CNS Infections in a Child

Question 1

signs and symptoms of meningitis?

Answer 1

bulging fontanelle
neck hyper extension and back
headache 
photophobia
neck stiffness 
fever 
kernig's sign - pain on leg straightening
brudzinski's sign - supine neck flexion -> knee/hip flexion
lethargy
drowsiness
non-blanching rash 
cushing triad = HR down, BP up, irregular RR.

Question 2

Investigations for meningitis?

Answer 2

LP
blood culutres (LP done before)
FBC, CRP, U+E and glucose
Coagulation profile
Further immunological analysis - complement deficiency

Question 3

Managmenet of bacterial meningtiis?

Answer 3

notify the HPU

Admit to hospital and follow sepsis 6 pathway

1 - antibiotics
- <3mnths - cefotaxime, amoxicillin

• > 3mnths - benzylpenicillin, ceftriaxone

2 - steroids (dexamethasone)

3 - mannitol (reduce ICP)

4 - IV saline sodium chloride

Question 4

Long term potential complications of meningitis

Answer 4

Hearing Loss

Neurological/development

Orthopaedic, skin, psychosocial complications

Renal Failure

Question 5

How to manage viral meningitis?

Answer 5

usually due to coxsackie group b, echovirus

dischrage home + supportive therapy

Question 6

What is encephalitis?

What causes it?

Answer 6

Inflammation of the brain parenchyma

Question 7

Aetiology of encephalitis?

Answer 7

Direct invasion of cerebellum

Post-Infectious encephalopathy

Slow Virus Infection

Question 8

Signs and symptoms of encephalitis?

Answer 8

same as meningitis

main - fever, altered conciousness, seizures

Question 9

Investigations for encephalitis?

Answer 9

Same as for meningitis

but no LP if:

cardiorespiratory instability
focal neurological signs

Question 10

Management for encephalitis?

Answer 10

IV acyclovir - 3 weeks

Question 11

What is anaphylaxis?

Answer 11

Type 1 hypersensitiviy reaction - antigen cross-linking with IgE membrane-bound antibody of mast cell or basophil

in children 85% due to food allergy

Question 12

Signs and symtpoms of anaphylaxis?

Answer 12

airway - swelling, hoarseness, stridor

breathing - high RR, wheeze, cyanosis, O2 < 92%
Circulation - pale, clammy, low BP, drowsy, coma
Skin- urticaria/angioedema

Question 13

Management of anaphylaxis?

Answer 13

ABCDE

IM adrenaline (1:1000) in thigh, repeat after 5 mins

• establish airway
• IV fluids
• IV chlorpheniramine
• IV hydrocortisone
• Salbutamol