meningitis Flashcards
how might neonates and infants present
poor feding
irritability
lethargy
vomiting
fever
symptoms by age
presentation by age
kernig and brudzinski sign
pathogens by age
investigations
lumbar puncture: allows identification of the oragnism with antibiotic susceptibility testiing, thus ensuring appropriate use of antibiotics
LP should be performed in all children with suspected meningitiss
contraindications of LP
coma/decreased level of consciousness
signs of raised ICP
seizures (wait until stable)
focal neurological sgns
purpuric rash
shock, cardiovascular compromise
things that are not contraindications for LP
breif tonic-clonic
drowsiness
irritability
vomiting
if LP is contraindicated
start antibiotics and consider CT instead
what tests to conduct on CSF
microscopy, culture and suscpetbilty
glucose aand protein
PCR to identfy viral and bacterial pathogens
other nvestigations
blood culture
PCR on blood
throat and rectal swabs (enterovirus testing)
FBC
C reactive protien
electrolytes
capillary/venous blood gas
coagulation studies
group and hold
role of cranial CT
when diagnosis is in doubt or when complications of meningitis are suspected
manaagement of suspected maningitis
empirical antibiotics
antimicrobial choice <1 month
<1 months: IV cefotaxime AND IV benzylpenicillin AND IV aciclovir
antimicrobial choice >1 month
IV ceftriaxone
ADD IV vancomycin maybe
In all children and especially neonates, consider adding IV aciclovir for suspected herpes simplex or varicella encephalitis.
when to add vanc
if gram positive cocci are seen on gram stain (pneumococcal)
patient has known or susppected otitis meda or sinusitis
patient has been recently treated with penicillin, cephalosporin orr carbepenem
patient is too unwell to undergo LP
when to add acicilovir
when suspected herpes ssimplex
or varicella encephalitis
role of steroids
dexamethasone
controversial but may reduce neurological sequelae
give early if at all
Current management at PCH is to give IV Dexamethasone: 3 months – 18 years, 0.15 mg/kg (maximum 10 mg) every 6 hours for 4 days.6
Where possible, give the first dose just prior to or at least concurrently with antibiotics.6
fluids
patients with meningitis are at risk of hyponatraemia due to SIADH
any fluid replacement should be isotonic with or without glucose
30-70% maintenance rate
boluses of IV fluid should be avoided unless patient is hypotensiveto avoid precipitating/exacerbating cerebral oedema
obsservations
use the observation and response tool
hourly full neurological examinations
admit
complications of bacterial meningitis
death
intellectual disability, spasticity, seizures, hydrocephalus, deafness
learning and behavioural disorders
decorticate/decerebrate posturing
signs of raised ICP
altered pupillary responses, absent doll’s eyes reflexes, papilloedema, decorticate/decerebrate posturing, cushings triad (abnormal respiratoyr pattern, hypertension, bradycardia)
