MENINGITIS
INTRODUCTION
Meningitis is an inflammation of the
meninges , the protective membranes
that surround the brain and spinal cord.
Common causes of meningitis may
include:
Bacteria, Virus, Fungi and Parasites.
Most episodes of meningitis result from
hematogenous seeding of infection
from other sites to the meninges.
1. Bacterial causes
Varies with age:
1. Newborn to 3 months of age:
E. coli and other coliforms, group B Streptococci,
Listeria monocytogenes, Strep pneumoniae,
H. influenza type b, Neisseria meningitidis
2. Age 3 months to adolescence:
N. meningitidis, S pneumoniae, H influenza type b
(in young children)
Mycobacterium tuberculosis is most common in
young children, but can affect children of any
age.
. Fungal Causes
Common in immunocompromised
patients. May include:Histoplasma ,
Coccidioides ,Paracoccidiodes ,Candida
, Aspergilus Cryptococcus neoformans
Viral Causes (aseptic meningitis)
include:-
Mumps
Enterovirus (coxackie, polio)
Adenovirus and
Herpes simplex
Classification of meningitis
1. Based on duration, meningitis is classified
as:
Acute: symptoms present within a period of 0 –
24 hrs
Sub acute: symptoms lasting from 1-7 days.
Chronic: symptoms lasting over 7 days
2. Based on aetiology:
Bacterial meningitis
Viral (aseptic) meningitis
Fungal meningitis
Clinical Presentation: Symptoms and
signs
1. Young infants < 3 months: The signs and
symptoms are non specific and may include:
Fever or hypothermia
Bulging fontanelle or acute increase in head
circumference
Convulsions / seizures
High-pitched cry, irritability
Lethargy, altered mental state
Apnoea
Poor feeding, vomiting.
2. Children > 3 months to
adolescents:
Fever is present in about ~ 50% of
patients.
Headache, photophobia, stiff neck, irritability or
lethargy, vomiting and altered level of
consciousness.
Kerning’s sign in older children (inability to
completely extend the leg).
Brudzinski’s sign in older children (flexion
at the knee in response to forward flexion
of the neck).
Convulsions in 20 – 30% of cases.
Focal neurological deficits due to vasculitis
or thrombosis of blood vessels.
Papilledema (Swelling of the optic disc
(where the optic nerve enters the eyeball);
usually associated with an increase in
intraocular pressure) is uncommon unless
in advanced cases. This suggests increased
intracranial pressure.
Laboratory
Investigations
1. CSF
Lumbar puncture or a shunt tap is
performed as soon as the diagnosis of
meningitis is suspected.
CSF should be examined for:
Microbiology and
Biochemistry
Laboratory Investigations cont.
2. C-Reactive protein (CRP).
3. Blood culture and other cultures (urine,
abscess, and middle ear).
4. Full Blood Picture (CBC) and ESR.
5. Serum electrolytes, Creatinine.
Investigations cont
6.Other examinations
Electro encephalogram (EEG) if seizures are
prominent.
Head imaging (CT). Indications for CT are:
Focal neurological examination findings,
Seizures,
Increasing head circumference,
Lack of improvement despite appropriate
treatment and
Suspected brain abscess.
CT should only be done when the patient is
stable.
Medical Treatment of Meningitis pediatric
1. Triage and ensure the ABCDs.
2. IV line for IV medication and rehydration
3. Drug therapy.
Treatment of Bacterial meningitis 1
Give antibiotic treatment as soon
as possible:
1. Infants < 3 month old:
Ampicillin 200 mg/kg/day IV 6hr,
PLUS
Cefotaxime 200 mg/kg/day IV 6hr
for 10 to 14 days
Treatment of bacterial meningitis 2
2. Age 3 months to < 18 years;
choose on of the following regimens:
1)Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Ampicillin 50 mg/kg IV (or
IM) 6 hourly
2)Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Benzyl penicillin 6o mg/kg
(100,000 IU /kg) IV or IM 6 hourly.
Treatment of bacterial meningitis 2
2. Age 3 months to < 18 years;
choose on of the following regimens:
1)Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Ampicillin 50 mg/kg IV (or
IM) 6 hourly
2)Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Benzyl penicillin 6o mg/kg
(100,000 IU /kg) IV or IM 6 hourly.
Treatment of bacterial meningitis 3
Alternative treatment:
If Haemophilus influenza or
Pneumococcus is common;
1) Ceftriaxone 50 mg/kg IV or IM 12 hourly or
100 mg/kg IV od for up to 10 – 14 days, or
2) Cefotaxime 50 mg/kg every 6 hrs for 3
weeks.
Supportive Treatment
Give paracetamol 15 mg/kg 6 – 8 hrly
for fever (>38.50 C)
IV fluids: isotonic fluids at
maintenance rate (250 ml/24hrs).
Feeding according to age requirement
(75 – 100 kcal/kg/day).
Give anticonvulsant if convulsing
Correct hypoglycemia if present
NGT for feeding
Physiotherapy
management
Monitor vital signs 2-4 hrly (Temperature, Pulse
rate, Oxygen saturation, BP, and Respiratory
Rate)
Monitor Input/output
Give treatment as prescribed.
Maintain a clear airway
• Turn the patient every 2 hours.
• Do not allow the child to lie in a wet bed.
• Pay attention to pressure points
Monitor IV fluids very carefully and examine
frequently for signs of fluid overload
monitor the child’s state of consciousness,
respiratory rate and pupil size every 3 hours during
the first 24 hours (thereafter, every 6 hours).
On discharge, assess all children for neurological
problems, especially hearing loss.
Measure and record the head circumference of
infants.
If there is neurological damage, refer the child for
physiotherapy, if possible, and give simple
suggestions to the mother for passive exercises
