CNS infections in children Flashcards
Definition of meningitis vs Encephelitis
Meningitis -infection of the meninges
Encephelitis -inflammation (not always infect) of the parenchyma of the brain
Organisms of meningitis in children
Less 3months -
Group B streptococci, E.coli, Listeria
3mo-6y - Neisserissa meningitidies, strep pneumoniae,
Heamophilius
6y> -Neisserissa meningitidies, strep pneumo
Organisms of encephalitis in children
Depends on aetiology of the inflammation Direct invasion by some virus -HSV Post infectious inflammation -measles Slow viral infection -most common in UK: Herpes 1/2, HSV, VZV, Resp virus (influenza), enteroviruses Rarer -chickenpox, fungal
HSV-1 responsible for 95% of cases in adults but VERY RARE in children -but its very very dangerous
typically affects temporal and inferior frontal lobes
very high mortality
Signs and Sx of meningitis in children
can be vague in children/toddlers -
Fevers, headache, neckstiffness, rash, photophobia
FAILURE to thrive, No E+D, dehydration
Signs - maculopapular rash, non blanching (meningoccocal)
tender neck, diffculties extending
child lethargic and barely functioning
overextended neck Fontanelle Bulging (riased ICP)
Kernings sign- pain on leg extension
Brudzinkis sign-when extend neck supine-flex knees
OBS -HR high to compensate brain ischemia (from ICP)
but baroreceptors detect high BP -drop HR
Cushings triad - Low HR, High BP, Irregular RR
Very late signs!
Investigation of meningitis in children
Obs -cushings triad (low HR, high BP, irregular RR)
In order -
LP -Counter indicated with high ICP - (can CT to check)
bacterial -cloudy, Low gluc, high prot, lots of different cells
Viral -clear, norm gluc, raised prot, Lymphocytes
Blood culture
FBC, UE, LFT,
Clotting -watch for DIC
if repeat meningitis -complement
Mangement of bacterial and viral menigitis in children
START BEFORE TESTS -
Age dependent -
If BACTERIAL -
Under 3mo -treat for Heam B-
IV cefotaxime, IV amoxicillin
Above 3mo-treat for Strep/Neisser
IM Benzylpenicillin -(if pen allergy -vancomycin)
IV Cefotaxime -duration depending on organism
If KNOW FOR A FACT not menigococcal but bacterial -dexamethasone for ICP
Mannitol for ICP
IV fluids
treat contacts with Ciproflaxin
If Viral - discharge home or admit for maintenance
Also consider treating encephelitis at the same time
Complications of meningitis in children
Brain damage
hearing loss, development delays, neuro issues
Skin, skeletal and phsyc problems
Renal problems
Purpura fulminans - consequence of DIC after generalised infection -heamorrhagic skin ischemia
Black spots all over skin
Signs of Encecephelitis in children
in children -can be identical looking to meningitis
just more neuro signs/Sx
main ones – fever, headache, psychiatric symptoms, seizures, vomiting
focal features e.g. aphasia
signs to look for LP contraincidaction - Cushigns triad Neuro signs, Coagulopathy indications it could be meningococcal meningitis
peripheral signs of HSV (like cold sores) -no relation
Investigations of encephelitis in children
OBS -cushings triad
LP if ICP normal
usually viral -clear, norm gluc, high prot, lymphocytes
PCR for HSV
CT vs MRI -MRI will have better view of frontal/temporal lobes usually affected
Management of encephilits in children
Often hard to differentiate immediatly from menigitis -esp before tests (need to start EARLY)
so treat for both until results
Encephelitis - IV aciclovir -HSV rare cause in children but dangerous-empirical treatment
If known CMV-add gangiclovir