Pediatric_Meningitis_Diagnostics_and_Management (1).pptx

Pediatrics meningitis and diagnostics using lab tests and clinical examination

1. Pediatric Meningitis: Diagnostics and Management

2. Introduction to Meningitis • Meningitis; is inflammation of the tissue s urrounding the brain and spinal cord,usually caused by an infection • Importance of early diagnosis to prevent disease progression and therefore disabilities (hearing loss,visual imparement,mental lag e.tc)

3. Radiological Procedures CT scan and MRI are the most common preffered N euroimaging in meningitis cases is used to detect and monitor complications Hydrocephalus Subdural effusion empyema infarction abcess thrombosis

4. Laboratory Diagnostic Procedures • Lumbar puncture and cerebrospinal fluid (CSF) analysis Complete blood count • Blood cultures PCR serology for specific pathogens

5. CSF EXAMINATION NORMAL CSF PROFILE; Opening pressure;50-180 mmH2O Gross appearance;clear and colourless Glucose;40-85 mg/dl Protein;15-45mg/dl Leukocyte;0-5Ul in adults, upto 30 Ul in newborns LP should not be done when its contraindications are present; increased intracranial pressure infected skin over puncture site

6. Bacterial Meningitis: Diagnosis and Management CLINICAL PICTURE Classic triad of fever headache and neck stiffness Kernig sign –inability to extend the leg after the thigh is flexed to a right angle with the axis of the trunk Brudzinski leg sign-passive flexion of one hip –flexion of other hip and knee Brudzinski neck sign-passive flexion of the neck-flexion of the hip and knee Stupor and drowziness Convulsions-usually generalized Coma Photophobia Altered mental status

7. CSF findings Opening pressure; increased Gross appearance; turbid Glucose;<40 mg/dl Protein;>250 mg/dl Leukocyte;>500 UL Culture; yields bacterial cause in upto 80% of the cases CSF gram stain and acid fast bacillus stain; Allows for rapid identification of bacteria. Chances for detection increase with higher concentration of bacteria and reduces with prior use of antibiotic CSF can be sent for geneXpert MTB which is preffered in suspected cases of TB Meningitis Complete blood count: shows elevated wbc count Serum electrolytes : to monitor SIADH Syphilis testing; CSF VDRL has high specificity ,but negative CSF VDRL doesn't rule out syphilis

8. Management

9. supportive mx 2)Supportive therapy ABCs Measures to decrease ICP(intracranial pressure) -Fluid restriction -Furosemide 1mg/kg iv repeated medical and neurological assesment of patient Important laboratory studies include: blood urea nitrogen; serum sodium, chloride, potassium, and bicarbonate levels; urine output and specific gravity; complete blood countsinitially the patient should recieve nothing by mouth. If a patient is normovolemic, with normal blood pressure, intravenous fluid administration should be restricted to one-half to two-thirds of maintenance, or 800-1,000 mL/m2/24 hr, until it can be established that increased ICP or SIADH is not present .Fluid restriction is not appropriate in the presence of systemic hypotensionseptic shock may requires fluid resuscitation and therapy with vasoactive agents such as dopamine and epinephrine

10. VIRAL MENINGITIS Most common cause is HSV and enterovirus common causes of recurring meningitis; varicella zoster virus(concurrent chicken pox,shingles) EBV Mumps clinical picture headache, fever, stiff neck seizures frontal/retroorbital headache non-blanching red purple or brown rash

11. Viral meningitis CSF findings Opening pressure; normal to elevated Glucose; normal . decreased in mumps Protein; <100 mg/dl moderate increase Leukocyte; <100 cells /UL Cell differential; neurophils in early stages,lymphocytes elevated as disease progresses CSF polymerase chain reaction ;is the gold standard in detecting viral meningitis, has greater sensitivity than culture swabs ;throat ,nasopharengeal and stool swabsmay detect enterovirus if CSF PCR is negative

12. Management treatment Acyclovir 10 mg/kg iv every 8hrs for HSV Pleconaril for enteroviral meningitis Ganticlovir for CMV supportive involves use of antipyretic, analgesics antoconvulsants and ICP lowering measures

13. Parasitic Meningitis: Diagnosis • Common parasites include Naegleria fowleri (brain eating amoeba), Toxoplasma gondii ,taenia solium,angiostrongylus cantonensis/rat lung worm clinical picture fever ,severe headache,visual disturbances,nausea csf findings most prominent finding is eosinophilia reduced Glucose elevaed protein level travel/exposure history is important in diagnosis

14. management Treatment varies with organism; i.v amphotericin+miltefosine used in naegleria fowleri albendazole/praziquantel used in taenia soleum albendazole and ivermectin may be used cautiously as they may worsen symptoms in some parasite supportive antiepileptics for seizure control cortocosteroids used to reduce inflammation especially in eosinophilic meningitis

15. Fungal Meningitis: Diagnosis and Management • Common fungal include Cryptococcus, Candida ,histoplasmosis Csf findings Reduced Glucose level Elevated Protein Presence of b-D Glucan(a glycoprotein found in fungal cell wall) is detected in all patients with fungal meningitis Lymphocytic pleocytosis in cryptococcal and eosinophylic pleocytosis in Cimmitis Fungal Culture Fungal serology e,g presence of hisma in csf ct and MRI needed to detect granulomas

16. management Amphotericin B;is the main treatment of all intracranial fungal infections Amphotericin B + Flucytosine used for aspergillosis,candidiasis and cryptococcosis(in immunocompitent) Fluconazole 400 mg PO for 8wks for cryptococcosis(in immunocompromised) surgical intervention in cases of granuloma

17. Prevention Strategies • Vaccinations (e.g., pneumococcal, meningococcal vaccines) Early detection