Meningitis causes bacterial Viral



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MENINGITIS


CAUSES

  • Bacterial

  • Viral

  • Fungal





Bacterial Meningitis - Organisms

  • • Birth - 4 wks: GBS, E.coli

  • 4 - 12 wks: GBS, E.coli, Pneumococcus Salmonella, Listeria, H. Influenza

  • 3 mths - 3 yrs: Pneumococcus, Meningococcus

  • H. Influenza

  • 3 yrs+ adult: Pneumococcus, Meningococcus



Bacterial Meningitis - Pathogenesis

  • Infection of upper respiratory tract

  • Invasion of blood stream (bacteraemia)

  • Seeding & inflammation of meninges



Meningitis: Clinical features

  • Newborn & Infants: non-specific

  • Fever

  • Irritability

  • Lethargy

  • Poor feeding

  • High pitched cry, bulging AF

  • Convulsions, opisthotonus



Kernig’s sign



Brudzinski’s sign



Meningitis: older children



Acute Meningococcaemia

  • Neisseria meningitidis: serotype Grp B commonest

  • Endotoxin causes vascular damage vasodilatation, third spacing, severe shock

  • Severe complication:

  • Waterhouse-Friderichsen syndrome: massive haemorrhage of adrenal glands secondary to sepsis: adrenal crisis-low B.P, shock, DIC, purpura, adreno-cortical insufficiency



Septicaemia



Purpura fulminans



Clinical features



Clinical features



Clinical features



Clinical features



Tumbler (glass) test



DIAGNOSIS

  • Hx & PE

  • Investigations:

  • FBC

  • R/L/B

  • CRP

  • Coag

  • Blood gas

  • Glucose



Diagnosis



CSF FINDINGS



Bacterial Meningitis Management

  • •  Medical emergency

  • •  Early diagnosis essential

  • Immediate optimum treatment

  • Intensive supportive therapy

  • Rehabilitation

  • Prophylaxis to family

  • Notification to GP & Public Health



Bacterial Meningitis/Meningococcaemia Management

  • ABC

  • PICU

  • Fluid management: aggressive resuscitation

  • Dexamethasone: only in Pneumococcal and HiB, given before antibiotics

  • Inotropes: increasing aortic diastolic pressure and improving myocardial contractility



Antibiotics

  • Less than 2 months of age:

  • Ampicillin + Cefotaxime+/- Gentamicin

  • Treat for 3 weeks (neonate)

  • Over 2 months:

  • Cefotaxime

  • Treat for 7-10 days



Prophylaxis

  • Rifampicin:

  • Children 5mg/kg bd x 2/7

  • Adults: 600 mg bd x 2/7

  • Pregnant contact:

  • Cefuroxime IM x 1 dose

  • OR

  • Just do T/S and await result



Meningitis - Complications

  • Septic shock - DIC

  • Cerebral oedema

  • Seizures

  • Arteritis/venous thrombosis

  • Subdural effusions

  • Hydrocephalus . Abscess . Brain damage

  • Deafness



Meningococcaemia - poor prognosis

  • • Onset of Petechiae within 12 hrs

  • • Absence of meningitis

  • • Shock (BP 70 or less)

  • • Normal or low WCC

  • • Normal or low ESR



Subdural Effusion

  • Failure of temp to show progressive reduction after 72 hours

  • Persistent positive spinal cultures after 72 hr

  • Occurrence of focal/ persistent convulsions

  • Persistence/recurrence of vomiting

  • Development of focal neurological signs

  • Clinical deterioration after 72 hr especially ICP



Partially treated meningitis

  • 50% cases prior antibiotic - alters the findings in bacterial meningitis -

  • Accurate history vital

  • CSF mainly lymphocytic [not usual polys]

  • Can have normal glucose

  • +ve cultures reduced by 30%

  • Gram stain reduced by 20%



Viral meningitis

  • Most common infection of CNS especially in <1yr

  • Causes: enterovirus (commonest, meningitis occurring in 50% of children <3mth ) herpes, influenza, rubella, echo, coxsackie, EBV, adenovirus

  • Mononuclear lymphocytes in CSF

  • Symptomatic treatment. Complications associated with encephalitis and ICP



TB Meningitis

  • Usually insidious: difficult to diagnose in early stages (fever 30%, URTI 20%)

  • Rare in children in developed countries

  • If untreated is usually fatal

  • Meningitis usually occurs 3-6mths after primary infection

  • 1 stage-lasts 1-2wk, fever malaise, headache

  • 2 stage-+/- suddenly, meningeal signs

  • 3 stage-worsening neurological condition, death



Mortality/Morbidity

  • Bac meningitis: Overall mortality 5-10%

  • Neonatal meningitis: 15-20%

  • Older children: 3-10%

  • Strep. pneumonia: 26-30%

  • H. influenza type B: 7-10%

  • N. meningitidis: 3.5-10%

  • 30% neurological complications

  • 4% Profound b/l hearing loss (sensorineural) in all bac meningitis



Mortality/Morbidity

  • Viral meningoencephalitis: Enteroviral fewer complications

  • Tuberculous meningitis: related to stage of disease

  • Stage I-30% morbidity

  • Stage II- 56%

  • Stage III-94%



VACCINATE!






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