Meningitis is an inflammation of the three membrane layers – called meninges, according to the Cleveland Clinic – that line the brain and the spinal column. Meningitis can be caused by a variety of infections, both viral and bacterial. While harmful and potentially deadly for patients of any age, meningitis can be especially dangerous in children and the elderly. An accurate and timely diagnosis of pediatric meningitis can be one of the most significant factors in determining patient outcomes. For some types of meningitis, a missed diagnosis can easily result in death or lifelong disability – yet an initial missed diagnosis is unfortunately not unusual in pediatric meningitis cases. If your family has been impacted by a medical professional’s failure to take concerns about your child’s health seriously and pursue prompt diagnosis to begin treatment, you may have a legal claim. Call 505-218-9949 to speak with a New Mexico medical injury attorney at Erin Marshall Law and discuss your family’s options for recovering compensation for your child’s medical expenses and other damages.
What Is the Number One Cause of Meningitis in Children?
Technically speaking, the suffix –itis refers to the inflammation, rather than the infection with which that inflammation is associated. In practical terms, however, the inflammation of the meninges we call meningitis is so consistently the result of an infection that the main diagnostic question in most cases is not whether an infection lies at the root of the patient’s symptoms, but rather which infection is responsible. There can be several culprits, but a few are more common in pediatric patients than others.
Leading Causes of Viral Meningitis in Children
According to Stanford Children’s Hospital, viruses that are known for being common causes of viral meningitis in children include:
- Polio (any of the polioviruses)
- Mumps (paramyxovirus)
- Flu (influenza A or influenza B)
- West Nile
Some of these viruses, like polio and mumps, are highly unusual in children who are vaccinated against them, although children with immune dysfunction may be susceptible in spite of vaccination. These viruses are also uncommon among children living in areas where most people have become immune (through vaccination or prior infection or both, depending), because most viruses are caught by circulation from one person to another – if a virus is not circulating locally, children are unlikely to catch it. Some, however, like West Nile, can be transmitted not just from one person to another directly, but from one person to another through a mosquito intermediary. The regional prevalence of the insect carrier (the mosquito) therefore interacts with local prevalence of the pathogen to infect risk. Influenza, meanwhile, is a persistent risk for children worldwide, particularly as all known strains of the flu virus mutate so rapidly that it is difficult to develop either a vaccine that fully prevents infection or long-lasting immunity derived from previous infections.
Leading Causes of Bacterial Meningitis in Children
The unfortunate thing about bacteria is that, unlike viruses, they can live, some of them for long periods, outside of any “host” organism – and they can reproduce outside the body. Whereas removing viruses from circulation in human hosts will usually go a long way toward removing the risk of infection, bacteria generally have a greater range of vectors from which to infiltrate the body’s defenses. However, not all bacteria are equally dangerous, or equally prone to causing meningitis.
Some known culprits of bacterial meningitis include:
- Group B streptococcus (note that the kind responsible for strep throat is normally Group A)
- A separate strep bacteria that commonly causes pneumonia
- Haemophilus influenzae (not related to the virus with a similar name that causes flu)
- Tuberculosis
- Lyme disease
- Syphilis
- E. coli (commonly found in fecal matter and responsible for some cases of food poisoning)
Tuberculosis is uncommon, but not unheard of, in the United States. Syphilis is known primarily as a sexually transmitted disease (STD), but women who have the infection during pregnancy can transmit it to their children.
Fungal and Parasitic Meningitis
Some fungi and parasites can also cause meningitis. Fungal meningitis is rare in the United States, and generally speaking is not among the first diagnoses suspected if a child begins showing symptoms consistent with meningitis. As the Meningitis Research Foundation explains, this type of meningitis is much more common in people, including infants, with impaired immune systems. Although some common types of yeast (notably candida strains) that are found worldwide can cause fungal meningitis in newborns exposed during or soon after birth, fungal meningitis also tends to be more common in parts of the world (often warm, humid regions) where fungi that more often cause infection are more prevalent in the environment.
The Centers for Disease Control and Prevention (CDC) specifically notes that parasitic meningitis is both uncommon and difficult to diagnose. For parents, this means that the chances your child will actually develop parasitic meningitis are low, but the chances of a missed diagnosis if your child does develop this type of meningitis are unfortunately higher than they might be with a disease that was either higher on a physician’s list of likely culprits or easier to distinguish from other potential causes of the same symptoms. Of the three parasites the CDC lists as “main” drivers of parasitic meningitis, one is much more common in the United States than the other two; to reduce the risk of a missed diagnosis, be sure to communicate with your pediatrician about any recent travel your child or anyone in your household may have taken.
Relative Risks of Pediatric Meningitis by Type
A general rule that many parents may find helpful is that any serious infection in a child can result in pediatric meningitis. A 2017 article in American Family Physician notes that viral meningitis is often “self-limiting” – meaning the condition is likely to resolve on its own, generally with the benefit of supportive care such as rest and fluids. Fungal and parasitic meningitis can be dangerous, but tend to develop more slowly than their viral and bacterial counterparts. Bacterial meningitis, meanwhile, is a medical emergency in which a missed diagnosis can cost precious hours, even days.
While medical professionals are certainly responsible for delivering a high standard of care for all their patients, you may be able to support your pediatrician’s efforts at diagnosis by:
- Keeping a running list or log of your child’s symptoms, from the time you notice something is wrong
- Keeping a record of your child’s recent infections, and any specific diagnosis of pathogen (to help determine whether common culprits of meningitis are on the list)
- Preparing notes for your pediatrician regarding symptoms and any recent infections in your household, as well as among your child’s caregivers and close associates (e.g., school friends) outside the household
Having this information as a reference may help your pediatrician determine which causes and pathogens to look for first, potentially reducing the time to accurate diagnosis and treatment. If your child suffers negative outcomes from meningitis because your pediatrician neglects to take the information you have provided into consideration in developing a diagnosis, you may wish to consider speaking with a medical injury lawyer at Erin Marshall Law to discuss your options for recovering compensation for your child’s care or, in the most tragic cases, for pursuing a wrongful death claim.
Risks of Missed Diagnosis in Pediatric Meningitis
According to study results published in the March 2023 issue of IJID Regions and available to the public through the National Library of Medicine’s PubMed Central, even a two-hour delay in treatment for community acquired bacterial meningitis (CABM) correlated with a marked increase in patient mortality, and a comparably sharp decline in the quality of patient outcomes. While the study was not focused on pediatric cases, the general conclusion that time is of the essence in diagnosing and treating bacterial meningitis is in line with guidance from the American Medical Association (AMA).
Missed Diagnosis of Pediatric Meningitis and Physician Responsibility: Balancing Difficult Diagnoses With Standard of Practice
If your child has suffered long-term health consequences due to a missed diagnosis of pediatric meningitis, the first thing to know is that a diagnosis of meningitis can be difficult; the authors of the IJID Regions study attributed more than 80% of treatment delays to a failure to suspect bacterial meningitis as the cause of patient symptoms. The second thing to know is that physicians have a responsibility to follow the accepted standard of practice in performing diagnostics.
In the United States, one of the available yardsticks for this standard of practice in relation to meningitis – particularly bacterial meningitis – is provided by the Infectious Diseases Society of America (IDSA), whose Practice Guidelines for the Management of Bacterial Meningitis (published in 2004; most recently updated in 2018) offer flowcharts of decision-making considerations for both pediatric and adult cases (separately). The 2017 article from American Family Physician contains broadly similar guidance. Globally, the World Health Organization (WHO) released guidance on the diagnosis and treatment of acute meningitis, offering another point of reference.
Seek Professional Assistance
Determining whether your own child’s physician has genuinely followed the standard of practice in your child’s care can be difficult for a parent, both because human instinct is to look for someone to blame for a child’s pain and because most parents are not themselves experts in the medical field. The consequences of a missed diagnosis in pediatric meningitis can be devastating, but whether the missed diagnosis rises to the level of a failure in professional responsibility can vary widely depending on the circumstances of the case. You may benefit from seeking advice and perspective from a pediatric malpractice lawyer who has seen other cases involving missed diagnosis. Call Erin Marshall Law today to schedule a consultation and discuss your concerns. Dial 505-218-9949 from anywhere in New Mexico to reach our Albuquerque office.
