Meningitis + Encephalitis Flashcards
What are pathogens in neonates of meningitis
Group B strep
E.coli
Listeria monocytogenes
What are pathogens in children of meningitis
S.pneumoniae - most common Meningococci H influenza Group A strep S.Aureus
What are the symptoms of meningitis in child (SUSPECT ANY ILL CHILD)
- May be subtle
- Don’t expect meningeal signs
- Septic signs are much more common and occur prior
Irritable Vomiting Fever Lethargy Poor feeding Nuchal rigid Kernick sign - resistance to extending knee with hip flexed Brudsinski sign - hips flex on bending head toward Headache Photophobia Decreased consciousness Focal neuro Seizure Rash - don't expect petechia in Menigococcus, may have macules or none, if you wait for purpura will be too late Bulging fontanelle - raised ICP Nappy pain
How do you Dx meningitis in children
LP (if not CI) If in doubt AX Blood culture Bloods - investigation as described in febrile child CT cerebrum to see if LP okay
What is shown on the bloods in meningitis
Leucocytosis or penia Thrombocytopenia CRP elevated DIC Acidosis Hypoglycaemia
What Ax are given for meningitis
If in community = BENPEN (DON"T DELAY) 3rd generation cephalosporin 1st line - ceftaxamine Add Amoxicillin if <1 to cover listeria Dexamethasone if >1 + non meningococcus Ciproflaxacin for contacts
How do you treat meningitis
ABCDE Alert blood bank 02 and fluid if shock IV access - blood and lactate IV Ax = early - give before fluid Fluid - 20ml / kg if shock Early inotropic support - adrenaline improves outcome (only senior inout if refractory to fluid bolus) Senior
What are the complications of pneumococcal meningitis
Brain damage Hearing loss Hydrocephalus Hemiparaesis Seizures CN palsies
What is H.influenza B
Gram -ve
Resistant to phagocytosis and complement lysis
B lactam resistant
What does H Influenza B cause
Bacteraemia
Meningitis as severe as pneumococcal
Pneumonia
Epiglottitis
What is meningococcus
Found in nasopharynx
What does meningococcus cause
Long term morbidity and death from septic shock and meningitis Amputation Scarring Cognitive Epilepsy Hearing loss
What is the endotoxin in meningococcus
Lipoligosaccharide
What vaccines are available
H influenza B
Pneumococcal
Meningococcal
How do you monitor meningitis
HR, RR, BP AVPU, GCS, pupils Monitor urine output Continuous EEG Bloods
When do you suspect meningitis / encephalitis
ANY YNWELL CHILD
SIGNS MAY BE SUBTLE
SEE INFETION
What is important in the history of fever
Onset, duration, progression and variation Systemic symptoms Specific RF / PMH Infective contacts
How do you follow up after meningitis
Hearing
Development
Why do you worry if immunocompromised
Fever may be only sign of serious infection
Rapid deterioration
Do full exam and prompt IV as per protocol
Why do we worry in <3 months
Immature immune
Vague symptoms
Low threshold for Ax
Call registrar straight away
What is common in <3 months
Group B
E.coli
Viral HSV / VZV have high mortality
What do we have in <3 months
Low threshold for Ax - even if no signs but fever / RF
Full septic screen
Possible LP for all unwell neonates once stable
Gent + benpen till culture back
What are the signs of encephalitis
Flu like prodrome Decreased consciousness Focal seizure Focal neuro signs Odd behaviour / fits Vomiting Fever Meningism
What is DDx
Hypo DKA Kernecterus SAH Malignancy - brain tumour
