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MENINGITIS Shashi Vaish Paediatric SpR AMNCH Tallaght Con Samaan
Shashi Vaish Paediatric SpR AMNCH Tallaght Con Samaan
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Con Samaan Bacterial Viral Fungal
CAUSES Bacterial Viral Fungal Con Samaan
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N. meningitides G-ve diplococci E.Coli G-ve bacilli Streptococci-GBS
Con Samaan N. meningitides G-ve diplococci E.Coli G-ve bacilli Streptococci-GBS G+ve cocci Strep. pneumoniae G+ve diplococci Con Samaan
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Bacterial Meningitis - Organisms
Con Samaan Bacterial Meningitis - Organisms • Birth - 4 wks: GBS, E.coli wks: GBS, E.coli, Pneumococcus Salmonella, Listeria, H. Influenza 3 mths - 3 yrs: Pneumococcus, Meningococcus H. Influenza 3 yrs+ adult: Pneumococcus, Meningococcus Con Samaan
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Bacterial Meningitis - Pathogenesis
Con Samaan Bacterial Meningitis - Pathogenesis Infection of upper respiratory tract Invasion of blood stream (bacteraemia) Seeding & inflammation of meninges Con Samaan
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Meningitis: Clinical features
Con Samaan Meningitis: Clinical features Newborn & Infants: non-specific Fever Irritability Lethargy Poor feeding High pitched cry, bulging AF Convulsions, opisthotonus Con Samaan
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Kernig’s sign
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Brudzinski’s sign
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Meningitis: older children
Con Samaan Meningitis: older children Con Samaan
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Acute Meningococcaemia
Con Samaan 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 Con Samaan
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Con Samaan Septicaemia Con Samaan
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Con Samaan Purpura fulminans Con Samaan
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Con Samaan Clinical features Con Samaan
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Con Samaan Clinical features Con Samaan
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Con Samaan Clinical features Con Samaan
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Con Samaan Clinical features Con Samaan
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Con Samaan Tumbler (glass) test Con Samaan
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DIAGNOSIS Hx & PE Investigations: FBC Blood C/S R/L/B Skin scrapings
Con Samaan DIAGNOSIS Hx & PE Investigations: FBC R/L/B CRP Coag Blood gas Glucose Blood C/S Skin scrapings PCR CXR+ Mantoux if TB suspected Con Samaan
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Con Samaan Diagnosis LP Con Samaan
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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 Con Samaan
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Bacterial Meningitis Management
Con Samaan Bacterial Meningitis Management • Medical emergency • Early diagnosis essential Immediate optimum treatment Intensive supportive therapy Rehabilitation Prophylaxis to family Notification to GP & Public Health Con Samaan
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Bacterial Meningitis/Meningococcaemia Management
Con Samaan 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 Con Samaan
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Antibiotics Less than 2 months of age:
Con Samaan Antibiotics Less than 2 months of age: Ampicillin + Cefotaxime+/- Gentamicin Treat for 3 weeks (neonate) Over 2 months: Cefotaxime Treat for 7-10 days Con Samaan
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Prophylaxis Rifampicin: Children 5mg/kg bd x 2/7
Con Samaan Prophylaxis Rifampicin: Children 5mg/kg bd x 2/7 Adults: 600 mg bd x 2/7 Pregnant contact: Cefuroxime IM x 1 dose OR Just do T/S and await result Con Samaan
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Meningitis - Complications
Con Samaan Meningitis - Complications Septic shock - DIC Cerebral oedema Seizures Arteritis/venous thrombosis Subdural effusions Hydrocephalus . Abscess . Brain damage Deafness Con Samaan
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Meningococcaemia - poor prognosis
Con Samaan Meningococcaemia - poor prognosis • Onset of Petechiae within 12 hrs • Absence of meningitis • Shock (BP 70 or less) • Normal or low WCC • Normal or low ESR Con Samaan
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Con Samaan Subdural Effusion Failure of temp to show progressive reduction after 72 hours Persistent positive spinal cultures after 72 hr Occurrence of focal/ persistent convulsions Persistence/recurrence of vomiting Development of focal neurological signs Clinical deterioration after 72 hr especially ICP Con Samaan
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Partially treated meningitis
Con Samaan Partially treated meningitis 50% cases prior antibiotic - alters the findings in bacterial meningitis - Accurate history vital CSF mainly lymphocytic [not usual polys] Can have normal glucose +ve cultures reduced by 30% Gram stain reduced by 20% Con Samaan
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Viral meningitis Most common infection of CNS especially in <1yr
Con Samaan 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 Con Samaan
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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 Con Samaan
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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
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Mortality/Morbidity Viral meningoencephalitis: Enteroviral fewer complications Tuberculous meningitis: related to stage of disease Stage I-30% morbidity Stage II- 56% Stage III-94%
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Con Samaan VACCINATE! Con Samaan
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Con Samaan THANK YOU Con Samaan
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