symptoms Fever – will usually be high, over 103. Severe headache – this is not a typical headache. It is extremely painful. It occurs because the infected lining of the brain gets severely inflamed. Vomiting – the irritation in the brain triggers persistent vomiting (more than just a few times). Neck pain and stiffness – this does NOT apply to sore throat pain in the front of the neck. It refers to severe pain in back of the neck. Looking down at your stomach (stretching the back of your neck) will cause severe pain. Some kids will refuse to even look down at all. They will keep their neck rigidly stiff. This occurs because the lining of the spinal cord is connected to the lining of the brain. When this infected and inflamed lining is stretched by looking down, it causes severe pain. Photophobia – this means that light hurts your eyes. Meningitis will cause someone to refuse to look into light, especially the bright sunlight. In infants, you cannot determine if they have neck stiffness because they are too young to communicate this. Severe, inconsolable irritability and/or lethargy (meaning limp, lifeless, won’t open eyes to focus on you) are signs of any severe infection, including meningitis.Stiff neck – as discussed above. Photophobia – as above. Severe back pain when the legs and knees are pulled up to the chest – this stretches the inflamed lining of the spinal cord. Lethargy or extreme irritability in infants. The doctor will consider these signs on exam and the symptoms that you are reporting, and will decide if meningitis is possible. If so, the doctor will recommend a spinal tap. There is no way to diagnose meningitis without a spinal tap. The dreaded spinal tap (also called a Lumbar Puncture) – no parent ever wants their child to undergo a spinal tap. The thought of sticking a needle into their child’s spinal cord sounds horrible. Many parents fear it can cause paralysis. Everyone’s grandmother has a story about someone being paralyzed by a spinal tap. You can be reassured that spinal taps are actually very simple procedures from the doctor’s standpoint. Every doctor performs several dozen during their training years. ER doctors perform as many as 100 or more each year. Ask the doctor how many he or she has done. Why do a spinal tap to find an infection in the brain? – the fluid that coats and flows through the brain also flows down into the spinal cord. So the spinal fluid reflects what is occurring in the brain. Here is what happens during a spinal tap: The skin over the lower part of the spine is numbed with an injection or cream. The area is cleaned thoroughly so it is sterile. The infant or child is curled up on his side and held securely by an assistant. Older children and adults may sit up. A needle is passed through the skin at a large space in between two of the lower vertebrae. The needle does NOT pass through bone. The needle is slowly advanced until it “pops” through the lining of the spinal canal into an area of spinal fluid. THIS IS THE PART MOST PARENTS DON’T UNDERSTAND. The needle does NOT go into the spinal cord where the nerves are. The spinal cord stops about ¾ of the way down the spine. The bottom ¼ of the spine simply contains a reservoir of spinal fluid. So you don’t need to worry about paralysis. Spinal fluid will flow out through the needle and the doctor will collect it and send it to the lab. Once the needle is pulled out, the hole seals up rapidly. Sounds painful? Well, if numbed up properly, then there is little pain. Most of the discomfort comes from being restrained during the procedure. Testing to Determine the Type of Meningitis The spinal fluid is tested in the lab for several things: Immediate results – within an hour the lab will determine if there are many white blood cells in the fluid. If there are, then it IS meningitis. 24 to 72 hour culture results – it takes this long for the lab to test whether or not a bacteria or a virus is causing the meningitis. 4-hour test results – some labs can test for the presence of viruses or bacteria within a few hours, but this type of test may not be as reliable of the 24 to 72 hour tests. There are several other aspects to testing the spinal fluid which are beyond the scope of this discussion. How is meningitis treated? If it is viral meningitis, antibiotics won’t help. Pain relief and anti-inflammatory medication is used. Bacterial meningitis is treated with 10 to 14 days of IV antibiotics. Often it is not clear whether a person has bacterial or viral meningitis until the lab runs the 24 to 72 hour culture tests. Some doctors will treat with antibiotics until this test confirms that it is NOT bacterial meningitis