Meningitis Flashcards
What should you suspect in any ill baby or child who is irritable, abnormal high pitched cry, lethargy, difficulty feeding, hypotonia, fever, seizures, apnoea, bulging fontanelles?
Meningitis
What should you do if you see any signs of meningococcal disease?
Give immediate IM benzylpenicillin
Which pathogens cause meningitis in those under 12 months old?
Bacterial - Group B streptococcus, gram positive cocci, streptococcus agalactiae
Which pathogens cause meningitis in those over 12 months old?
Bacterial - Neisseria meningitidis
Which pathogens cause meningitis in children of all ages most commonly?
Virus - enterovirus
Which signs come first and which come second in meningitis?
- septic signs
2. meningeal signs
What are the septic signs seen in meningitis?
Fever, cold hands and feet, limb or joint pain, abnormal skin colour, odd behaviour, rash, tachycardia, tachypnoea, hypotension.
What are the meningeal signs in meningitis?
Non blanching rash, stiff neck, photophobia, Kernig’s signs, Brudzinski’s sign.
How is meningitis investigated?
- FBC, CRP, U&Es, LFTs
- Blood MCS, whole blood PCR, sputum culture, urine culture
- CT for raised ICP if indicated
- LP before antibiotics unless raised ICP/septic/coagulopathy
What is the management for meningitis?
- ABCDE, high flow oxygen
- 20ml/kg IV saline boluses, if persists after 2, give blood as third bolus
- IV ceftriaxone for over 3 months old
- IV cefotaxime and IV amoxicillin if <3 months old
- dexamethasone if meningeal signs positive
- if viral IV acyclovir
What are the complications of meningitis?
- DIC, septic shock
- skin infarction or gangrene
- secondary abscess
- hydrocephalus
- paralysis
- sensorineural hearing loss (give steroids)
- reduced IQ
- epilepsy
Which antibiotic is given prophylactically to prevent meningitis in those over and under 12 years old?
- > 12 - ciprofloxacin
2. <12 - rifampicin or ceftriaxone
