Meningitis and Meningococcal Septicaemia **** Flashcards
Presentation
Behaviour Feeding Neck Fontanelle Temperature When might pneumonia be present?
Complications
Can be quite non-specific if young including just fever
Irritable
Miserable
Lethargic
High-pitched cry
Poor feeding
Neck stiffness
Bulging fontanelle
Hypothermia
In listeriosis
Seizures and apnoea’s
Causes
Bacterial - < 3 months and > 3 months
Other bacterial causes
Viral
Other causes
Group B strep
Niesseria Meningitidis
Staph aureus
E. coli
TB
Influenzae
Enteroviruses -
Herpes simple
Mumps
Measles
Fungal Cancer Drugs Inflammatory Autoimmune
Risk Factors
Immunosuppression
Skull fractures
Crowding
Investigations:
Hx and exam
What if no apparent cause from Hx and exam?
Illnesses currently in family or school Immunisations Recent travel Animal contact Immunosuppression
Look for local infection signs
Midstream urine or NICE traffic light system
Investigations
When is septic screen and IV antibiotics done?
Other investigations to consider?
Severely ill
Young
Immunocompromised
Cefotaxime IV
U&E plus bicarbonate and chloride if vomiting LFT Thick film if travel Crossmatch Nose/throat swab
What antibiotics is given?
IV/IM cefotaxime (200mg/kg/24hrs) 6 hourly
Septic signs
High temp Cold hands and feet Limb/joint pain Abnormal skin colour Odd behaviour Rash DIC Tachycardia Hypotension
Meningeal signs
Why is meningitis difficult in children?
5 signs you might see?
Very late and less common in young children
Usually not sensitive and specific
Neck stiffness Kernig's sign Brudzinki's sign Photophobia Opisthotonos
LP - when is it contraindicated?
What tests should be done on CSF fluid?
If there are focal signs DIC Purpura or brain herniation is near (odd posture or breathing) Reduced GCS Dilated pupils Hypertension Bradycardia
Gram stain Culture Virology Glucose Protein
Pyogenic (bacterial) meningitis
What needs to be protected?
At what age is ceftriaxone given in children?
At what age is cefotaxime + amoxicillin/ampicillin given in children?
What else can be given with first dose for AB’s if child is over 3 months old and not meningococcal septicaemia?
Why could IVI mannitol be given?
Airways - oxygen should also be provided
From 3 months to 18 yrs
From birth to 3 months
Dexamethasone
If there are signs of brain herniation
Complications of meningitis
Secondary accesses Subdural effusions Hydrocephalus Ataxia Paralysis Deafness Epilepsy
Why is seeing purpuric rash not a good sign?
It present quite late and is untreatable.
What can be given prophylactically?
Rifampicin
Ciprofloxacin
What is the difference between bacterial meningococcal disease and viral meningitis?
Bacterial meningococcal disease, including meningococcal meningitis, usually has a more sudden onset and is a more severe illness than viral meningitis.
There is a vaccine for meningococcal disease, including meningitis, which covers about 80 percent of meningococcal infections.
Bacterial infections can be treated with antibiotics.
Meningococcal infection may cause:
meningitis- inflammation of the brain and spinal cord and the coverings that surround them
sepsis – an infection of the blood
Waterhouse-Friedrichsen Syndrome – adrenal gland failure
other conditions.
Viral meningitis is caused by several different viruses that are common in our environment. Most people who are in contact with those viruses will only get a common cold or diarrhea and vomiting, but will not get meningitis. Viral meningitis is an unusual immune response to a common virus that causes an individual’s brain to swell. The symptoms are similar to bacterial meningitis: fever, stiff neck, headache, nausea and vomiting, light sensitivity. The symptoms are often less severe than bacterial meningococcal illnesses. These common viruses are contagious through coughing, sneezing or saliva, or sometimes through inadequate hand washing after using the toilet.
