1. 1394/03/28

2. Meningitis/ Encephalitis
Dr Mostafavi SN
Department of Pediatric Infectious Disease
Isfahan University of Medical Science
1394

3. Definition
Meningitis: Inflammation of pia mater, arachnoid and cerebrospinal fluid
Encephalitis: Inflammation of brain parechyma
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4. Etiology Meningitis Encephalitis < 2 mo: Enteroviruses
Enteric g- s,
Group B streptococcus
viruses: enteroviruses
L. monocytogen
> 1 mo:
Pneumococcus
H.flu type b
Meningococcus
Viruses: enteroviruses, mumps, …
Enteroviruses
Mump
HSV
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5. Transmission Encephalitis: Meningitis: Hematogenous Hematogenous
Direct invasion:
Surgery: Staphylococcus aureus, Coagulase negative staphylococci
Trauma: Pneumococcus
CSF shunt: Coagulase negative staphylococci, Staphylococcus aureus, enteric gram negatives
Encephalitis:
Hematogenous
Ascending: HSV
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6. When we suspect? Encephalitis: Meningitis:
↓level of consciousness/ psychosis +
Fever
Focal neurological signs
Seizure
lymphocytic pleocytosis
Ab NL EEG
Ab NL CT or MRI
Meningitis:
Fever+
Meningeal sign especially after 18 mo
↓level of consciousness, poor feeding
Psychosis, Irritability
Focal neurological signs
Seizure except in <5 yr
Brain edema signs
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7. Brain edema signs Bulging fontanel Papilledema
Oculomotor or abdocent nerve palsies
Altered level of consciousness
Seizure
Cushing's response( HTN +Bradycardia+ apnea or hyperventilation)
Signs of herniation ( unequal pupils, irregular respiration, ↓ level of consciousness, unresponsive pupils (
Severe headache, vomiting?
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8. When we suspect meningitis in febrile convulsion patients?
Another indication
Age< 1 yr
Status FC
Seizure after 24 hr. of fever
Previous use of antibiotics( 1 week)
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9. How can we confirm the diagnosis?
Meningitis:
CSF analysis
CSF gram stain: 70-90%
CSF culture
Blood culture: up to 80-90%
PCR for viruses
ESR, CRP
Encephalitis:
CSF analysis
CSF PCR
EEG
MRI
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10. Contraindications for LP
Cardiopulmonary compromise
Increased ICP signs except ( only) bulging fontanel
Infection at the site of needle entry
Thrombocytopenia (Plts <50, 000/mm3)/ Coagulopathy
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11. CSF finding in CNS infections
Sugar / BS
( mg/dl)
Protein
% PMN
WBCs/hPF
Condition
> 75% ,(> 50)
< 45
1-3
< 5
Normal
(> 36)
< 120
2-3
< 30
Normal neonate
< 50% (< 40)
> 100
> 75-95
> ,000
Bacterial meningitis
(NL, <40 in mumps)
< 200
< 50
( except in 1st 8-24 hr. & mumps)
<
( except in mumps)
Encephalitis, Viral meningitis, brain abscess
Usually < 50% (< 40)
Usually > 50
> 5
Partially treated bacterial meningitis( > 2-3 d)
1394/03/28

12. How can we treat it? Meningitis Encephalitis
Antibiotic: ceftriaxon+ vancomycine( > 1mo)+ ampicillin in (< 2mo)
Dexamethason in >6 wk, prior to ABs
Supportive care( SIADH, hydration, seizure, …)
Encephalitis
Acyclovir until R/o HSV
Supportive care( SIADH, hydration, seizure, …)
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13. Choice of ABs after culture
Duration( d)
Choice
Pathogen
10-14
Penicillin G or Ceftriaxone+/- vancomycin,
S. Pneumonia
7-10
Ceftriaxone
H. Inf type b
5-7
Penicillin G or Ceftriaxone
N. Meningitidis
14-21
Acyclovir
HSV
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14. Complications Behavioral problems Hearing loss
Mental retardation & decreased IQ
Delay language
Epilepsy
Visual impairment
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15. 1394/03/28