Pediatric Meningitis: Contemporary Epidemiology, Pathogenesis, Diagnosis, and Evidence-based Management in the Vaccine Era
Karamjeet Kaur *
Department of Pediatrics Nusring, SGRD, CON, Amritsar, Punjab, India.
Prabhjot Kaur Gill
Department of Genetics, Sri Guru Ram Das University of Health Sciences, Vallah, Amritsar, India.
*Author to whom correspondence should be addressed.
Abstract
Meningitis remains a major cause of childhood mortality and long-term neurodevelopmental disability worldwide despite advances in vaccination, diagnostics, antimicrobial therapy, and critical care. The burden is unevenly distributed across regions and age groups, with neonates and young infants at the highest risk of severe outcomes. This narrative review synthesises literature published between 2000 and 2025 on pediatric meningitis epidemiology, mechanisms of disease, diagnostic approaches, and best-practice management, and highlights prevention strategies and priorities to reduce global inequities in outcomes. Etiologies vary by age, geography, immune status, and vaccine coverage, spanning bacterial (including Streptococcus pneumoniae, Neisseria meningitidis, group B Streptococcus, Escherichia coli, and Listeria monocytogenes), viral (notably enteroviruses and herpesviruses), mycobacterial, and fungal pathogens. Disease pathogenesis is driven by microbial invasion of the central nervous system and a host inflammatory cascade that disrupts the blood–brain barrier, contributing to cerebral oedema, vasculopathy, intracranial hypertension, and neuronal injury. Rapid recognition and timely empiric therapy remain critical, while contemporary management increasingly relies on pathogen-directed treatment, local resistance patterns, and meticulous supportive care to prevent secondary brain injury. Diagnostic strategies are evolving with multiplex PCR panels and adjunctive biomarkers, and clinical prediction rules may assist risk stratification in carefully selected populations. Persistent challenges include delayed presentation, limited access to lumbar puncture and advanced microbiologic testing in many settings, emerging antimicrobial resistance, and substantial post-infectious sequelae. Vaccination has substantially reduced disease in many settings, but high residual burden persists due to inequities in access, evolving pathogen ecology, outbreaks, and limitations in timely diagnosis and care. Effective management depends on rapid clinical recognition, early empiric antibiotics tailored to age and local resistance patterns, integration of modern diagnostics to accelerate targeted therapy, and meticulous supportive care to prevent secondary neurologic injury.
Keywords: Pediatric meningitis, bacterial meningitis, viral meningitis, tuberculous meningitis, cerebrospinal fluid, multiplex PCR, vaccines, antimicrobial therapy, neurodevelopmental sequelae