Medical Overview

Historically, bacterial meningitis was a significant cause of morbidity and mortality in the pediatric population (Dawson et al. 1999), but the discovery of antibiotics in the 1930s and 1940s greatly decreased the mortality rate of children with bacterial meningitis (Tyler 2008). Additionally, the implementation of vaccines targeted against two forms of bacterial meningitis, Haemophilus influenzae type B disease and 7-valent pneumococcal conjugate vaccine (PCV7), further decreased infections of bacterial meningitis in infants and children in the developed world (Best and Hughes 2008; Tsai et al. 2008). Despite the implementation of these vac

This work has been supported by the National Institute of Mental Health.

cines, there is still a 5% mortality rate of bacterial meningitis in the developed world and about 30% in the developing world (Best and Hughes 2008).

Viral meningitis accounts for 82%-94% of the cases of acute meningitis (Dubos et al. 2006; Michos et al. 2007). Viral meningitis infection can range from aseptic meningitis, a syndrome of meningeal inflammation in which common infectious agents cannot be identified in the cerebrospinal fluid, to encephalitis, an acute inflammation of the brain (Eppes et al. 1999). Severe illness and death are uncommon in viral meningitis (Centers for Disease Control and Prevention 2003).

Fungal meningitis is a rare but serious infection accounting for 5%-10% of all pediatric meningitis infections and primarily seen in hospitalized patients with severe underlying disease (Krcmery and Para-disi 2000). Patients who most frequently present with fungal meningitis are critically ill neonates, neurosurgical patients, or patients whose care involves foreign body insertion (such as a catheter or central line), use of broad-spectrum antibiotics, immunocompromised status, use of steroids, and/or use of total parenteral nutrition (McCullers et al. 2000).

Encephalitis is a rare but serious pediatric health concern. There are many causes of encephalitis, with bacterial and viral infections of the CNS being the most common (Granerod and Crowcroft 2007). The clinical signs of encephalitis are similar to those of the other CNS infections mentioned previously. Fever, headache, and altered consciousness are symptoms associated with encephalitis. Neurological defects are also common and include focal or multifocal neurological impairments and focal and/ or generalized seizures (Granerod and Crowcroft 2007). Overall, encephalitis is often associated with fatal outcome or profound impairment, such as severe cognitive and behavioral impairment, mood disorders, and epileptic seizures (Granerod and Crowcroft 2007).

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