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Paediatrics > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis?

A

It is inflammation of the leptomeninges (arachnoid and pia mater)

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2
Q

What is encephalitis?

A

It is inflammation of the brain

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3
Q

What is the pathogenesis of meningitis?

A

The host body produces cytokines like tumor necrosis factor and interleuki-1 which results increased ice, permeability of BBB, vasogenic, cytotoxic and interstitial oedema and decreased cerebral flow

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4
Q

What are the most common symptoms of meningitis?

A
  1. Fever
  2. Headaches or nausea/vomiting(signs of raised ICP)
  3. Stiff neck or kernigs or brudzinki’s sign
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5
Q

What are the neonatal signs of meningitis?

A

Difficult to tell in neonates

  • poor feeding
  • lethargy
  • bulging fontanelle
  • hypothermia/hyperthermia
  • irritability
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6
Q

What are the things that cause an increase in risk for meningitis in babies?

A
  1. Low birth weight
  2. Prolonged delivery
  3. Premature rupture of membrane
  4. Male
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7
Q

What specific pathogens cause meningitis in neonates?

A
  1. E. Coli
  2. Listeria
  3. Group B streptococcus
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8
Q

What specific pathogens cause meningitis in infants? (1 month to 2 years)

A
  1. Group B streptococcus

2. Streptococcus penumoniae

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9
Q

What specific pathogens cause meningitis in children and teens?

A
  1. Neisserra meningitidis

2. Streptococcus pneumoniae

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10
Q

What kind of organism is streptococcus pneumoniae?

A

Gram positive diplococci

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11
Q

Why do children with sickle cell have higher changes of streptococcus pneumonia meningitis?

A

They have functional asplenia

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12
Q

Which patients are most likely to get streptococcus pneumonia meningitis?

A

-skull fractures, paranasal sinuses, frontal bone fractures that lead to CSF leak and ottorhea

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13
Q

What kind of organism is Neissera meningitidis?

A

Gram negative

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14
Q

How does neissera meningitidis present in babies?

A
  • with petechiae or purport
  • we can scrape the rash to find the organism
  • they release endotoxins which can cause shock, bilateral adrenal haemorrhage and DIC
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15
Q

What is the histology of haemophillus influenza?

A

Gram negative pleomorphic bacillus

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16
Q

How can haemophillus influenza present?

A
  • slow onset

- usually in children who come from overcrowding, children with splenectomies

17
Q

What does haemophillus influenza meningitis cause?

A
  • hearing loss
  • epileptic fits
  • mental retardation
  • subdural effusions
18
Q

How do we diagnose meningitis?

A
  • LP
  • make sure the child is not comatose before doing the LP because there could be a space occupying lesion
  • Rather do a CT/MRI scan
19
Q

In which situations would we do an MRI/CT?

A
  1. Prolonged coma
  2. Decreased level of consciousness
  3. Altered mental status
  4. Hydrocephalus
  5. Purulent otitis media-possible brain abscess
20
Q

What makes it difficult to diagnose meningitis?

A
  1. Partially treated meningitis with AB
  2. TBM diagnosis because the neutrophils occur early and then turn into lymphocytes
  3. Early viral encephalitis
  4. Recurrent meningitis
21
Q

What causes recurrent meningitis?

A

-it is rare firstly
-but causes include some anatomical, surgical or medical disorder
Examples include: organism resistant to AB and sickle cell anaemia and splenectomies

22
Q

What complications can meningitis cause?

A
  1. Epileptic fits
  2. Thrombosis of veins and small arteries
  3. Subdural effusions
  4. Hydrocephalus
  5. Cranial nerve palsy-sensorineural hearing loss
  6. Hemiplegia
  7. Cerebral oedema
  8. Syndrome of inappropriate ADH secretion
  9. Cerebral oedema
23
Q

What organisms contribute more to subdural effusions?

A
  1. H. Influenza, strep pneumonia, N meningitidis
24
Q

Why should we be careful of giving benzodiazepines and phenobarbitone in patients with epileptic fits?

A

-this can cause respiratory and CNS depression

25
Q

Which group gets hydrocephalus more?

A

Neonates get hydrocephalus more than older kids

26
Q

What are the symptoms of syndrome of inappropriate ADH secretion?

A

Irritability and convulsions which occurs in 15-20% of patients
Hyponatraemia

27
Q

What can we expect in a normal child when we do an LP?

A
  1. 0 neutrophils and 1-6 lymphocytes
  2. Glucose- 3,6 to 5,6
  3. 0,15-0,45 protein
28
Q

What can we expect on LP in a child with bacterial meningitis?

A
  1. 100-50 000 neutrophils predominantly
  2. Glucose 1,1-1,6
  3. Protein mild or moderately increased
29
Q

What can we expect on LP in viral meningitis?

A
  1. 25-500 lymphocytes predominantly
  2. Glucose normal
  3. Protein mildly increased
30
Q

What can we expect in LP in TBM?

A
  1. Neutrophils predominate early
    25-100 lymphocytes
  2. Glucose 2,2-2,7 but usually below 0,5
  3. Protein-moderately increased
31
Q

What is the treatment for meningitis?

A

It is categorized according to whether the child <2 months or >2 months
1. <2 months
Cefotaxime 50mg/kg AND ampicillin 50 mg/kg AND gentamycin

  1. > 2 months
    Give ceftriaxone 100mg/kg OR cefotaxime 75 mg/kg AND dexamethesone 0,6mg/kg
    Make sure to give dexa 30 minutes before the antibiotic

Supportive Rx: oxygen and nebuliser

32
Q

How long do we give the treatment in group B streptococcus

A

14 days

33
Q

Which meningitis has the worst prognosis’s?

A

Pneumococcal meningitis, has a mortality of >10% and neurological sequelae

34
Q

What prophylaxis do we need to do?

A

This is for family and nursery school contacts
N. Meningitidis we give rifampicin and ceftriazone
H. Influenza we give (usually <5 year old family members)
We give rifampicin 20mg/kg

Paediatrics (40 decks)

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