Meningitis

Question 1

Describe the symptoms of Meningitis in infants and older children.

Answer 1

○ Infants: inconsolable crying, fever or hypothermia, lethargy, grunting, poor feeding, bulging fontanelle
○ Older children: fever, vomiting, headache, photophobia, confusion, seizures, sore/stiff neck
*N. meningitidis often has petechiae on lower extremities + Waterhouse-Friderichsen syndrome.

Question 2

Describe the meningeal signs

Answer 2

Meningeal signs:
Nuchal rigidity
Brudzsinki (flexion of neck causes flexion of both legs and thighs)
Kernig (flexing one hip causes flexion of the other)
○ Risk of permanent neuro damage: sensorineural deafness, focal deficits,
epilepsy

Question 3

Describe the causes of Pediatric Meningitis according to the time interval that occurs

Answer 3

■Birth to 3 months: GBS, E. coli, Listeria
● Screen for GBS ~36 weeks gestational age
● give BCG vaccine after birth to prevent tuberculosis meningitis

■ 3 months-18 years: S. pneumo, N. meningitidis, E. coli, H. influenzae
■ Nonbacterial: viruses like HSV, echo, coxsackie, polio, VZV, etc.

Question 4

How to diagnose Meningitis?

Answer 4

Dx: CBC, blood culture, consider CT/MRI
■ Lumbar puncture:
● Bacterial : Low glucose, High Neutrophil, Very high Protein.
● Fungal /Tuberculotic : Low glucose, High Lymphocytes, High Protein
● Viral : Normal Glucose, High Lymphocytes, Slightly elevated protein

Question 5

Treatment of Meningitis

Answer 5

■ Neonates: ampicillin + gentamicin (or cefotaxime/ceftriaxone)
■ Infants/Children: Ceftriaxone, may also get vancomycin or gentamicin.
■ Duration: S pneumo for 10-14 days, N meningitidis 5-7 days, Hib 10
days, E coli 21 days or more, GBS or listeria 14 days or more
■ Use corticosteroids in H. influenzae meningitis, debated for
pneumococcal meningitis