Meningitis is commonly a complication of what?
primary bacteremia
What used to be the primary organism that caused pediatric meningitis?
Haemophilus influenza type b
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Why has the median a
...
Meningitis is commonly a complication of what?
primary bacteremia
What used to be the primary organism that caused pediatric meningitis?
Haemophilus influenza type b
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01:26
Why has the median age for meningitis shifted from age 15mo to 25yrs?
use of Haemophilus influenzae vaccine
What happens during bacteremia that leads to infection of the meninges?
Products of bacterial multiplication alter the permeability of the blood brain barrier and extend the infection to the brain and surrounding cerebrospinal fluid spaces.
What is a less common route of infection?
Hematogenous spread from a distant primary focal infection, direct extension from adjacent infection, or following cribriform plate or sinus infection.
What causes the neurologic damage that follows meningitis?
Results from direct inflammatory effects, brain edema, increased intracranial pressure, decreased cerebral blood flow, and vascular thrombosis.
What causes increased risk of meningitis?
Impaired splenic function
Immunosuppression/immunodeficiency
What bacterial agents are responsible for meningitis in neonates?
GBS
E. coli
L. monocytogenes
What bacterial agents are responsible for meningitis in older infants and children?
Strep pneumo
N. meningitidis
Sx of meningitis in infants?
irritability, inconsolability, hypotonia, and lethargy
Sx of meningitis in older children?
headache, photophobia, nausea, vomiting, neck pain/stiffness
Sx of fulminant meningitis?
shock, seizures, coma, febrile status epilepticus
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Rare sx of meningitis in infants?
hypothermia
Diagnostic tests to order.
CSF analysis: WBCs, glucose, protein, Gram stain and culture
Head CT (if focal neuro signs or increased ICP present)
What does CSF pleocytosis indicate?
Herpes encephalitis
What medication should be administered if viral cause is also suspected?
Acyclovir
When should acyclovir be part of the treatment regimen in infants and small children?
10 mg/kg/dose in neonates with seizures, or ill-appearing neonates and in neonates with vesicular lesions
What are the next steps in managing a patient in whom a LP is unobtainable?
Patient should be admitted, hydrated, given meningitis doses of antibiotics, and blood and urine cultures obtained. LP may be successful after hydration.
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