Please enable JavaScript.
Coggle requires JavaScript to display documents.
Meningitis - Coggle Diagram
Meningitis
Bacterial
may have severe consequences
over 80% of cases are under 16
5-10% mortality
10% of survivors have long term neuro impairment
pathophysiology
usually follows bacteraemia
most of damage caused by host response
inflamm mediators released
leucocytes activated
endothelial damage -> cerebral oedema -> raised ICP -> decreased cerebral blood flow
vasculopathy -> cerebral infarct -> CSF resorption blocked -> hydrocephalus
causative organisms vary according to child's age
neonate-3mo: GBS, E Coli, L monocytogenes
1mo-6y/o: N men, S pneumo, Hib
over 6y/o: N men, S pneumo
presentation
early signs + sx non-specific, esp in infants + young children
only children old enough to talk will describe classic sx
neck stiffness
can also be in tonsilitis + cervical lymphadenopathy
Brudzinski sign: flexion of neck while supine causes flexion of knees + hips
Kernig sign: lie child supine, flex knees + hips, then extend knee, +ve if pain in back
signs of shock
tachycardia
tachypnoea
prolonged cap refill
hypotension
purpura (should be assumed meningococcal sepsis in any febrile child)
fever, headache, photophobia, lethargy, poor feeding, vomiting, irritability, hypotonia, drowsiness, LOC, seizures, bulging fontanelle, opisthotonus, focal neuro signs, altered consciousness, rarely papilloedema
Investigations
FBC
blood glucose + gas
coag screen
CRP
U+E, LFTs
cultures - blood, throat swab, urine, stool
rapid antigen test on blood/urine/CSF
LP
CIs
CR instability
focal neuro signs
signs of raised ICP
coagulopathy/thrombocytopenia
infection @ LP site
consider MRI, CT, EEG
management
no delay in antibiotic admin
3GC - cefotaxime, ceftriaxone
length of antibiotic course depends on causative organism + clinical response
beyond neonatal period dexamethasone given to reduce risk of long term comps
prophylactic rifampicin given to all household to eradicate NP carriage of N men + Hib
if Men C give household contacts Men C vaccine
comps
hearing loss
due to inflamm damage of cochlea
may benefit from hearing aid or cochlear implant
cranial N palsies
due to local vasculitis
cerebral infarct
seizures, may lead onto epilepsy
subdural effusion
a/w Hib + pneumococcal
confirmed by CT
most resolve spontaneously
may require prolonged antibiotics
hydrocephalus
VP shunt may be required
cerebral abscess
signs of SOL
temp fluctuates
confirmed on CT
may need drainage
partially txed bacterial meningitis
when PO antibiotics given
raised white cells in CSF, but cultures -ve
rapid antigen screens + PCR helpful
recurrent bacterial meningitis
immunodeficiency
structural abnormalities of skull/meninges
Viral
most common cause (accounts for 2/3)
most self resolving
enteroviruses, EBV, adenoviruses, mumps
usually much less severe than bacterial, full recovery expected
investigations
CSF PCR
cultures: stool, urine, NP aspirate/swabs
serology
Causes
viral infections
bacterial infections
non-infectious aka aseptic meningitis
malignancy
AI disease
uncommon pathogens
mycoplasma
borrelia burgdorferi (Lyme disease)
fungi
more likely if child immunodeficient
CSF changes
Bacterial: turbid, increased polymorphs, high protein, low glucose
Viral: clear, high lymphocytes, normal/high protein, normal/low glucose
TB: turbid or clear, high lymphocytes, high protein, low glucose
Intro
inflamm of meninges
inflamm cells in CSF