Septicaemia and meningitis in children

One of the unexpected advantages of the social distancing measures introduced at the beginning of the coronavirus pandemic was a drop in cases of other infectious diseases. Fewer cases of colds and flu, for instance, were recorded in the winter of 2020 compared with previous years (i). And at the start of 2021, figures released by Public Health England also showed the number of people with bacterial meningitis and septicaemia had dropped too – down from 526 in 2018 - 2019 to 461 in 2019 - 2020 (ii).
 
These numbers may not sound that significant. But meningitis and septicaemia (or sepsis, as it’s also called) are serious, life-threatening diseases that can be fatal in a matter of hours. They also affect more babies, children and young people than adults.
 
Meningitis is an infection of the meninges, which are the protective membranes that cover the brain and the spinal cord. There are two main types of meningitis: bacterial and viral. Bacterial meningitis is by far the more serious of the two, and it can sometimes also cause another potentially serious condition called septicaemia (meningococcal septicaemia is the medical term for septicaemia caused by meningitis bacteria).
 
According to the charity Meningitis Now, babies and young children are particularly vulnerable to meningitis because their immune systems aren’t fully developed, which means they can’t fight infection as effectively as older children and adults (iii).
 
• Viral meningitis is rarely life threatening and most children recover well – but it can still make them very ill. It’s more common than bacterial meningitis, though there aren’t any exact figures to show how many children are affected.
 
• Bacterial meningitis, on the other hand, is far more serious, and while most children do recover around 10 per cent die, while others can develop disabilities that affect them for the rest of their lives (ii). However, while it’s less common than it used to be, there are still nearly 10 cases of bacterial meningitis a day in the UK (iv).
 
Meanwhile septicaemia is often described as a type of blood poisoning caused by bacteria (including the same bacteria that can cause meningitis) entering the bloodstream. Many experts, including those from the NHS, define septicaemia as a life-threatening reaction to an infection that happens when your immune system overreacts to the infection and starts to damage your tissues and organs (v), though nobody really knows why this happens.
 
Around one in 500 people develops severe septicaemia every year in England, with babies under a year old and elderly people aged 75+ among those most at risk (vi).
 
There is a third type of meningitis caused by fungal infections. Thankfully it’s very rare, but it is serious, and only tends to affect people with weakened immune systems.
 
For parents, the most important thing regarding meningitis and septicaemia is to be able to recognise the symptoms quickly, since getting treatment as early as possible can give a baby, child or teenager the best chance of having a good recovery.
 

What is meningitis?    

 
There are more than 50 different types of bacteria that can cause meningitis, with most cases in the UK caused by the bacterium Neisseria meningitidis (the two other most common causes of bacterial meningitis in babies younger than one month being Streptococcus pneumoniae, Listeria monocytogenes, E. coli and Streptococcus agalactiae; with S. pneumoniae and Haemophilus influenzae type b (Hib) most common in those aged three months or older).
 
Neisseria menigitiditis is a germ that lives in the nose and throat of around one in four people without causing any harm (iv) (if you carry the germ but have no symptoms, you’re called a carrier). It’s spread to others via close contact during coughing, sneezing or kissing. Most people who are passed the germ don’t develop any problems, which means the risk of becoming ill is quite low. However if it overcomes your immune system it can cause meningitis and/or septicaemia. Unfortunately we still don’t know why some people carry the bacteria without having symptoms while others can become extremely ill.
 
Most cases of viral meningitis, on the other hand, are caused by enteroviruses that normally live in the lining of the intestines, though many other viruses such as those that cause herpes, measles, mumps, chickenpox and flu can lead to viral meningitis too.
 

What are the symptoms of meningitis in children?

 
Bacterial and viral meningitis symptoms are similar, though they can be fairly non-specific – for example, a child may just not feel well or look well in general. The most common symptoms – though not every child will experience most or all of them – include:
 
• High temperature
 
• Severe headache
 
• Feeling sick
 
• Vomiting
 
• Sensitivity to light
 
• Drowsiness
 
• Stiff neck
 
Meanwhile, babies and very young children can develop other symptoms, including:
 
• Refusing to eat
 
• Making unusual grunting sounds
 
• Irritability when picked up
 
• A tense or bulging soft spot on the head
 
• Body stiffness with jerky movements, or they may appear floppy or lifeless
 
• High temperature is still common but it doesn’t always appear in young babies aged three months or younger
 
It’s also useful to be aware some experts believe three other symptoms can develop earlier on, usually before the classic symptoms appear (v). These are:
 
• Pains in the legs (these can be so bad your child may not be able to walk or stand)
 
• Cold hands and feet (even when accompanied by a high temperature)
 
• Pale, dusky or blue-coloured skin around the lips
 

Meningitis rash

 
The symptom most people have heard of, however, is often called the meningitis rash – though it’s important to realise that not every child (or adult) with meningitis will have this typical rash. The rash is actually a sign of septicaemia, so a child who has meningitis without septicaemia may not have a rash at all.
 

What does a meningitis rask look like? 

 The meningitis rash is red or purple, starting as small spots that can appear anywhere on the body, sometimes in groups, sometimes in isolation. These spots can get bigger and look more like blotches. Sometimes they look a bit like little bruises. One or two spots usually appear at first, but more tend to develop.
 

How can you tell it’s the meningitis rash?  

There is an easy way to check if any rash is a meningitis rash or another type of rash altogether, called the glass test. Just place the side of a clear glass on an area with one or more spots or blotches and press it firmly against the skin. If you can still see the spots through the glass, call your doctor or take them to A&E straight away. If the spots disappear under the pressure of the glass it’s unlikely your child has meningitis – though if you’re not sure or you’re worried for any reason call NHS 111, contact your GP or take them to A&E.
 
Most importantly, don’t wait for a rash to appear if you think there’s any possibility your child has meningitis, as the earlier they get medical help, the more likely they will make a full recovery. They’ll also need to have tests as early as possible too, as you can only tell whether someone has viral or bacterial meningitis by analysing samples of their blood.
 

How do you treat meningitis?      

 
If your doctor suspects your child has meningitis they’ll refer them to hospital immediately. Then if the diagnosis is confirmed at the hospital, your child may be given antibiotics even before it’s clear whether they have the viral or bacterial type. If tests show a virus has caused the infection, they won’t be given any more antibiotics, since antibiotics don’t work against viruses. Instead, you will usually be able to look after them yourself at home, and just give them over-the-counter pain relief if they need it.
 
Other than that and getting plenty of rest, there’s no specific treatment for the viral form of meningitis, and the symptoms should clear up within seven to 10 days.
 
On the other hand, if test results show your child has bacterial meningitis it’s very likely they’ll have to stay in hospital where they can be given antibiotics through a drip, as well as other medicines if they need them. They may only have to stay in hospital for a few days, though some cases may need hospital treatment for several weeks.
 
Bacterial meningitis can also cause several complications in children, including hearing problems, learning and behavioural problems, epilepsy (caused by brain injury after meningitis), kidney problems and joint or bone problems that can sometimes develop several years later. Meanwhile complications are very rare with viral meningitis, with a small number of cases developing brain injuries.
 

Septicaemia signs and treatment

 
The bacteria that cause meningitis can also cause septicaemia. However the two don’t always go hand in hand, and you can also develop septicaemia without having meningitis (and vice versa). Indeed any type of infection – whether bacterial, viral or fungal – can potentially lead to septicaemia, including lung infections (pneumonia, for instance), kidney infections, bladder infections, flu or even a cut, a bite or a burn on the skin if it becomes infected. You can’t, however, catch septicaemia from another person (though you can catch meningitis, which can lead to septicaemia).
 
So if a child can get any type of infection, theoretically they can develop septicaemia – though some are more likely to develop septicaemia from an infection than others, including babies less than a year old (particularly those who were born prematurely or babies whose mothers had an infection while they were pregnant)
 

What are the symptoms of septicaemia?

 
Like meningitis, the symptoms of septicaemia can be quite general and vague, and they may often be mistaken for another condition such as flu or a chest infection. Indeed, according to the NHS, in babies and young children, septicaemia can be particularly difficult to spot (v).
 
The signs of septicaemia often start suddenly and can include:
 
• High temperature
 
• Fatigue or extreme tiredness
 
• Shivering violently
 
• Chills
 
• Feeling lightheaded or faint
 
• Pale, clammy skin
 
• Rapid and shallow breathing
 
Other symptoms of septicaemia can include:
 
• Blue, pale or blotchy skin, lips or tongue
 
• Breathing difficulties (including breathlessness or breathing very quickly)
 
• High-pitched crying (babies and young children)
 
• Being sleepier than usual or difficult to wake (babies and young children)
 
• Not responding normally, such as having no interest in food or normal activities (babies and young children)
 
• Confusion or slurred speech (older children)
 
Another common symptom of septicaemia caused by meningitis is the meningitis rash (see above for more details). If your child or anyone else has a rash that doesn’t disappear when you press a glass against it firmly or any of the other symptoms listed above, speak to a doctor or take them to A&E immediately.
 
Meanwhile you should also call NHS 111 straight away if your child is affected by any of the following (they may not have septicaemia but it’s important to get advice):
 
• Vomiting
 
• Swelling, redness or pain around a cut or wound
 
• Not having urinated all day (older children) or during the last 12 hours (babies and younger children)
 
• Very high or very low temperature (that is, they feel very hot or very cold to the touch)
 
Spotting the signs as early as possible is essential, since septicaemia can get worse very quickly. If it isn’t treated soon enough septicaemia can also turn into septic shock, which can cause organ failure and is life threatening.
 

What is septicaemia treatment?

 
If your child is diagnosed early with septicaemia and tests show their internal organs haven’t been affected, they can often be treated at home with a course of antibiotics. More severe cases, however, may need hospital treatment, where children receive antibiotics through a drip. Other medicines and treatments may be needed in the most serious cases, including the use of a ventilator to help them breathe or surgery to remove areas of infection.
 
The good news is most children make a full recovery from septicaemia if it’s diagnosed and treated early. In such cases recovery usually takes two or three weeks – though this can vary from one child to the next – and there shouldn’t usually be any long-term complications. More severe septicaemia, however, may lead to damage to a child’s organs and tissues, which can affect them permanently.
 

Meningitis vaccine: How to protect your child

 
These days there are several vaccinations available to babies, children and teenagers offer good protection against the most common causes of bacterial meningitis. So making sure your child gets all their vaccines on time is probably the best thing you can do to help stop them becoming ill (all children should receive these vaccines as part of the NHS vaccination schedule).
 
Here’s a quick rundown of the meningitis vaccines available to children in the UK:
 

Meningitis B  

This protects against meningococcal group B bacteria, a common cause of meningitis in young children (the peak age for infection is five months). Babies typically get their first dose when they are eight weeks old, then a second dose at 16 weeks and a booster around the time they reach their first birthday.
 

6-in-1  

As its name suggests, this vaccine offers protection against six different diseases, including meningitis caused by the Haemophilus influenzae type b (Hib) bacteria (the other diseases covered by the vaccine are tetanus, whopping cough, diphtheria, hepatitis B and polio). Babies receive this vaccine three times: when they are eight, 12 and 16 weeks old.
 

Pneumococcal  

This vaccine protects against infections caused by pneumococcal bacteria, which includes meningitis. Babies these days are given the vaccine at 12 weeks plus a booster when they’re around a year old.
 

Hib-Men C  

Offered to babies at around one year of age, the Hib-Men C vaccine protects against meningitis-causing bacteria called meningococcal group C bacteria.
 

MMR  

Babies usually get this vaccine when they’re a year old, then they get a second dose when they’re three years and four months. The vaccine protects against measles, mumps and rubella, any of which can sometimes lead to meningitis.
 

Meningitis ACWY  

This vaccine is offered to older children, including younger teenagers in school years 9 and 10, sixth formers and young adults starting university (including students up to the age of 25). It protects against four different strains of bacteria (A, C, W and Y) that can cause meningitis.
 
Keeping up with these and other vaccines can help prevent meningococcal septicaemia and septicaemia caused by other infections too (this includes the flu jab if your child is offered it – some children are already eligible, with more age groups being offered the flu jab every year). There are also other things you can do to help prevent infections that can lead to septicaemia, including:
 
• Keeping wounds and burns clean and free from infection by making sure they’re properly cared for and dressed regularly.
 
• If your child has a mouth infection, get treatment and advice from their GP.
 
• If your child is taking antibiotics for an infection, follow their doctor’s instructions carefully and make sure they finish all their tablets, even if they feel better.
 
• Wash your own hands regularly and show your child the right way to wash and dry their hands thoroughly (encourage them to wash regularly too).
 

Can lifestyle help?

 
In general, having a healthy lifestyle may help reduce your child’s changes of developing infections. That’s because a healthy diet based on a variety of nutritious foods and plenty of exercise can help keep their immune system strong and healthy, which may improve their resistance to infections of all types.
 
You may also want to consider boosting their diet with supplements to make sure they’re getting all the major nutrients their body – and their immune system – needs, including:
 

Multivitamin and mineral  

These are ideal for children who are fussy eaters or who don’t always eat as healthily as they should (teenagers, for instance). There are several multivitamins available for children and young people, so choose one for your child’s age group as it will have the right vitamins and minerals they need in the right amounts. If your child has difficulties swallowing tablets, try a chewable multivitamin or one that dissolves in water to make a tasty fizzy drink.
 

Vitamin D   

Getting the right amount of vitamin D can help support normal immune function. Your child can get the vitamin D they need in a good multivitamin and mineral supplement, or you may want to give them a separate vitamin D supplement (vitamin D drops are handy if they don’t like taking tablets).
 
Public Health England recommends all children from birth to four years old take a daily vitamin D supplement throughout the year, while children over four years should take vitamin D during the autumn and winter months (or all year round if they don’t spend much time outdoors during the spring and summer or they usually wear clothes that cover up most of their skin when they’re out and about) (viii). Children with dark skin may also not get enough vitamin D from sunlight.
 

Vitamin C and zinc  

A good-quality children’s multivitamin and mineral will also give your child vitamin C and zinc, which they need for immune function support (ix). As with vitamin D, you can also give your child separate vitamin C and/or zinc supplements – just check any supplement gives them the right amount of each nutrient for their age.
 

Fruit concentrates   

Other supplements that may help keep your child’s immune system strong include natural concentrates such as elderberry, blackcurrant and rosehips, Not only are they good sources of beneficial antioxidant plant compounds, but elderberry, blackcurrant and rosehip concentrates taste delicious too – so you shouldn’t have any arguments from your child about taking them. Look for products that are naturally sweetened, as children may find these more palatable than those that include artificial sweeteners.
 
 
Meningitis and septicaemia in children – as well as in adults – can be very serious. But being able to spot the symptoms as early as possible can make a big difference to a child’s recovery. And while it’s not always possible to prevent either condition, there are things you can do to protect your child against them – most notably making sure they’re up to date with all their vaccines. There’s lots more information about childhood and adult health issues in our pharmacy health library. Why not take a look?
 

References:

1. Available online: https://www.nature.com/articles/d41586-020-03519-3
2. Available online: https://www.gov.uk/government/publications/meningococcal-disease-laboratory-confirmed-cases-in-england-in-2019-to-2020
3. Available online: https://www.meningitisnow.org/meningitis-explained/signs-and-symptoms/signs-and-symptoms-babies-and-toddlers/
4. Available online: https://patient.info/childrens-health/meningitis-leaflet
5. Available online: https://www.nhs.uk/conditions/sepsis/
6. Available online: https://patient.info/infections/sepsis-septicaemia-leaflet
7. Available online: https://patient.info/childrens-health/meningitis-leaflet
8. Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
9. Maggini. S., Wenzlaff. S., Hornig. D. Essential role of vitamin C and zinc in child immunity and health. J Int Med Res. (2010 Mar-Apr). 38(2):386-414. Available online: https://www.ncbi.nlm.nih.gov/pubmed/20515554

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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