meningitis Flashcards
meningism
symptom complex:
- headache
- neck stiffness (on passive flexion)
- photophobia
- vomiting
pathogenesis of meningitis 5 steps
- attachment to mucosal epithelium
- transgression of mucosal barrier
- survival in blood stream
- entry into CSF
- production of infection in meninges
common bacterial causes of meningitis in children
Neisseria meningitidis
(meningococcal infection) - MUCH MORE SEVERE
case fatality 5-15%
Streptococcus pneumoniae
(pneumococcal infection )
enter via nasopharynx epithelium
bacterial causes in neonates
E. coli
Group B streptococci
viral causes
- Echoviruses
- Coxsackie A and
B viruses
if suspected - PCR CSF
shunt associated meningitis
ventriculo-atrial / peritonial shunts develop ventriculitis and meningitis - coagulase (-) staphylococci
remove shunt
aseptic meningitis
neoplasm
reaction to drugs
high WBC but nothing cultured in CSF
non infective causes of meningism
SAH
migraine
RFs for meningitis
DM
recent head trauma
Alcoholism
kernig’s sign
hip flexed - can’t straight leg due to hamstring spasm
Tests
Blood cultures
LP: if any ICP then don’t
FBC
CSF results if bacterial meningitis
turbid, increased cells, neutrophils, reduced glc
CSF results if viral meningitis
lymphocytes, normal plc
treating acute bacterial meningitis
- early clinical recognition
- rapid detection of pathogen
- rapid initiation of appt A/Bs
- early recognition of sequelae of septicaemia: DIC, hypoxia, acidosis
- a/b prophylaxis for contacts
Meningococcal Meningitis
Neisseria meningitidis
(meningococcal infection) - commonest cause, presents rapid/acute - due to initial nasopharynx infection
common in children/young adults
MUCH HIGHER MORTALITY RATE THAN pneumococcal disease (strep pneumoniae)
indian, SSA, Middle East
Meningococcal Meningitis
Neisseria meningitidis
group A meningococcal
vaccine for infants
vaccine for adolescent booster
Men B
Men ACWY
fulminant meningococcal septicaemia
startling sudden onset of symptoms:
- rapid loss of consciousness
- DIC
- Fever
- Septicaemia shock
- PURPURIC RASH
commonly die <24hrs
GP =a/bs –> hosp
tx of meningococcal meningitis or sepsis at GP
parenteral penicillin
poor prognostic markers for Meningococcal Meningitis
Neisseria meningitidis
delay in a/bs, extremes of age, purpuric lesions, shock, hyperpyrexia
presence of DIC
on discharge and to contacts tx
for Meningococcal Meningitis
(Neisseria meningitidis)
rifampicin eradicate from nasopharynx
Pneumococcal Meningitis (streptococcus pneumonia)
epidemiology
most frequent cause in adults - predisposing factors: pneumonia, sinusitis, IE, head trauma
Pneumococcal Meningitis tx
high dose ceftriaxone
PC of Pneumococcal Meningitis
altered conscious level, focal neurological signs with concurrent infections - sinuses etc
pneumococcal vaccine for?
over 65yrs
or high risk: DM, CKD, HIV
pneumococcal conjugate vaccine
children
fungal meningitis more important cause in what sub group of people
Cryptococcus neoformans (yeast form) - in HIV pts
found in bird droppings
fungal meningitis tx
high dose fluconazole
neonatal meningitis
PC
vague symptoms
neonatal meningitis
RFs:
low birth weight
prolonged rupture of membranes
maternal DM
neonatal meningitis tx
cefotaxime
Primary symptom of paed sepsis
commonly hypothermic
the younger the child the higher the risk of sepsis
- neonates > children
- greater risk than adults
child gender risk of sepsis
boys > girls
symptoms of paed sepsis
- Fever, hypothermia
- Cold hands, feet
- Prolonged cap refill
- Chills / rigors
- Limb pain can be first symptom of sepsis
- Vomiting / diarrhoea – inflammatory mediator release
- M weakness
- M joint aches
- Skin rash
- Diminish urine output
PC of meningitis in neonates
- irritability
- lethargy
- NAPPY PAIN (stretching meninges)
- bulging fontanelles
Severe PC of meningitis in neonates
seizures
focal neurological abnormalities
tx for meningitis +/- sepsis in paeds
- supportive: ABC DEFG
- a/bs with good penetration - cephalosporin
back up option for culturing if blood cultures weren’t taken prior to a/bs
skin lesion biopsy
paediatric sepsis
SIRS + proven/infection
SIRS: fever/hypothermia, tachycardia, tachypnoea, leucocytosis/leucocytopenia
Pneumococcal meningitis complications
children
morbidities:
- brain damage
- hearing loss (always test hearing post infection)
- hydrocephalus
paeds meningococcal meningitis complications
- amputation
- cognitive impairment/epilepsy
paeds meningococcal disease steps –> meningitis
meningococcus in bloodstream
<12 hrs: septic shock (common period for mortality)
< 18-36 hrs sign of meningitis
