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Meningitis in children

Meningitis in children

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Meningitis in children

  1. 1. Meningitis • Infection and inflammation of the meninges surrounding the brain by direct inoculation or hematogenous spread.
  2. 2. • Epidemiology: • can be caused by bacteria, viruses, or, rarely, fungi. • Viral meningitis is caused principally by entero-viruses, including coxsackieviruses, echoviruses, and, in unvaccinated individuals, polioviruses. Meningitis
  3. 3. • The organisms commonly causing bacterial meningitis : S. pneumoniae , N. meningitidis and H. influenzae type b . • Incidence of H. influenzae type b meningitis has decreased dramatically as a result of immunization. the most frequent pathogens varied according to age as follows: • 1 month and <3 months—GBS (39%), gram-negative bacilli (32%), S. pneumoniae (14%), N. meningitidis (12%). • ≥3 months and <3 years—S. pneumoniae (45%), N. meningitidis (34%), GBS (11%), gram-negative bacilli (9%). • ≥3 years and <10 years—S. pneumoniae (47%), N. meningitidis (32%). • ≥10 years and <19 years—N. meningitidis (55%). Meningitis
  4. 4. • Clinical manifestations: Preceding upper respiratory tract symptoms are common. • Rapid onset is typical of S. pneumoniae and N. meningitidis. • Indications of meningeal inflammation include headache, irritability, nausea, nuchal rigidity, lethargy, photophobia, and vomiting. • Fever usually is present. Meningitis
  5. 5. • Kernig and Brudzinski signs of meningeal irritation usually are positive in children older than 12 months of age. • In young infants, signs of meningeal inflammation may be minimal with only irritability, restlessness, depressed mental status, and poor feeding. Clinical manifestations
  6. 6. • Focal neurologic signs, seizures, arthralgia, myalgia, petechial or purpuric lesions, sepsis, shock, and coma may occur. • Increased intracranial pressure is reflected in complaints of headache, diplopia, and vomiting. • A bulging fontanel may be present in infants. • Ptosis, sixth nerve palsy , bradycardia with hypertension, and apnea are signs of increased intracranial pressure with brain herniation. • Papilledema is uncommon, unless there is occlusion of the venous sinuses, subdural empyema, or brain abscess. Clinical manifestations
  7. 7. • Neurologic sequelae include focal deficits, seizures, hearing loss, and vision impairment. • The most common permanent neurologic sequel is hearing loss. Complications
  8. 8. Complications: include  subdural effusion,  intracranial infection (subdural empyema, brain abscess),  cerebral infarction,  hydrocephalus,  diabetes insipidus, and  disseminated infection (arthritis, pneumonia). Complications
  9. 9. Diagnosis Cerebrospinal Fluid Evaluation (CSF) Normal Bacterial Viral Tuberculosis WBC per mL 0–5 (allow up to 30 in neonates) 100–100,000 50–1,000 100 s Glucose (mg/dL) 45–65 Low Normal Low Protein (mg/dL) 20–45 High Slightly increased High Gram stain Negative Positive Negative Negative Meningitis
  10. 10. Treatment • In neonates, initiate ampicillin plus cefotaxime. • Cefotaxime will treat GBS and gram-negative enterics and penetrates the CSF. • Ampicillin is mainly used for its effectiveness against Listeria monocytogenes. Meningitis
  11. 11. • In infants and children outside of the neonatal age group, third-generation cephalosporin & Vancomycin • Third-generation cephalosporin is generally used empirically, as it treats pathogens most likely recovered at this age, including S. pneumoniae, N. meningitidis & H. influenzae type b . • Vancomycin is added for resistant S. pneumoniae. Treatment Meningitis
  12. 12. • Duration of treatment is 10 to 14 days for S. pneumoniae, 5 to 7 days for N. meningitidis, and 7 to 10 days for H. influenzae. • Dexamethasone shown to decrease hearing loss in those with meningitis due to H. influenzae type b (given before or concurrently with first dose of antibiotics). • Antibiotic prophylaxis of close contacts to those with meningococcal meningitis and H. influenzae type b meningitis is indicated. Treatment Meningitis

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Meningitis in children

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