Meningitis Flashcards
• ____________ -Meningitis
• ____________-Encephalitis
• ____________-Ventriculitis
• ____________-Myelitis
• Leptomeninges
Parenchyma
Ventricles-
• Spinal cord
Routes ofinfection
• Haematogenous (blood borne) e.g. _____________
• __________ e.g. following open skull fracture, neurosurgical procedures
• CNS anomalies e.g. meningo-myelocoele, dermal sinus
• ________ spread e.g. from ___________ or local infection
septicaemia
Post-traumatic
Contiguous spread; otitis media
80% and 20% of children carry Haemophilus influenzae type b and
Neisseria meningitides in their ____________
nasopharnyx
Common organisms: Neonatal period
• __________
• Group Bstreptococcus (type III)
• _____________
• _____________
• _____________
• _____________ __________ (gram +ve rod)
• E.coli
• Group Bstreptococcus (type III)
• Staphylococcus aureus
• Pseudomonas
• Klebsiella
• Listeria monocytogenes (gram +ve rod)
Common organisms
Children <5years
•______________ (50%)
•___________ _____________
• ___________ _____________
H. influenzae type b
Streptococcus pneumonia
Neisseria meningitides
1 in 24 sicklers have ___________ meningitis by the age 4 years
pneumococcal
Common Organisms
Older children (> 5 years)
• __________ __________ (40%)
•__________(30%)
• __________ __________ (30%)
Other organisms include:
• __________ __________
• Viruses (enteroviruses, Herpes simplex etc).
• Fungi (Cryptococcus neoformans)
• Protozoa (Toxoplasma gondii)
Neisseria meningitides (40%)
H. Influenzaetypeb(30%)
Streptocoecus pneumonia (30%)
Mycobacterium tuberculosis
Pathology of meningitis
•__________ of __________ +/- __________
• __________ in sulci
• __________ leading to __________ of related tissue and nerve roots.
Congestion ; brain vessels
oedema ; Exudate
Arteritis ; infarction
Pathology of meningitis
Exudate in Sulci
Base: __________ and __________ meningitis
Vertex: __________ meningitis
All over: __________ meningitis
Base: TBM and meningo-coccal meningitis
Vertex: Pneumococcal meningitis
All over: H. Influenza meningitis
Clinical Presentation
Neonates (non-specific)
• (Males or Females?) > (Males or Females?)
• __________ instability
• Lethargy
• __________ difficulty
• _______________
• Vomiting
• Jaundice
• Irritability
• __________
Males > Females
• Temperature instability
• Lethargy
• Feeding difficulty
• Respiratory distress
• Vomiting
• Jaundice
• Irritability
• Convulsion
______________ and a _________________ are not helpful signs as they are absent in 75% of neonates with meningitis
Neck stiffness
full anterior fontanelle
Clinical presentation
Infants<12months
• (Male or Female?) > (Male or Female?)
• _______
• Nausea/Vomiting
• Irritability
• ________________
• Male > Female
• Fever
• Full anterior fontanelle
Clinical features
In older infants
• __________
• __________
• Headaches
• Positive __________ and __________ sign
• __________ (30%)
• Focal neurological signs
• Arthralgia/myalgia
• Shock (9% of children with meningococcal and 5% of those with H. Influenzae)
• __________ __________ in the early stages of meningococcal infection.
Inolderinfants
• Neck stiffness • Photophobia • Headaches
• Positive Kernigs and Brudzinski’s sign
• Seizures (30%)
• Focal neurological signs
• Arthralgia/myalgia
• Shock (9% of children with meningococcal and 5% of those with H. Influenzae)
• Petechial haemorrhages in the early stages of meningococcal infection.
Pyogenic meningitis
Macroscopy
Cell count
Protein
Glucose
Turbid
Mainly polymorphs
Increased
Decreased
Tuberculosis meningitis
Macroscopy
Cell count
Protein
Glucose
Clear with strands on standing
Mainly lymphocytes with polymorphs
Increased
Reduced
Viral meningitis
Macroscopy
Cell count
Protein
Glucose
Clear, Colorless
Mainly lymphocytes
Increased
NORMAL
How might encephalitis present?
•________________
•________ ___________________ signs
•Altered sensorium
•Multi-focal neurological signs
How might cerebral abscess present?
•______-grade swinging (intermittent) pyrexia
•________________ signs or as a ______________________ lesion
High-
Focal neurological signs
Space occupying lesion
Complications of meningitis
Immediate
• Brain ___________
• Damage to cranial nerves (___________)
• Dehydration (secondary to ___________)
• ___________
• Inappropriate ADH secretion
• Sub-dural effusion
Long-term
• Neurological deficits (hemiplegia, ataxia, hyperactivity, languagero
• ___________ disorders
• Brain ___________
Brain abscess
III,IV,VI, VII, VIII ; vomiting
Hydrocephalus ; Seizure disorders
Brain damage
Treatment of meningitis
• General considerations of treatment
Symptomatic ___________ emergencies should be treated without delay to avoid further damage to vital organs.
BP should be decreased by no more than _____% in the first _______
• Patient should undergo cardiac and continuous BP monitoring.
• Any serious complications must be managed before or as hypertension is being treated (e.g, anticonvulsants should be administered to a seizing patient along with hypertensive medications
hypertensive
25% ; 2hrs
Definitive Treatment
___________ choice depends on the age group and the sensitivity pattern
Neonatal period
No previous exposure to antibiotics/community
• IV _____________ (100-200mg/kg/D in 4 divided doses) + IV ____________ ( 5 - 7 5 .
Previous exposure to antibiotics
• Alternatively, __________ (100mg/kg/D in 2 divided doses) +an aminoglycoside (dosage as above)
Total duration of treatment: _______ days
Antibiotic
Ampicillin; Gentamycin
cefotaxime
14 - 21 days
Treatment of meningitis
Infancy onwards
No previous exposure to antibiotics/community
•______________(200,000-400,000 units /kg/D in 4 divided doses) + IV ____________
Previous exposure to antibiotics
• Alternatively, ____________ (200 mg/kg/D in 3 divided doses) or ____________.
Total duration of treatment: ______ days
If due to Herpes simplex give IV ____________
If due to Mtuberculosis commence ____________
Benzylpenicillin ; chloramphenicol
Cefotaxime; ceftriaxone.
10-14 days
acyclovir;anti-TB regime
Supportive Treatment
• Anticipate and prevent complications
• Maintain __________ to _____ maintenance
• NPO if child is ________
• _________ control
hydration ; full maintenance
unconscious ; Seizure
Preventive Treatment
• _________
• Chemoprophylaxis (_________ 20mg/kg/D) where organism is definitively identified.
This is not recommended where ___________________ and rifampicin is used as first line treatment
• _________
Vaccines
Rifampicin ; TB is endemic
Gamma-globulins
