1. MENINGITIS Revised from Shashi Vaish Paediatric SpR AMNCH Tallaght
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MENINGITIS
                                       
Revised from
Shashi Vaish
Paediatric SpR
AMNCH
Tallaght
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2. Con Samaan Bacterial Viral Fungal
CAUSES
Bacterial
Viral
Fungal
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3. N. meningitides G-ve diplococci E.Coli G-ve bacilli Streptococci-GBS
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N. meningitides
G-ve diplococci
E.Coli
G-ve bacilli
                                                                                                              
Streptococci-GBS
G+ve cocci
Strep. pneumoniae
G+ve diplococci
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4. Bacterial Meningitis - Pathogenesis
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Bacterial Meningitis - Pathogenesis
Infection of upper respiratory tract
Invasion of blood stream (bacteraemia)
Seeding & inflammation of meninges
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5. Meninges + itis = ??

6. Meningitis: Clinical features
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Meningitis: Clinical features
Newborn & Infants: non-specific
Fever
Irritability
Lethargy
Poor feeding
High pitched cry, bulging AF
Convulsions, opisthotonus
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7. Kernig’s sign

8. Brudzinski’s sign

9. Meningitis: older children
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Meningitis: older children
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10. Acute Meningococcaemia
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Acute Meningococcaemia
Neisseria meningitidis: serotype Grp B commonest
Endotoxin causes vascular damage vasodilatation, third spacing, severe shock
Severe complication:
Waterhouse-Friderichsen syndrome: massive haemorrhage of adrenal glands secondary to sepsis: adrenal crisis-low B.P, shock, DIC, purpura, adreno-cortical insufficiency
*DIC = disseminated intravascular coagulation
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11. Con Samaan
Septicaemia
                                                                                                                     
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12. Con Samaan
Purpura fulminans
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13. Con Samaan
Clinical features
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14. Con Samaan
Clinical features
                                                          
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15. Con Samaan
Clinical features
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16. Con Samaan
Tumbler (glass) test
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17. Con Samaan
Diagnosis LP
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18. CSF FINDINGS Con Samaan · Bacterial Viral TB
·        Cells , <2,
·        polys lymphs lymphs
·        Glucose low normal very low
·        Protein N-INC N-INC N-INC
·        G-Stain gen +ve ve ve Zn
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19. Bacterial Meningitis Management
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Bacterial Meningitis Management
•  Medical emergency
•  Early diagnosis essential
Immediate optimum treatment
Intensive supportive therapy
Rehabilitation
Prophylaxis to family
Notification to GP & Public Health
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20. Bacterial Meningitis/Meningococcaemia Management
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Bacterial Meningitis/Meningococcaemia Management
ABC
PICU
Fluid management: aggressive resuscitation
Dexamethasone: only in Pneumococcal and HiB, given before antibiotics
Inotropes: increasing aortic diastolic pressure and improving myocardial contractility
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21. Viral meningitis Most common infection of CNS especially in <1yr
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Viral meningitis
Most common infection of CNS especially in <1yr
Causes: enterovirus (commonest, meningitis occurring in 50% of children <3mth ) herpes, influenza, rubella, echo, coxsackie, EBV, adenovirus
Mononuclear lymphocytes in CSF
Symptomatic treatment. Complications associated with encephalitis and ICP
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22. Con Samaan
TB Meningitis
Usually insidious: difficult to diagnose in early stages (fever 30%, URTI 20%)
Rare in children in developed countries
If untreated is usually fatal
Meningitis usually occurs 3-6mths after primary infection
1 stage-lasts 1-2wk, fever malaise, headache
2 stage-+/- suddenly, meningeal signs
3 stage-worsening neurological condition, death
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23. Mortality/Morbidity Bac meningitis: Overall mortality 5-10%
Neonatal meningitis: 15-20%
Older children: 3-10%
Strep. pneumonia: 26-30%
H. influenza type B: 7-10%
N. meningitidis: %
30% neurological complications
4% Profound b/l hearing loss (sensorineural) in all bac meningitis

24. Mortality/Morbidity
Viral meningoencephalitis: Enteroviral fewer complications
Tuberculous meningitis: related to stage of disease
Stage I-30% morbidity
Stage II- 56%
Stage III-94%

25. Please, Please…..VACCINATE!
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Please, Please…..VACCINATE!
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