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Paediatrics > Meningitis + Encephalitis > Flashcards

Meningitis + Encephalitis Flashcards

1
Q

What are pathogens in neonates of meningitis

A

Group B strep
E.coli
Listeria monocytogenes

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2
Q

What are pathogens in children of meningitis

A 
S.pneumoniae - most common
Meningococci 
H influenza 
Group A strep
S.Aureus
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3
Q

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
A 
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
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4
Q

How do you Dx meningitis in children

A 
LP (if not CI) 
If in doubt AX 
Blood culture 
Bloods - investigation as described in febrile child 
CT cerebrum to see if LP okay
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5
Q

What is shown on the bloods in meningitis

A 
Leucocytosis or penia 
Thrombocytopenia
CRP elevated
DIC
Acidosis 
Hypoglycaemia
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6
Q

What Ax are given for meningitis

A 
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
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7
Q

How do you treat meningitis

A 
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
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8
Q

What are the complications of pneumococcal meningitis

A 
Brain damage
Hearing loss
Hydrocephalus 
Hemiparaesis 
Seizures 
CN palsies
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9
Q

What is H.influenza B

A

Gram -ve
Resistant to phagocytosis and complement lysis
B lactam resistant

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10
Q

What does H Influenza B cause

A

Bacteraemia
Meningitis as severe as pneumococcal
Pneumonia
Epiglottitis

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11
Q

What is meningococcus

A

Found in nasopharynx

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12
Q

What does meningococcus cause

A 
Long term morbidity and death from septic shock and meningitis 
Amputation
Scarring
Cognitive
Epilepsy 
Hearing loss
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13
Q

What is the endotoxin in meningococcus

A

Lipoligosaccharide

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14
Q

What vaccines are available

A

H influenza B
Pneumococcal
Meningococcal

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15
Q

How do you monitor meningitis

A 
HR, RR, BP
AVPU, GCS, pupils
Monitor urine output
Continuous EEG 
Bloods
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16
Q

When do you suspect meningitis / encephalitis

A

ANY YNWELL CHILD
SIGNS MAY BE SUBTLE
SEE INFETION

17
Q

What is important in the history of fever

A 
Onset, duration, progression and variation
Systemic symptoms 
Specific 
RF / PMH
Infective contacts
18
Q

How do you follow up after meningitis

A

Hearing

Development

19
Q

Why do you worry if immunocompromised

A

Fever may be only sign of serious infection
Rapid deterioration
Do full exam and prompt IV as per protocol

20
Q

Why do we worry in <3 months

A

Immature immune
Vague symptoms
Low threshold for Ax
Call registrar straight away

21
Q

What is common in <3 months

A

Group B
E.coli
Viral HSV / VZV have high mortality

22
Q

What do we have in <3 months

A

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

23
Q

What are the signs of encephalitis

A 
Flu like prodrome 
Decreased consciousness 
Focal seizure
Focal neuro signs 
Odd behaviour / fits 
Vomiting
Fever
Meningism
24
Q

What is DDx

A 
Hypo
DKA
Kernecterus
SAH 
Malignancy - brain tumour
25
Q

What causes encephalitis

A

HSV = most common
Mumps - parotiditis / testicular pain Hx
VZV - chicken pox history
CMV if immunocompromised
Rabies / parvovirus / influenza / TB / toxoplasmosis
Malaria / Ricketsia/ Lymes = specialist
Autoimmune = non-infective

26
Q

How do you Dx

A 
LP - CSF PCR
MRI brain 
Culture urine, stool + blood 
HIV testing recommended in all cases 
Ask about vaccinations
27
Q

What is CI to LP

A

Raised ICP - focal neuro, papilloedema, bulging fontanelle
DIC
Cerebral herniation

28
Q

How do you treat encephalitis

A

IV acyclovir

Repeat LP to see if successful

29
Q

What are complications

A 
Fatigue
Change personality
Change in mood / cognition
LD
Headache 
Chronic pain
Movement disorder
Sensory disorder
Seizures
30
Q

When is LP indicated in children

A

<1 month + fever
1-3 months = unwell
<1 year = unexplained fever

31
Q

When do you not give corticosteroid

A

Meningococcus

<3 months

32
Q

When should you use irritable

A

Only if meningitic

NOT for grumpy

33
Q

Vaccine

A

MEN B - 2,4, 12 mths
Men C - 12 maths
Men ACWY - 14 year

34
Q

When is pneumococcal common

A

Immunocompromied

Hyposplenism

35
Q

Who gets booster

A

> 65

5 yearly if at risk e.g. hyposplenic

Paediatrics (35 decks)

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