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This Article Full Text Full Text (PDF) Take the CME quiz: Vol. 29 No. 12, December 2008 Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Mann, K. Articles by Jackson, M. A. PubMed Articles by Mann, K. Articles by Jackson, M. A. Related Collections Infectious Diseases Neurologic Disorders Fetus and Newborn Infant

(Pediatrics in Review. 2008;29:417-430.)
© 2008 American Academy of Pediatrics

Meningitis

Keith Mann, MD^*
Mary Anne Jackson, MD

^* Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Associate Director, Pediatric Residency Program, Vice Chair of Clinical Affairs-Inpatient Services, Children's Mercy Hospital and Clinics, Kansas City, Mo
Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Section Chief, Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, Kansas City, Mo

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. List the typical clinical manifestations of meningitis.
   
2. Distinguish bacterial, viral, tuberculous, and fungal meningitis based on clinical presentation and cerebrospinal fluid analysis.
   
3. Describe key management issues for a child who has bacterial meningitis.
   
4. Recognize the common acute complications of meningitis.
   
5. Identify the long-term sequelae of meningitis.
   

	Introduction

 
Since the last review of meningitis in Pediatrics in Review in 1998 by Wubbel and McCracken, a number of developments have occurred in the epidemiology and management of meningitis in the pediatric patient. Pneumococcal and meningococcal conjugate vaccines have been implemented, use of enteroviral polymerase chain reaction (PCR) has become routine in most children's hospitals, and additional data concerning the effective use of adjunctive dexamethasone are now available.

Still, meningitis remains one of the most significant infections in children, and morbidity and mortality in the child who has bacterial meningitis has not changed in the last 15 years, despite the availability of newer antibiotics and preventive strategies. It is crucial for pediatricians to remain vigilant in their understanding of the epidemiology, pathogenesis, management, and follow-up of affected patients. Although this article focuses on meningitis, key central nervous system (CNS) pathogens that cause meningoencephalitis or encephalitis also are discussed because clinical symptoms, signs, and laboratory findings in these conditions often overlap.

	Epidemiology and Etiology

 
A variety of infectious agents can cause meningitis, including bacteria, viruses, fungi, and mycobacteria. Most pathogens are specific to certain age groups, seasonality, geography, and underlying host factors. In the developed world, meningococcus and pneumococcus currently cause 95% of cases of acute bacterial meningitis in children. Pneumococcal and meningococcal meningitis occur with an annual incidence in the range of 4 to 5 and 2.5 cases per 100,000 children younger than 5 years of age, respectively. Group B Streptococcus (GBS) remains the predominant bacterial pathogen in . . . [Full Text of this Article]