MENINGITIS Flashcards
Type of meningitis common in Nothern and Upper regions of Ghana
Cerebrospinal meningitis (CSM)
Which season is CSM most common
Harmattan season
Causative agent for cerebrospinal meningitis
Neisseria meningitides
Bacterial causes of meningitis
Neisseria meningitides
Streptococcus pneumoniae
Haemophilus influenza
Mycobacterium tuberculosis
Staphylococcus aureus
Escherichia coli (neonates)
Viral causes of meningitis
Herpes virus
Protozoal causes of meningitis
Toxoplasma gondii in HIV
Fungal causes of meningitis
Cryptococcus neoformans
Symptoms of meningitis in children less than 1year
Fever
Vomiting
Irritability
Refusal to eat
Poor suckling
Focal or generalized convulsions after which the child is sleepy
Lethargy
Bulging fontanelle
Signs of meningitis in adults and children over 5 years
Fever
Neck stiffness
Kernig’s sign
Altered consciousness
Coma
Symptoms of meningitis in adults and children over 5 years
Fever
Neck pains
Severe headache
Photophobia
Convulsions
Vomiting
Symptoms that occur in both children and adults
Fever
Vomiting
Signs of meningitis in children less than 1 year
Neck retraction
Hypotonia or hypertonia
Bulging fontanelle
Presence or absence of neck stiffness
Presence or absence of fever
Coma
Convulsion
Investigations in meningitis
FBC
RDT for malaria
Blood film for malaria
Lumbar puncture
Blood culture and sensitivity
Signs of meningitis that is present only in children under 1 year
Bulging fontanelle
Hypotonia or hypertonia
Neck retraction
Signs of meningitis that can be present or absent in children less than 1 year
Fever
Neck stiffness
Non-pharmacological interventions
Tepid sponging
Keep the airway clear
Nasogastric tube feeding if applicable
Lumbar puncture is done only after excluding……………..
Increased intracranial pressure
Second line treatment for bacterial meningitis
IV Cefotaxime and IV Vancomycin
First line treatment for bacterial meningitis
IV Ceftriaxone and IV Vancomycin
or
IV Benzylpenicillin and IV Chloramphenicol
or in penicillin allergy
IV Clindamycin and IV Chloramphenicol
Prophylaxis for cerebrospinal meningitis
Tab Ciprofloxacin
or
IM Ceftriaxone
Dose of ciprofloxacin for prophylaxis of CSM
Adults
500 mg as a single dose
Children
5-12 years; 250 mg as a single dose
Role of steroids in meningitis
Dexamethasone started together with the first dose of the appropriate antibiotic has been found to lead to major reduction in hearing loss and death in both children and adults.
Dose of dexamethasone in bacterial meningitis
IV Dexamethasone 4-10 mg 6hourly for 5-7 days
Dose of ceftriaxone for prophylaxis of CSM
Adults
250 mg as a single dose
Children
< 12 years; 125 mg as a single dose
Dose for IV vancomycin in Bacterial meningitis
Adults and children over 2 years:
15 mg/kg 12 hourly for 7-10 days
1 month-2 years; 15 mg/kg 8 hourly for 10-14days
< 1 month; not recommended
IV Cefotaxime dose used in Bacterial meningitis
Adults
2g 6 hourly for 7 days
Children
> 12 years or body weight > 50kg; 2 g 6 hourly
< 12 years or body weight < 50kg; 50 mg/kg 6 hourly
Dose for IV Clindamycin in bacterial meningitis
Adults
600-900 mg 8 hourly for 14 days
Children
13 mg/kg 8 hourly for 14 days
IV Chloramphenicol dose in bacterial meningitis
Adults
1g 6 hourly for 14 days
Children
25 mg/kg 6 hourly for 14 days
Dose for IV/IM Ceftriaxone in bacterial meningitis
Adults
2-4 g daily for 7-10 days
Children
> 12 years; 2-4 g daily for 7-10 days
< 12 years; 50-80 mg/kg for 10-14 days
Neonates; 20-50 mg/kg once daily for 21 days
Dose for benzylpenicillin in bacterial meningitis
Adults
4 MU 4 hourly for 14 days
Children
0.2 MU/kg 6 hourly for 14 days
Dose for IV chloramphenicol in bacterial meningitis
Adults
1 g 6 hourly for 14 days
Children
25 mg/kg 6 hourly for 14 days
Dose for IM Chloramphenicol in bacterial meningits
Adults
100 mg/kg as a single dose
Children
100 mg/kg as a single dose
Chloramphenicol is not used in these populations….
Children below 2 months
Pregnancy
Lactation
Most likely pathogens for bacterial meningitis in adults under 50 years
Meningococcus
Pneumococcus
Haemophilus Influenza
Most likely pathogens for bacterial meningitis in adults over 50 years
Pneumococcus
Listeria
Gram-negative bacilli
Most likely pathogens for hospital acquired meningitis
Staphylococci,
Gram-negative bacilli
Pneumococcus
Pseudomonas
First line antibiotics for managing meningitis in patients under 50 years
Ceftriaxone
And
Vancomycin
Alternative antibiotics for managing meningitis in people under 50 years
Cefotaxime
Meropenem
Fluoroquinolones
First line antibiotics for managing meningitis in patients over 50 years
Ceftriaxone
Or
Ampicillin
And
Vancomycin
Alternative antibiotics for managing meningitis in patients over 50 years
Fluoroquinolones
First line antibiotics for managing hospital acquired meningitis
Ceftazidime with/without Gentamycin
Alternative antibiotics for managing hospital acquired meningitis
Meropenem
Vancomycin
