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Meningitis and Meningococcal Disease - Coggle Diagram
Meningitis and Meningococcal Disease
Meningitis vs Meningococcal Disease
Meningitis
Inflammatory disease of the meninges
Epidemiology
Viral>Bacterial
Most viral meningitis is self limiting
Bacterial meningitis may have serious consequences
Meningococcal Sepsis
Sepsis secondary to invasive meningococcal bacterial infection which has not crossed the BBB
Meningitis
Causes
Infectious
Viral
Enterovirus
Adenovirus
EBV
HSV
HHV6
VZV
Bacterial
Neonate:
GBS
E coli
Listeria
1-3 months
GBS
Listeria
Strep pneumo
Neisseria meningitidis
3months - 3yrs
Strep pneumo
N meningitidis
GBS
E coli
Listeria
3-10 years
Strep pneumo
N meningitidis
10 years
N meningitidis
Non-infectious
Malignancy
Autoimmunity
Clinical Features
Infant
Classic Presentation
Fever
Irritability
Poor feeding
Bulding fontanelle
Seizure / altered conciousness
Rash
Older Child
Headache
Neck stiffness
Photophobia
Seizures
Altered conciousness
Rash
Classic Signs
Kernig's sign
Supine patient with hip flexed 90°
Knee cannot be fully extended
Brudzinski's neck sign
Neck rigidity
Passive flexion of neck causes flexion of both legs and thighs
Investigations
Bloods
FBC
WCC differntial and platelets
CRP
Elevetion in infx
COAG
Can cause petechia / DIC
U&E
Check renal fx and electrolyte dysfx
Glucose
Perform in any critial child
Initial hyperglycaemia
Blood culture
Suspected sepsis
PCR
Blood and CSF for potential organisms
Other tests indicated by cliical situation
Lumbar puncture
Indication
Clinically stable child
Send for MCS(microscopy, culture and sensitivity) , glucose, protein, PCR (viral and bacterial
Knoiw how to interpret this
C/I
Cardiorespiratory instability
Focal neurology signs
Signs of ICP
High BP + brady (cushing's sign)
Papilloedema
Coma
Coagulopathy
Thrombocytopenia
Local infection
Management
Early tx with Abx improves outcomes
Antibiotics
Over 8 weeks
Cefotaxime IV
Neonates
Cefotaxime
Amoxicillin
Gentamicin
All IV
Duration depends on presentation and organism
Typically min 7 days
Additional tx
Acyclovir - viral aetiology
Dexamethasone - Hib / Strep pneumo
Follow Up
Developmental follow up
Hearing test (even for viral men)
Report to public health
Sepsis and Septic Shock
Sepsis
A life threatening organ dysfunction due to a dysregulated host response to infx
Treatment
Sepsis 6
Consider dexmethasone
Septic Shock
Sepsis that has circulatory, cellular and metabolic abnormalities that are associated with a greater risk of mortality than sepsis alone
Type of distributive shock
Medical emergency
Meningitis vs Sepsis
Sepsis
Infant <2months
GBS
E coli / gram negatives
Listeria
Older children
N menigitidis
Strep pneumo
Staph aureus
GAS
Bacterial Meningitis
Infants <2months
GBS
E coli / other gram negatives
Listeria
Children > 2months
Strep pneumo
N meningitidis
HiB
Viral Meningitidis
Enterovirus
HSV
HHVV6
VZV
Meningococcal Disease
Bacterial infection caused by N meningitidis
Gram (-)
Facts
Commensal bacteria in the nasopharynx - up to 50%
6 serogroups known to cause disease
A
B (vaccine)
C (vaccine)
W
X
Y
Spread by respiratory sectretinos
Childhood predominance - 50% under 4
Ireland has highest incidence per square meter
10% mortability
Presentations
Meningitis
May lead to neurodevelopmental sequelae
Septicaemia
More dangerous
Meningitis + Septicaemia combo
Arthritis
Osteomyelitis
Conjunctivitis
Risk Factors
Younger age
Vaccination status
Socioeconomic disadvantage
Immunocompromise
Overcrowding
Medical emergency
Clinical Features
Early
Irritable
Poor feeding
Lethary
Pale
Fever
Late
Rash
Classic non-blanching petechial / purpuric rash
11% exclusively petechial rash
30% nonspecific maculopapular rash with non-blanching elements
Signs
Deranged vitals
↑HR, RR, CRT
↓BP
Pallor
Photophobia
Neck stiffness
May be simply shock / critically unwell
Investigations
FBC
CRP
Coag
U&E
Glucose
Blood culture and PCR
Lumbar puncture
Other : Blood gas, LFTs
Management
Emergency management
Stabilisation with ABCDE
Early antibiotics
Broad spectrum
Early admin
Prolonged course IV min 7 days
Supportive care
IV fluids
Analgesia
Organ-specific management
Sequelae / Complications
8-10% die of septic shock
10% deafness
10% neurodevelopmental complications
5% subtle neurodevelopmental abnormalities
Prevention
Men C vaccine schedule
Men B vaccine schedule
Men ACWY vaccine
Used in high risk eg dialysis, immunodeficiency
Differential Diagnoses
Rash and Fever
DIC
HUS
HSP
ITP - Immune thrombocytopenia
Sepsis of any aetiology
Critically unwell
Sepsis
Encephalutis
DKA
ICH
Metabolic or cardiac deterioration
Investigations
FBC
CRP
Coag
U&E
Glucose
Blood culture and PCR
Lumbar puncture
Other : Blood gas, LFTs
Encephalitis
Inflammation of brain tissue
Causes
Direct invasion by nurotoxic virus
Following disordered neuro-immunological response
3, Slow virus infx
Causative organisms
Viruses
Enterovirus
HSV
HHV6
VZV
Mycoplasma
Lyme disease
Clinical Features
Similar to meningitis + behavioural changes
Behavioural changes
Focal neurological palsies
Impaire conciousness
Fever
Less acute than meningitis
Investigtions
Bloods
FBC
RLB profile
CRP
Lactate
VBG
Metabolic work up
Neuroimaging
MRI brain
Lumbar puncture
Micro
Cell count
Virology
PCRs
Viral swabs
Nasal
Rectal
Treatment
Abx + Aciclovir while waiting on microbiology results
Post Exposure Guidlines
All
unimmunised
household contact should have
MenB&C
vaccination + Chemoprophylaxis
Includes child-minders + carers
Ciprofloxacin
Recent black box warning due to increased incdidence of tendonitis association
Liase with micro before prescribing
Rifampicin 1st line
