What are the symptoms and treatment for meningitis in a 2-year-old?

Symptoms and Treatment of Meningitis in a 2-Year-Old

The classic symptoms of meningitis in a 2-year-old include fever, vomiting, irritability, and lethargy, with less reliable presentation of neck stiffness and photophobia compared to older children. 1 Immediate recognition and treatment are essential as bacterial meningitis is potentially life-threatening with high mortality and morbidity rates.

Key Symptoms to Recognize

Common Presenting Symptoms

• Fever: Present in 92-93% of children with bacterial meningitis 2, 1
• Vomiting: Occurs in 55-67% of cases 2, 1
• Irritability and lethargy: Often the earliest signs in toddlers
• Poor feeding: Common in young children 2
• Altered mental status: Present in 13-56% of cases 2

Less Common but Important Signs

• Neck stiffness: Less reliable in toddlers (present in 40-82% of older children) 2, 1
• Bulging fontanelle: Important sign if fontanelle is still open 3
• Seizures: Occur in 10-56% of children with bacterial meningitis 2
• Petechial or purpuric rash: Particularly suggestive of meningococcal disease 2

Important Diagnostic Considerations

• The classic triad of fever, neck stiffness, and altered mental status is present in only 41-51% of cases 1
• Symptoms in toddlers are often more subtle and non-specific than in older children 2
• Kernig's and Brudzinski's signs have poor sensitivity in young children 1

Treatment Algorithm

1. Initial Assessment and Stabilization

• Urgent referral to secondary care is required for any child with suspected meningitis 2
• Administer parenteral antibiotics immediately upon suspicion of bacterial meningitis, even before hospital arrival 2

2. Antibiotic Therapy

• First-line treatment: Intravenous cefotaxime for children over 3 months 2
  • Alternative: Ceftriaxone 100 mg/kg/day (not to exceed 4 grams daily) 4
• Duration: 7 days for meningococcal disease, assuming satisfactory clinical progress 2

3. Adjunctive Therapy

• Corticosteroids: For confirmed meningococcal meningitis or suspected bacterial meningitis, administer parenteral dexamethasone (0.15 mg/kg every six hours) with or within 24 hours of the first antibiotic dose, continuing for four days 2
• Fluid management: If signs of shock are present, administer rapid infusion of intravenous fluids (isotonic crystalloid or colloid) up to 60 ml/kg, given as three boluses of 20 ml/kg, with reassessment after each bolus 2

4. Intensive Care Considerations

• Arrange transfer to pediatric intensive care for patients who continue to deteriorate despite appropriate supportive treatment 2
• Consider early ventilatory support for children with fluid-resistant shock 2

Complications and Follow-up

Common Complications

• Neurological sequelae: Occur in up to 24% of survivors 1, 5
• Hearing loss: Affects 34% of children after bacterial meningitis 1, 5
• Seizures: Develop in 13% of survivors 1, 5
• Cognitive deficits: Occur in 9% of children 1, 5

Follow-up Care

• Hearing evaluation should be performed during admission or within 4 weeks of recovery 1
• Monitor for neurological deficits, cognitive impairment, and developmental delays 1
• Assess for potential long-term complications including epilepsy, movement disorders, and communication problems 1

Prevention of Secondary Transmission

• Offer prophylaxis to close household contacts of a child with meningococcal disease during the seven days before onset of illness 2
• Liaise with local public health department to ensure appropriate public health actions 2

Pitfalls to Avoid

• Delayed recognition: Symptoms in toddlers may be non-specific; maintain high suspicion with fever and irritability
• Waiting for classic signs: The absence of neck stiffness or full triad does not rule out meningitis 1
• Delayed antibiotic administration: This can significantly worsen outcomes 1
• Relying solely on physical examination: Lumbar puncture is essential for definitive diagnosis unless contraindicated 2

Early recognition and prompt treatment are critical for improving outcomes in bacterial meningitis, as mortality rates can be as high as 20% with one-third of survivors developing persistent neurological complications 1, 5.