1
Fifth stage
Pediatric
Lec. 7
.د
رياض
1/3/2017
Meningitis
Causes and clinical picture
• It is inflammation of meninges by bacteria, viruses or fungal. Most serious is bacterial
M.
• Bacterial men.is life threatening infection so it need rapid diagnosis and prompt
antibiotic therapy, any delay in suggestion and in antibiotic treatment will lead to
serious mortality and morbidity states. It is medical emergency.
• features ; headache, fever, vomiting, irritability, seizures, neck stiffness, kerning sign
and brudziniski sign are +ve.
• Lumber puncture should be done to diagnose the CSF finding, and should be early
without delay for the start of antibiotics. fundoscopy should be done to exclude
papilledema. or CT SCAN OF BRAIN but here should take blood culture and give first
dose antibiotic before sending for CT scan.
Complications
Bacterial meningitis is serious condition and if not treated rapidly; may have mortality by
30%. Delay in treatment may lead to meningococcemia, DIC. Multiorgan failure, or
morbidity post meningitis problems as hydrocephalus, epilepsy ,cranial nerve palsy,
subdural effusion, sensorineural hearing defect.
Some misdiagnosed cases may be partially treated by outpatient doctors by oral antibiotics
and lead to diagnostic confusion.
Lumber puncture
• Contraindicated in;
• Increased intracranial pressure as indicated by focal neurological sign and
bradycardia and by papilloedema or persistent tense bulging fontanele in case of still
open. or if the patient is depressed in mentation or be cardiorespiratory
compromise, or if has infection at the lumber site.
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Treatment
• Should be rapid by conservative fluid therapy and antibiotics; Imperical therapy
• combination of ceftriaxone+vancomycin+acyclovir if viral cause cannot excluded.
Then specific antibiotic according culture &sensitivity result can be choosed. Steroid
usually dexamethasone should be started soon; together or before the start of
antibiotics to get benefit from its anti-inflamatory effect and to reduce adhesions in
the meninges.
• Continue therapy for10-14 days.
• Bacteria agent are; N.meningitis, H.influenza b.,pneumococcus; are most common
Partially treated meningitis
• Partially treated bacterial meningitis
• It is due to wrongly antibiotics given before considering the real diagnosis in the
patient as erroneously some doctors miss the diagnosis and give oral or injectable
antibiotics on assumption of simple upper respiratory infection for at least 24 hours
and so this will mask the CSF findings. Usually CSF will show normal pressure and
normal sugar,proteins remain elevated for some days and cells may show
lymphocytosis, and gram stain and culture may be negative.Diagnosis for bacterial
antigens by latex agglutination test for CFS may detect positive finding for
pneumococcus,meningococcus,or H,influenza
CSf finding in meningitis