Pediatric CNS Infections - Tucker Flashcards
6yo M, fever and HA, T 102, tachycardia, tachypnea, wincing in room, doesn’t want to open eyes, clear rhinorrhea, meningismus
meningitis
kernigs sign
pain with extension of knee with hips flexed
brudzinski sign
patient flex neck - reflex flex knee
bacterial meningitis
elevated WBC with left shift - or norma
lumbar - increased WBC with neutrophils - low glucose, high protein
viral meningitis
CHC, ESR, BMP normal
lumbar - increased WBCs - lymphocytes
pregnany hx
important- group B strep status and STI hx
prenatal antibiotics - decreased incidence of group B strep
irritable child, bulging fontanelle, fever
needs full sepsis work up
CBC, blood culture, urinalysis, urine culture, LP
meningitis in children over 2 months
MC - pneumococcus
-second is meningococcus
MC meningitis in young adults
meningococcus
infants less than 2 months
group B strep
listeria
E. coli
ad herpes coverage up to 4-6 weeks
tx infants less than 2 month
3rd gen cephalosporin and ampicillin
and acyclovir for herpes
tx kids > 2 months
pneumococcus and meningococcus
-3rd gen cephalosprorin and vancomycin
viral meningitis
herpes
enterovirus
EBV, HHV 6, and ricketsia
meningitis in infants
prematurity, PROM, chorioamnionitis
complications of meningitis
cerebral edema
cushings triad - bradycardia, HTN, respiratory abnormal
tonsillar herniation
SIADH
30% of meningitis - have decreased sodium
tx- fluid restriction
seizures after 72 hours of tx
vascular insult or abscess development
long term complications of meningitis
hearing loss, seizure, hydrocephalus, spastic, blind, learning disability
