hearing Impairment

  Several factors for poor prognosis in newborns with culture-proven bacterial meningitis were found: high CSF protein concentration, congenital heart disease, hearing impairment, and seizure. [ncbi.nlm.nih.gov]

  Even with optimal treatment, one in four children who recover from meningitis are at risk of neurodevelopmental disorders and hearing impairment [ 2 ]. [pediatricneurologybriefs.com]

  Sufferers were five times more likely to have a significant hearing impairment: 2.4% of survivors had bilateral hearing loss that required a cochlear implant. The risk of amputation was also increased, the study said. [theguardian.com]

  Otoacoustic Emissions as a Screening Test for Hearing Impairment in Children Recovering From Acute Bacterial Meningitis. Pediatrics 1998;102;1364. Koomen I, Grobbee DE, Roord JJ, et. al. [pediatriceducation.org]

• Stupor

  Stupor and irritability are common in late-onset meningitis as are neurological complications. [acepnow.com]

  Symptoms among older children and adults may progress from irritability through confusion, drowsiness, and stupor, possibly leading to coma. [rarediseases.org]

  […] macular, mucosal) Tachypnea or apnea Jaundice Bulging fontanelle (late) Vomiting or diarrhea Altered sleep pattern PHYSICAL EXAMINATION In the physical examination of a newborn or infant with meningitis, findings may range from completely normal to stupor [aafp.org]

• Opisthotonus

  Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. [ncbi.nlm.nih.gov]

  Stiff neck (generally not present in children under the age of one year or in patients with altered mental state), back rigidity, bulging fontanelle (in infants), photophobia, opisthotonus (if severe). [patient.info]

  Late in the illness, classical features of raised intracranial pressure such as full and tense fontanelles, setting‐sun eye appearance, retrocollis, opisthotonus (when the neck of the infant is twisted backwards) and seizures can occur. [cochranelibrary.com]

• Somnolence

  The neonate may be febrile, euthermic, or hypothermic and may be tachypneic, have apneic spells, or be excessively somnolent. [medlink.com]

  He was mildly anorectic, more irritable and more somnolent. He had no cough, vomiting or diarrhea. The prenatal history was remarkable for maternal first-trimester primary genital herpes simplex virus (HSV) infection. [aafp.org]

• Neonatal Seizures

  For example, if a baby shows signs of neonatal seizures, they may need anticonvulsant medications. Magnetic resonance imaging (MRI) should be performed before antibiotics are discontinued (4). [abclawcenters.com]

• Focal Seizure

  Case report A 28 days old boy was presented to the Emergency Department with a history of fever, irritability, poor feeding of 1 week duration and right-sided focal seizures on the day of presentation. [casesjournal.biomedcentral.com]

Meningitis is associated with an increased risk of mortality in neonates and hence, there should be no delay in the workup of a neonate suspected of suffering from meningitis. A lumbar puncture is the gold standard test to be done in such neonates, even in the absence of neurological manifestations.

The major findings seen on cerebrospinal fluid (CSF) analysis include an elevated CSF protein, decreased CSF glucose and pleocytosis, with polymorphonuclear leucocytes dominating the picture in both bacterial and viral meningitis. All three parameters need to be normal for a diagnosis of meningitis to be excluded [4]. Symptomatic neonates should also undergo a CSF culture for confirmation of the diagnosis. It has been found though, that 15-30% of CSF-proven cases have negative blood culture results [5].

Another modality with higher sensitivity and specificity rates to detect neonatal meningitis is the polymerase chain reaction (PCR) assay, that is being increasingly used to detect the presence of organisms such as group B streptococci, herpes simplex virus, enterovirus etc [6] [7].

Urinary latex particle agglutination (LGA) is another method designed to rapidly screen neonates for meningitis.

The neuroimaging study of choice is magnetic resonance imaging (MRI) that may help to locate the foci of infection, areas of edema, hemorrhage, infarction or abscesses. Follow-up scans may help evaluate the resolution of infection. Newer MRI techniques such as diffusion-weighted scans and diffusion tensor imaging are being used to note any white matter changes associated with neonatal meningitis [8].

Computed tomography (CT) scans may appear to be beneficial in patients posted for neurosurgery, whilst cranial ultrasonography may be useful to document ventricle size in hydrocephalus. Chest radiography and electroencephalography (EEG) studies may be done in some cases.

• Herpes Simplex Virus Type 2

  Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission. Obstet Gynecol. 2007; 109 :403–409. [ PubMed ] [ Google Scholar ] 72. International Perinatal HIV Group. [ncbi.nlm.nih.gov]

• Lumbar Puncture Abnormal

  Clinicians frequently use the presence of positive blood cultures to determine whether neonates should undergo lumbar puncture. [ncbi.nlm.nih.gov]

Follow-up MRI was performed in five of the neonates in the patient group after 2 weeks of antibiotic treatment. FA and MD values were compared in patients before and after antibiotic treatment as well as with those in the healthy controls. [ncbi.nlm.nih.gov]

The aim for these treatments is to sterilize the cerebrospinal fluid of all pathogens. A repeat spinal tap 24 to 48 hours after treatment has been started should be done to confirm sterilization. [en.wikipedia.org]

Patients with the outcomes of death and having sequelae were regarded as having a poor prognosis. Those who were lost to follow-up were excluded from the analysis of outcome. [ncbi.nlm.nih.gov]

Early recognition of neonates at risk of poor prognosis would be helpful in providing timely management. [journals.plos.org]

In this study the main etiological agent identified from CSF culture was S. pneumoniae. [springerplus.springeropen.com]

The histologic diagnosis therefore is suppurative meningitis, with culture results necessary to establish the etiologic agent. [labce.com]

Coagulase-negative staphylococci were considered to be the etiological agent of meningitis only when they was isolated in CSF and blood cultures at the same time. [scielo.br]

BACTERIAL ETIOLOGIES Typical pathogens vary with age ( Table 4 ). In the first month of life, group B streptococcus is the most common etiologic agent. [aafp.org]

The epidemiological findings suggest that the cases reported from Malaysia were community-acquired in contrast with those from the USA and Thailand. [ncbi.nlm.nih.gov]

Transmission and Epidemiology (Escherichia coli) Occurs most often in premature babies, with a 20% mortality rate, even with aggressive treatment. Those who survive have permanent brain damage. [quizlet.com]

Over the past few years, major progress has been made in the understanding of the pathophysiology of E. coli O18:K1:H7 neonatal meningitis. [ncbi.nlm.nih.gov]

Noninfectious meningitis Sarcoidosis Tumor metastases (meningeal carcinomatosis and meningeal leukemia ) Medication (e.g., NSAIDs ) References: [1] [2] [3] [4] [5] [6] Pathophysiology Most pathogens that cause meningitis colonize the nasopharynx or the [amboss.com]

It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis. [ncbi.nlm.nih.gov]

Currently, the best means of neonatal GBS prevention is the use of maternal IAP to prevent early onset GBS disease. However, IAP only prevents early onset GBS disease, 38 and the majority of GBS meningitis cases are of late onset. [doi.org]

Prevention of neonatal meningitis is primarily intrapartum (during labor) antibiotic prophylaxis (prevention) of pregnant mothers to decrease chance of early-onset meningitis by Streptococcus agalactiae. [en.wikipedia.org]

Prevention and Treatment (Cronobacter sakazakii) -FDA and CDC advise hospitals to use ready-to-feed and concentrated liquid formulas. [quizlet.com]

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2. Pong A, Bradley JS. Bacterial meningitis and the newborn infant. Infect Dis Clin North Am. 1999 Sep. 13(3):711-33, viii.
3. Unhanand M, Mustafa MM, McCracken Gh, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one year experience. J Pediatr. January 1993. 122:15-21.
4. Garges HP, Moody MA, Cotten CM, et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?. Pediatrics. 2006 Apr. 117(4):1094-100.
5. Malbon K, Mohan R, Nicholl R. Should a neonate with possible late onset infection always have a lumbar puncture?. Arch Dis Child. 2006 Jan. 91(1):75-6.
6. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med. March 2009. 1-6.
7. Kimberlin D. Herpes simplex virus, meningitis, and encephalitis in neonates. Herpes. 2004. 11 Supp 2:65A-76A.
8. Shah DK, Daley AJ, Hunt RW, Volpe JJ, Inder TE. Cerebral white matter injury in the newborn following Escherichia coli meningitis. Eur J Paediatr Neurol. 2005. 9:13-17.