Case 29: Meningitis in a 3 year old unvaccinated boy Flashcards
What are the symptoms for meningitis in an infant?
Lethargy
Irritability
Photophobia
Fever
Anorexia
What drug should children with suspected bacterial meningitis be commenced on immediately?
I.V. Cefotaxime
What will the appearance of CSF be in bacterial meningitis?
Turbid
What will glucose, protein and leucocyte levels be in bacterial meningitis?
Leucocytes: High
Glucose: low
Protein: high
What is the Gram stain result for H. influenzae?
Gram negative bacilli - pleomorphic
Why isn’t there a slide agglutination test for N. meningitidis?
Because N. meningitidis has a scialic acid capsule
What is the result of H. influenzae growth on HBA?
No growth
What is the result of H. influenzae growth on HBA with X and V factors?
Small white round colonies
What is the requirement for X and V factors by H. influenzae?
Requires both X and V together
Will H. influenzae grow on CHA?
Yes
Which 3 factors suggest that H. influenzae is the likely pathogen?
Gram -ve
Latex agglutination positive
Growth on CHA
Which 3 bacteria commonly cause meningitis in this age group (around 3 years old)
H. influenzae
N. meningitidis
Strep. pneumoniae
What is the inherent limitation of a Gram stain?
Not very sensitive, requires 5-10 organisms/ml
Which 2 antimicrobials is H. influenzae susceptible to?
Ceftriaxone
Chloramphenicol
Is H. influenzae susceptible to Ampicillin?
No
When would Chloramphenicol be used to treat H. influenzae instead of Ceftriaxone?
If the patient was penicillin hypersensitive
How could meningitis caused by H. influenzae been avoided in this child?
Vaccination – HiB vaccine
99.5 – 100% efficacy
With regard to administration of cefotaxime, is this appropriate treatment for suspected bacterial meningitis?
Yes
3rd generation cephalosporins have broad spectrum
Good penetration across BBB
