Meningitis in children

Dhanya VJ, Assistant Professor, Child health nursing ,SUM Nursing college,Bhubaneswar

1. MENINGITIS DHANYA VJ ASSISSTANT PROFESSOR SUM NURSING COLLEGE

2. MENINGES The meninges is the system of membranes which envelops the central nervous system. It has 3 layers: 1. Dura mater 2. Arachnoid mater 3. Pia mater

3. DEFINITION Meningitis is an inflammation of the meninges, the protective membranes that surround the brain and spinal cord.

4. INCIDENCE Meningitis can occur at all ages but it is commonest in infancy. While 95% of the cases take place between 1 month- 5 years of age. It is more common in males than females

5. TYPES Bacterial meningitis / pyogenic meningitis Viral (aseptic) meningitis Tuberculous meningitis

6. Pyogenic Meningitis It is caused by a wide variety of pyogenic bacteria like hemophilius influenza, meningococcus , pneumococcus and streptococcus . Tuberculous meningitis It is caused by mycobacterium tuberculosis.

7. Viral meningitis The viral agents for aseptic meningitis include the following: Enterovirus (polio virus, Echovirus, Coxsackievirus ) Herpesvirus (Hsv-1,2, Varicella.Z,EBV ) Paramyxovirus (Mumps, Measles) Togavirus (Rubella) Rhabdovirus (Rabies) Retrovirus (HIV)

8. ETIOLOGY Common causes of meningitis may include : Bacteria, Virus, Fungi and Parasites 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 .

9. ETIOLOGY Viral Causes (aseptic meningitis) include:- Mumps Enterovirus ( coxackie , polio) Adenovirus and Herpes simplex

10. PATHOPHYSIOLOGY

11. CLINICAL FEATURES 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

12. 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. Convulsions in 20 – 30% of cases. Focal neurological deficits due to vasculitis or thrombosis of blood vessels. Papilledema (Swelling of the optic disc) CLINICAL FEATURES

13. Kernig’s sign - is assessed with the patient lying supine, with the hip and knee flexed to 90 degrees. In a patient with a positive Kernig's sign, pain limits passive extension of the knee

14. Brudzinski signs -A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip.

15. LABORATORY INVESTIGATIONS 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 Polymerase chain reaction

16. LABORATORY INVESTIGATIONS C-Reactive protein (CRP). Blood culture and other cultures (urine , abscess, and middle ear). Full Blood Picture (CBC) and ESR. Serum electrolytes, BUN, Creatinine Electro encephalogram (EEG) if seizures are prominent . Head imaging (CT).

17. MANAGEMENT Give antibiotic treatment as soon as possible : Infants < 3 month old: Ampicillin 200 mg/kg/day IV div q6hr , Cefotaxime 200 mg/kg/day IV div q6hr for 10 to 14 days

18. MANAGEMENT Age 3 months to < 18 years; choose on of the following regimens: Chloramphenicol 25 mg/kg IV (or IM) 6 hourly , plus Ampicillin 50 mg/kg IV (or IM) 6 hourly Chloramphenicol 25 mg/kg IV (or IM) 6 hourly , plus Benzyl penicillin 6o mg/kg (100,000 IU /kg) IV or IM 6 hourly

19. 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

20. NURSING 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. Monitor IV fluids very carefully and examine frequently for signs of fluid overload.

21. PREVENTION The vaccines against Hib , measles, mumps, polio, meningococcus , and pneumococcus can protect against M eningitis Hib vaccine: all infants should receive at 2,4,6 months of age & booster 1 year later. After 1 year 1 dose is given till the age of 5 years. Pneumococcal vaccine: 0.5 ml is given IM