Meningitis in children

Meningitis in children

1. Dr.Azad A Haleem AL.Mezori MRCPCH,DCH , FIBMS Lecturer University Of Duhok College Of Medicine Pediatrics Department 2019 [email protected] Meningitis in children

2. Meningitis Infection and inflammation of the meninges surrounding the brain by direct inoculation or hematogenous spread.

3. 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

4. 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

5. 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

6. 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

7. 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

8. Neurologic sequelae include focal deficits, seizures, hearing loss, and vision impairment . The most common permanent neurologic sequel is hearing loss . Complications

9. Complications: include subdural effusion, intracranial infection (subdural empyema , brain abscess), cerebral infarction, hydrocephalus , diabetes insipidus , and disseminated infection (arthritis, pneumonia). Complications

10. 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

11. 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

12. 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

13. 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