Where There Is No Doctor 2011 185
MENINGITIS
This is a very serious infection of the brain, more common in children. It may
begin as a complication of another illness, such as measles, mumps, whooping
cough, malaria, or an ear infection. Children of mothers who have tuberculosis
sometimes get tubercular meningitis in the first few months of life.
Signs:
• Fever
• Severe headache.
• Stiff neck. The child looks
very ill, and lies with his head
and neck bent back, like this:
• The back is too stiff to put the
head between the knees.
• In babies under a year old: the fontanel (soft spot on top of the head)
bulges out.
• Vomiting is common.
• In babies and young children, early meningitis may be hard to recognize.
The child may cry in a strange way (the ‘meningitis cry’), even when the
mother puts the child on her breast. Or the child may become very sleepy.
• Sometimes there are seizures (fits, convulsions) or strange movements.
• The child often gets worse and worse and only becomes quiet when he
loses consciousness completely.
• Tubercular meningitis develops slowly, over days or weeks. Other forms of
meningitis come on more quickly, in hours or days.
Treatment:
Get medical help fast—every minute counts! If possible take the person to
a hospital. Meanwhile:
♦ Inject ampicillin every 6 hours, 500 mg. for children or 1 g. for adults (see
p. 352). If possible, also give chloramphenicol (see p. 356).
♦ If there is high fever (more than 40°), lower it with wet cloths and
acetaminophen or aspirin (see p. 378 to 379).
♦ If the mother has tuberculosis or if you have any other reason to suspect
that the child has tubercular meningitis, inject him with 20 mg. of
streptomycin for each kg. he weighs and get medical help at once. Also,
use ampicillin in case the meningitis is not from TB.
♦ If you know the meningitis came from malaria, give an injection of
artesunate or quinine at once (see p. 366).
Prevention:
For prevention of tubercular meningitis, newborn babies of mothers with
tuberculosis should be vaccinated with B.C.G. at birth. Dose for the newborn is
0.05 ml. (half the normal dose of 0.1 ml.). For other suggestions on prevention of
TB, see pages 179 to 180.