Meningitis and Kawasaki

Question 1

Which pathogens commonly cause Meningitis in children?

Answer 1

<2 months: Ampicillin+gentamicin, cefotaxime
-Group B strep/S. agalactiae
-E. coli
-Listeria monocytogenes (rare)
treatment: Ampicillin (covers Strep) +gentamicin or cefotaxime (for E. coli) - cefotaxime penetrates the CSF better than gentamicin

> 2 months:
-S. pneumoniae
-H. influenzae
-N. meningitidis
treated with Ceftriaxone or cefotaxime +/- vancomycin (in case there is resistant staph depending on the area)

Question 2

What are the symptoms of Meningitis in children?

Answer 2

-vomiting and nuchal (neck) rigidity (>12 months)
-irritability (1-5y)
-impaired consciousness (6-11y)

-poor feeding

Question 3

How is Meningitis diagnosed?

Answer 3

lumbar puncture

-WBCs should be elevated (>2000 leukocytes/mm3)
-CSF glucose should be decreased (<23% of serum)
-CSF protein should be increased (>220 mg/dl)

Question 4

Which drug is used as an adjunctive to reduce hearing loss associated with Meningitis?

Answer 4

Dexamethasone

(Rifampin is sometimes added for Strep pneumonia induced Meningitis)

Question 5

What is the role of Rifampin in Meningitis treatment?

Answer 5

-short term adjunctive in S. pneumoniae-induced Meningitis

-Chemoprophylaxis for patients who are exposed to Meningitis-infected individuals
(may also use ceftriaxone or ciprofloxacin for Chemoprophylaxis)

Question 6

Which part of the body is affected by Kawasaki disease in children?

Answer 6

-multisystem vasculitis (inflammation of the blood vessels) especially of the heart

Question 7

Symptoms of Kawasaki disease

Answer 7

-high fever
-rash
-conjunctivitis
-inflammation of the mucus membranes
-erythematous induration of the hands and feet
-cervical adenopathy
-fever !!!

Question 8

Which symptom has to be present to be considered Kawasaki disease?

Answer 8

fever for 5 or more days

+ 4 of these symptoms:

-Bilateral congestion of ocular conjunctivae (conjunctivitis)
-Changes of lips and oral cavity
-Dryness, redness, and fissuring of lips
-Protuberance of tongue papillae (strawberry tongue)
-Diffuse reddening of oral and pharyngeal mucosa

Question 9

Other symptoms indicative of Kawasaki’s disease

Answer 9

-Reddening of palms and soles
-Membranous desquamation from fingertips
-Polymorphous exanthema of body trunk
-Acute nonpurulent swelling of cervical lymph nodes
-Carditis
-Increased ESR, CRP
-Thrombocythemia
-Aseptic meningitis
-Mild jaundice or slight increase in L

Question 10

Which drug is used to treat the inflammation caused by Kawasaki disease in children, and how is it dosed?

Answer 10

Aspirin
start with 80-120 mg/kg/day (anti-inflammatory, anti-platelet dose)

-reduce to 30-50 mg/kg/d after fever goes away

-reduce to 3-5 mg/kg/d if ESR (erythrocyte sedimentation rate, test for inflammation in the body)

-may stop when platelets return to normal

Question 11

Which drug is used to prevent artery lesions in Kawasaki disease?

Answer 11

-IV Immunoglobulin
2g/kg given over 12h -> watch for anaphylaxis: flu-like symptoms, muscle aches, immune hemolysis

-IV corticosteroids if 2 doses of IV Ig don’t work

-Infliximab in IVIg-resistant patients (risk: infection, aseptic meningitis)