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MENINGITIS Shashi Vaish Paediatric SpR AMNCH Tallaght Shashi Vaish Paediatric SpR AMNCH Tallaght.

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Presentation on theme: "MENINGITIS Shashi Vaish Paediatric SpR AMNCH Tallaght Shashi Vaish Paediatric SpR AMNCH Tallaght."— Presentation transcript:

1 MENINGITIS Shashi Vaish Paediatric SpR AMNCH Tallaght Shashi Vaish Paediatric SpR AMNCH Tallaght

2 CAUSES Bacterial Viral Fungal

3 N. meningitides G-ve diplococci N. meningitides G-ve diplococci Streptococci-GBS G+ve cocci Streptococci-GBS G+ve cocci Strep. pneumoniae G+ve diplococci Strep. pneumoniae G+ve diplococci E.Coli G-ve bacilli E.Coli G-ve bacilli

4 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

5 Bacterial Meningitis - Pathogenesis Infection of upper respiratory tract Invasion of blood stream (bacteraemia) Seeding & inflammation of meninges

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

7 Kernig’s sign

8 Brudzinski’s sign

9 Meningitis: older children

10 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

11 Septicaemia

12 Purpura fulminans

13 Clinical features


15 Clinical features

16 Clinical features

17 Tumbler (glass) test

18 DIAGNOSIS Hx & PE Investigations: FBC R/L/B CRP Coag Blood gas Glucose Blood C/S Skin scrapings PCR CXR+ Mantoux if TB suspected

19 Diagnosis

20 CSF FINDINGS  Bacterial Viral TB  Cells10-100,000 <2,  polys lymphs lymphs  Glucoselow normal very low  ProteinN-INC N-INC N-INC  G-Stain gen +ve -ve +ve Zn

21 Bacterial Meningitis Management Medical emergency Early diagnosis essential Immediate optimum treatment Intensive supportive therapy Rehabilitation Prophylaxis to family Notification to GP & Public Health

22 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

23 Antibiotics Less than 2 months of age: Ampicillin + Cefotaxime+/- Gentamicin Treat for 3 weeks (neonate) Over 2 months: Cefotaxime Treat for 7-10 days

24 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

25 Meningitis - Complications Septic shock - DIC Cerebral oedema Seizures Arteritis/venous thrombosis Subdural effusions Hydrocephalus. Abscess. Brain damage Deafness

26 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

27 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

28 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%

29 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

30 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

31 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

32 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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