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Y3 paediatrics > meningitis > Flashcards

meningitis Flashcards

1
Q

what is meningitis

A

disease caused by inflammation of the meninges

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2
Q

what is meningism

A

clinical signs and symptoms suggestive of meningeal irritation

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3
Q
A
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4
Q

signs and symptoms of meningitis in older children

A
  • fever
  • headache
  • photophobia
  • neck stiffness - nuchal rigidity

raised ICP:

  • N+V
  • reduced GCS
  • seizures
  • focal neurological deficits
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5
Q

signs and symptoms of meningitis in young infants

A
  • fever/hypothermia
  • poor feeding
  • vomiting
  • lethargy
  • irritability
  • resp distress
  • apnoea - pause in breathing for at least 20s, signs of significant resp distress and reduced resp drive
  • bulging fontanelle - raised ICP
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5
Q

signs and symptoms of meningitis in young infants

A
  • fever/hypothermia
  • poor feeding
  • vomiting
  • lethargy
  • irritability
  • resp distress
  • apnoea - pause in breathing for at least 20s, signs of significant resp distress and reduced resp drive
  • bulging fontanelle - raised ICP
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6
Q

clinical signs of meningitis

A
  • nuchal rigidity - palpable resistance to neck flexion
  • Brudzinski’s sign - hips and knees flex on passive flexion of the neck
  • Kernig’s signs - flex hip and knee to 90 degrees, pain of passive extension of the knee
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7
Q

causes of child meningitis

A
  • bacterial - 4-18%
  • viral - mainly enterovirus, 54-88%
  • fungal - neonates, immunocompromised
  • unknown/aseptic - 40-76%
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8
Q

bacterial meningitis - causative organisms in neonates (<1m)

A

group B streptococcus

Escherichia coli

Listeria monocytogenes

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9
Q

bacterial meningitis - causative organisms in older infants and children

A

Streptococcus pneumoniae

Neisseria meningitidis

Haemophilus influenzae type B- uncommon now following vaccination

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10
Q

what type of bacterial is Haemophilus influenzae

A

small

non-motile

gram -ve

coccobacillus

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11
Q

where is H influenzae carried

A

nasopharyngeal carriage

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12
Q

what is encapsulated H. influenzae and why is it important

A
  • resist phagocytosis and complement mediated lysis
  • 6 serotypes (a-f)
    • Hib - main cause of invasive H. influenzae infection
  • bacteraemia, meningitis, epiglottitis, pneumonia
  • RF - asplenia, sickle cell disease, antibody deficiency
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13
Q

non-encapsulated H. influenzae

  • what does it lead to
A

aka non typeable H. influenzae (NTHI)

  • otitis media and sinusitis
  • invasive infection is rare
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14
Q

what meningococcal serotype causes the majority of invasive meningococcal disease

A

B

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15
Q

what type of bacteria is Neisseria meningitidis

A

gram -ve diplococcus

16
Q

carriage and transmission of Neisseria meningitidis

A

humans are the only natural host

nasopharyngeal carriage

transmission via resp secretions

infection often follows URTI

17
Q

structure of Neisseria meningitidis

A

polysaccharide capsules

  • capsule composition determines serogroup e.g. A, B, C, W, Y

endotoxin production (LPS) - this is why it can leading to overwhelming sepsis

18
Q

risk factors for invasive meningococcal disease

A
  • <1y, 15-24y/o
  • unimmunised
  • crowded living conditions
  • household or kissing contact
  • cigarette smoking (active or passive)
  • recent viral/mycoplasma infection
  • complement deficiency
19
Q

features of invasive meningococcal disease

  • meningitis
  • sepsis
A
  • 15% have isolated featrues of meningitis
  • 25% isolated sepsis
  • 60% have features of both
20
Q

rash in invasive meningococal infection

A

starts off as a blanching maculopapular rash

progresses to petichiae or purpura

purpura fulminans - purpura coaslesce together to form bruise like lesions (poor tissues perfusion and can lead to necrosis)

21
Q

prognosis of meningococal disease - mortality and significant long term sequelae

A

rapidly progressive

case fatality 5-15%

  • 50% of deaths in 1st 12h
  • 80% of deaths in 1st 48h

significant long term sequelae

  • amputation 14%
  • scarring 48%
  • hearing loss
  • cognitive impairment/epilepsy
22
Q

what type of bacteria is streptococcus pneumoniae (pneumococcus)

A

gram +ve

lancet shaped

diplococcus

facultative anaerobe

23
Q

capsule in streptococcus pnuemoniae

A

polysaccharide capsule

  • inhibits neutrophil phagocytosis
  • inhibits complement mediated cell lysis
24
Q

serotypes of streptococcus pnuemoniae

A

>90 known serotypes

all serotypes can cause invasive disease

25
Q

where does streptococcus pnuemoniae colonise

A

colonises nasopharynx (11-93%)

carriage is higher in nursery aged children and in adolescence

26
Q

what often precedes streptococcus pnuemoniae invasive infection

A

preceeding viral URTI

27
Q

transmission of streptococcus pnuemoniae

A

respiratory droplet

28
Q

pneumococcal infection - colonisation vs invasive infection

A
  • otitis media, sinusitis
  • meningitis
  • septicaemia
  • pneumonia, empyaema
  • peritonitis
  • arthritis, osteomyelitis
29
Q

risk factors for invasive pneumococcal disease

A
  • age <2
  • cigarette smoking (active/passive)
  • recent viral URTI
  • attendance at childcare
  • cochlear implant
  • sickle cell disease
  • asplenia
  • HIV infection
  • nephrotic syndrome
  • immunodeficiency/immunosuppression
30
Q

prognosis of pneumococcal meningitis

A

case fatality in children 8%

neurological sequelae common:

  • hydrocephalus
  • neurodisabilty
  • seizures
  • hearing loss
  • blindness
31
Q

management of meningitis

A

Airway

Breathing

Circulation - 20ml/kg fluid bolus, inotropes

DEFG - 2ml/kg 10% dextrose

abx - 3rd gen cephalosporin (e.g. cefotaxime, ceftriaxone), add amoxicillin if <1mth to cover for listeria

32
Q

investigations for meningitis

A

BLOODS:

  • FBC - leukocytosis, thrombocytopaenia
  • U+Es, LFTs
  • CRP
  • coagulation screen - DIC
  • blood gas - metabolic acidosis, raised lactate
  • glucose
  • BLOOD CULTURE
  • meningococcal/pneumococcal PCR

LUMBAR PUNCTURE:

  • essential
  • ideally prior to abx but don’t delay abx if LP cannot be performed
33
Q

CI to LP

A
  • signs of raised ICP: GCS <9, abnormal tone/posture, HT and bradycardia, pupillary defects, papilloedema
  • focal neurological signs
  • recent seizure (within 30 mins), if recent long seizure avoid LP for longer
  • CV instability
  • coagulopathy
  • thrombocytopenia
  • extensive/extending purpura
34
Q

what to request on LP

A

microscopy

gram stain

culture

protein

glucose

viral PCR

35
Q

findings on LP from bacterial meningitis

A
  • turbid or purulent
  • high opening pressure
  • +++ WCC (polymorphs)
  • +++ protein
  • –glucose (<50% serum)
36
Q

treatment durations for bacterial meningitis

A

N meningitidis - 7 days

H influenzae - 10 days

strep pneumoniae - 14 days

group B strep - ≥14 days

Listeria monocytogenes - 21 days

Y3 paediatrics (45 decks)

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