lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
TRANSCRIPT
Definition
• Meningitis – inflammation of the meninges• Encephalitis – infection of the brain
parenchyma
Signs and symptoms
• Fever• Altered consciousness, irritability,
photophobia• Vomiting, poor appetite• Seizures 20 - 30%• Bulging fontanel 30%• Stiff neck or nuchal rigidity• Meningismus (stiff neck + Brudzinski + Kernig
signs)
Clinical clues in meningitis
CSF FINDINGS IN ENCEPHALITIS+
CSF FINDINGS
Diagnosis – lumbar puncture
Bacterial meningitis - Organisms
Neonates• Most caused by Group B Streptococci• E coli, enterococci, Klebsiella, Enterobacter,
Samonella, Serratia, Listeria
Older infants and children• Neisseria meningitidis, S. pneumoniae,
tuberculosis, H. influenzae
Increased intracranial pressure (ICP)
• Papilledema CUSHING’S TRIAD• Bradycardia• Hypertension• Irregular respiration• ICP monitor (not routine)• Changes in pupils
Meningitis - Fluid management
• Restore intravascular volume & perfusion.• RESTRICTED I/V fluids to 2/3rd of
maintainance.• Monitor serum Na+ (osmolality, urine Na+)• If severely hyponatremic, give 3% NaCl • SIADH 4 - 88% in bacterial meningitis 9 - 64% in viral meningitis
• Diabetes insipidus• Cerebral salt wasting
Bacterial Meningitis - TreatmentNeonatal (<3 mo)
• Ampicillin (covers Listeria) +
• Cefotaxime.• Corticosteroids therapy (Dexametazon
0.6мg/kg /dose every 4 hrs for 2 days. The first doses is prescribe 10-15 min before a/b injections
Pneumococcal meningitis – Mgmt
• Vancomycin + cefotaxime or ceftriaxone, if > 1 month old.
• If hypersensitive (allergic) to beta-lactam antibiotics, use vancomycin + rifampin.
Antibiotic use inPneumococcal meningitis
• PenG 250,000 - 400,000 U/kg/day … Q 4 - 6 h• Ceftriaxone 100 mg/kg/day ..Q 12 - 24 h• Cefotaxime 200 - 300 mg/kg/day .. Q 8 h• Chloramphenicol 50 - 100 mg/kg/day .. Q 6 h
Vancomycin use inpneumococcal meningitis
• Vancomycin 60 mg/kg/day …Q 6 h
Complications of meningitis
• Hydrocephalus• Cranial nerve palsies• Mental retardation• Subdural effusion• Deafness• Blindness• Epilepsy
PROPHYLAXIS
• Meningococcal infection with rifampicin or ciprofloxacin.
• MenC, a meningococcal C conjugate vaccine. • A combined A and C meningococcal vaccine is
sometimes used prior to travel to endemic regions, e.g. Africa, Asia; and a quadrivalent ACWY vaccine .
• pneumococcal vaccine is used after recurrent meningitis, e.g. after a CSF leak following skull fracture. • Hib (Haemophilus influenzae).vaccine.rifampin
prophylaxis.
ENCEPHALITIS
• Encephalitis means inflammation of brain parenchyma, usually viral.
Acute viral encephalitis: The usual organisms are• herpes simplex,• ECHO,• Coxsackie, • mumps and• Epstein-Barr viruses• Adenovirus, varicella zoster, influenza, measles and
other viruses are rarer.
CLINICAL PICTURE
• Many encephalitides are mild . • In a minority, serious illness develops with
high fever, headache, mood change and drowsiness over hours or days.
• Focal signs, seizures and coma ensue. Death, or brain injury follows.
INVESTIGATIONS
• CT and MR imaging show diffuse areas of oedema, often in the temporal lobes.
• EEG.• CSF.• Viral serology .• Brain biopsy
TREATMENT
• Acyclovir.• Supportive measures • Prophylactic immunization against Japanese
encephalitis is advised for travelers to endemic areas in Asia.