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B - Paediatrics MANAGEMENT > Bacterial Meningitis > Flashcards

Bacterial Meningitis Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges covering the brain

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2
Q

What usually precedes a bacterial infection of the meninges?

A

Bacteraemia

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3
Q

What is responsible for the damage caused by meningeal infection?

A

Host response to the organism

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4
Q

What changes influence the damage caused by the immune system?

A
  • Release of inflammatory mediators
  • Activated leukocytes
  • Endothelial damage
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5
Q

What can occur as a result of immune response in meningitis?

A
  • Cerebral oedema
  • Raised ICP
  • Decreased cerebral blood flow
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6
Q

What effect can inflammatory response have below the meninges?

A

Vasculopathy leading to cerebral cortical infarction

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7
Q

How may meningitis cause hydrocephalus?

A

Fibrin deposits may block CSF reabsorption

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8
Q

What does the causative organism vary according to?

A

Age of the child

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9
Q

What are the most common causative organisms in neonates - 3 months?

A
  • Group B strep
  • E. coli
  • Listeria monocytogenes
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10
Q

What are the most common causative organisms in 1 month - 6 years?

A
  • Neisseria meningitides
  • Strep pneumoniae
  • Haemophilus influenzae
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11
Q

What are the most common causative organisms in >6 year olds?

A
  • Neisseria meningitides

- Strep pneumoniae

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12
Q

What has affected the commonness of causative organisms over time?

A

Introduction of vaccines

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13
Q

How may meningitis present in general?

A
  • Non-specifically

- With specific symptoms

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14
Q

What is the result of meningitis sometimes presenting with non-specific symptoms?

A

It can be hard to distinguish from other conditions

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15
Q

What are some non-specific symptoms of meningitis?

A
  • Fever
  • N&V
  • Lethargy
  • Irritability
  • Refusing food
  • Headache
  • Muscle aches/joint pains
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16
Q

What are some more specific symptoms of meningitis?

A
  • Non-blanching rash
  • Stiff neck
  • Altered mental state
  • Shock
  • Photophobia
  • Bulging fontanelle
  • Focal neurological deficits
  • Seizures
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17
Q

How may focal neurological deficits present?

A
  • Cranial nerve involvement

- Abnormal pupils

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18
Q

What physical examination tests may be useful when looking for meningitis?

A

Kernig’s and Brudzinski tests

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19
Q

What is a positive Kernig’s test?

A

Where the patient lies supine and the knee is unable to fully extend when the hip is flexed to 90 degrees

20
Q

What is a positive Brudzinski test?

A

When the patient is lying supine and lifting the patients head causes flexion of the knees and hips

21
Q

What are the risk factors for bacterial meningitis?

A
  • Young children
  • Immune deficiency
  • Contact with someone with meningitis
22
Q

What tests should be performed on any child with an unexplained fever and rash?

A
  • FBC
  • CRP
  • Coag screen
  • Blood culture
  • Whole blood PCR for N. meningitides
  • Blood glucose
  • Blood gas
23
Q

What other investigation should be performed if suspecting meningitis unless contraindicated?

A

LP

24
Q

What are the contraindications for lumbar puncture?

A
  • Signs of raised ICP
  • Extensive purpura
  • Convulsions
  • Coagulation abnormalities
25
Q

How should the CSF be investigated following LP?

A
  • WBC count
  • Total protein and glucose concentrations
  • Gram stain and culture
26
Q

What are some differentials for bacterial meningitis?

A
  • Encephalitis
  • Meningococcal septicaemia
  • Sepsis
27
Q

What is the main curative treatment for bacterial meningitis?

A

Antibiotics

28
Q

What antibiotics are given to infants under 3 months?

A

IV cefotaxime with amoxicillin OR ampicillin

29
Q

What antibiotics are given to children over 3 months?

A

IV ceftriaxone

30
Q

What should be given as an additional antibiotic if the patient has recently travelled outside the UK or has had prolonged antibiotic exposure in the last 3 months?

A

Vancomycin

31
Q

What drug should be given if indicated by LP result?

A

Dexamethasone

32
Q

How should dexamethasone be administered if indicated?

A

0.15mg/kg to max dose of 10mg QDS for 4 days if over 3 months

33
Q

What LP results indicate need for dexamethasone?

A
  • Frankly purulent CSF
  • CSF WBC > 1000/uL
  • Raised CSF WBC with protein > 1g/L
  • Bacteria on gram stain
34
Q

What supportive management should be given?

A
  • Respiratory support

- Fluids

35
Q

If the patient is self-ventilating what respiratory support should be given?

A

15L oxygen via non-rebreathe mask

36
Q

If there is loss of airway patency what management step is necessary?

A

Intubation

37
Q

What complications should be monitored for when the child is intubated?

A
  • Aspiration
  • Pulmonary oedema
  • Worsening shock
38
Q

How should the need for fluids be assessed in a patient with bacterial meningitis?

A

Look for signs of dehydration, shock and raised ICP

39
Q

If fluids are needed how should the deficit be corrected?

A

Enteral or IV fluids

40
Q

What type of fluids should be given in IV replacement?

A

Isotonic e.g. saline

41
Q

In neonates what maintenance fluids should be used?

A

Glucose 10% with added sodium chloride

42
Q

When should fluids be restricted?

A

Only if there is raised ICP or raised ADH

43
Q

What signs of deterioration should be monitored?

A
  • RR
  • Pulse
  • BP
  • SpO2
  • GCS
44
Q

What public health measures must be taken if a patient has bacterial meningitis?

A
  • Notify PHE

- Potential need for prophylactic antibiotics for close relatives

45
Q

What antibiotic can be given as prophylaxis for bacterial meningitis?

A

Rifampicin

46
Q

What are the potential complications of bacterial meningitis?

A
  • Death
  • Deafness
  • Epilepsy
  • Hydrocephalus
  • Cognitive deficits

B - Paediatrics MANAGEMENT (106 decks)

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