Problem 6 Flashcards
Which bacteria are the most common for meningitis
heamophilus influenzae
neisseria meningitidis
streptoccocus pneumoniae
What are the most common viruses causing meningitis
enterovirus
parechoviruses
herpes
epstein-barr virus
What are the risk factors for meningitis
genetic predisposition (race) acquired or congenital immunodeficiencies functional or anatomical asplenia cochlear implantation penetrating head trauma recent neurosurgical procedure crowding (creche) A CSF leak (fistula), resulting from congenital anomaly or following a basilar skull fracture
What are the clinical manifestations of meningitis
Apnea Stiff or Painful Neck Headaches Hearing Loss Fever Without a Source Irritable Infant Nausea/Vomiting Photophobia Focal neurological signs seizures arthralgia myalgia petechial or purpuric lesions sepsis shock coma bulging fontanelle because of increased intracranial pressure
Which signs in the clinical exams
Kernig and Brudzinski
Examens complementaires pour meningite
prise de sang ponction lombaire (white blood cell count, glucose, protein, gram stain
What is the treatment for meningitis
empiric: ceftriaxone + vancomycine
adjunctive therapy: dexamethasone
iv perfusion for rehydration
What is the duration of treatment
depends on the bacteria but could be 10-14 days (for pneumoccoques)
Complications
up to 30% have sequelae, including deafness, seizures, blindness, paresis, ataxia, or hydrocephalus
What is encephalitis
inflammation of the brain’s parenchyma which usually presents with fever, headache, and mental status changes
What are 2 ways by which organisms can cause encephalitis
(1) direct infection of the brain parenchyma via an extension of meningitis, secondary to viremia, or retrograde spread via peripheral nerves
(2) a postinfectious, immune-mediated response in the CNS that usually begins several days to weeks after clinical manifestations of the infection
Which organisms are the most frequent cause of encephalitis
viruses: enteroviruses, arboviruses, herpesviruses and HIV
What is acute disseminated encephalomyelitis
the abrupt development of multiple neurological signs related to an inflammatory, demyelinating disorder of the brain and spinal cord.
ADEM can follow childhood viral infections (such as
measles and chickenpox) or vaccinations, and can clinically resemble multiple sclerosis.
What is autoimmune encephalitis
Autoimmune encephalitis is a relatively common cause
of encephalitis and is associated with specific autoantibodies directed to brain antigens, such as anti-N-methyl-D-aspartate receptor antibodies. The presentation is often subacute with psychological manifestations, cortical dysfunction, movement disorders, autonomic dysfunction, and seizures.
What are the clinical manifestations of encephalitis
Stiff or Painful Neck Headaches Ataxia Altered Mental Status Hearing Loss Query Polyuria
Examens complementaires pour encephalite
ponction lombaire (lymphocytic pleocytosis, elevation in protein content, normal glucose)
prise de sang
MRI or CT
electroencephalogram
Treatment of encephalitis
acyclovir if herpes
ganciclovir if CMV
ADEM is treated with corticosteroids
autoimmune encephalitis is treated with steroids, intravenous immunoglobulin (IVIG), and rituximab
How can meningitis happen
bacteria cross the blood-brain barrier from the blood
trans, para or in macrophages
How is Kernig sign done
flexing the hip and extending the knee to elicit pain in the back and legs
How is Brudzinski sign done
passive flexion of the neck elicits flexion of the hips
What is a late sign of intracranial pressure
The constellation of systemic hypertension, bradycardia, and respiratory depression (Cushing’s triad)
Which pathogens for neonatal meningitis
streptocoque B
herpes
E Coli (Gram-)
Listeria
Risk factors for neonatal meningitis
rupture prolongee des membranes
infection maternelle intra-partum
prematurite
poids<2.5 kg
Clinique des nouveau-nes pour meningite
fievre et hypothermie irritabilite, lethargie vomissements, troubles alimentaires fontanelle bombante apnee
When to do prophylaxie de l’entourage
meningocoque
pour enfant rifampicine
pour adulte ciprofloxacine
pour femme enceinte ou si allergie ceftriaxone
If vomiting, what do we suspect for neonates
common congenital GI anomalies that cause obstruction, such as esophageal or intestinal atresia or web, malrotation, meconium ileus, or Hirschsprung’s disease.
Indication pour une ponction lombaire pour un nouveau-ne de <1 mois
tout état infectieux
Indication pour une ponction lombaire pour un enfant entre 1 mois et 3 mois
- si état toxique, à discuter si enfant présentant un état fébrile avec irritabilité, enfant amorphe ou si symptômes neurologiques avec à la biologie une PCT ≥ 0.5, des polynucléaires neutrophiles >10G/L et/ou une CRP
>20mg/L.
Indication pour une ponction lombaire pour un enfant entre 3 et 9 mois
- tout état infectieux avec une atteinte neurologique ou psychique (irritabilité, somnolence, apathie, convulsions, mauvais tonus, mauvaise succion)
Indication pour une ponction lombaire pour un enfant >9 mois
- état infectieux et signes méningés
Caracteristiques d’une ponction lombaire a meningite bacterienne
- pression augmentee
- aspect: trouble
- > 1000 GB 80% PMN
- hyperproteinorachie
- hypoglycorachie
Caracteristiques d’une ponction lombaire a meningite virale
- pression normale
- aspect clair
- 10-500 GB >50 % lympho
- glucose normale
- moins de proteines que dans la bacterienne
ttt pour 0 jour de vie à 1 semaine de vie et non prématuré
Amoxicilline 200 mg/kg/j en 4 doses iv
+ Cefotaxime 150mg/kg/j en 3 doses iv
ttt pour 1 semaine - 1 mois de vie
Amoxicilline 200mg/kg/j en 4 doses iv + Cefotaxime 200mg/kg/j en 4 doses iv
ttt pour 1 a 3 mois
Amoxicilline 200 mg/kg/j en 4 doses iv + Ceftriaxone 100 mg/kg/j en 1x/j iv (injecter en 30 min)
Durée du traitement : 14-21 jours selon le germe
ttt pour > 3 mois
Ceftriaxone 100mg/kg/j en 1 dose/24h, IV (max. 4 g )
(+/- Vancomycine 60 mg/kg/j en 4 doses si diplocoques Gram + à la coloration du Gram, notamment si enfant issu/en provenance des EtatsUnis, en attendant le résultat de la culture et de l’antibiogramme).
Effets indesirables de la rifampicine
- coloration des urines et des larmes (verres de contact)
- interaction avec contraceptifs oraux, anticoagulants, digitale, quinidine, antidiabétiques oraux, méthadone, stéroïdes.
Quand avertir le medecin cantonal
Méningite à méningocoque, à mycobactérie tuberculeuse et à Haemophilus influenzae du groupe b. Si méningocoque, Haemophilus ou méningite tuberculeuse avec atteinte pulmonaire associée:
Avertir également le SSEJ via Nathalie Farpour-Lambert au 022.546.43.40 (standard 022.546.41.00)
