Definition
• Meningitis – inflammation of the meninges
• Encephalitis – infection of the brain
parenchyma
Signs and symptoms
• Fever
• Altered consciousness, irritability,
photophobia
• Vomiting, poor appetite
• Seizures 20 - 30...
Clinical clues in meningitis
CSF FINDINGS
Diagnosis – lumbar puncture
Bacterial meningitis - Organisms
Neonates
• Most caused by Group B Streptococci
• E coli, enterococci, Klebsiella, Enterob...
Increased intracranial pressure (ICP)
• Papilledema
CUSHING’S TRIAD
• Bradycardia
• Hypertension
• Irregular respiration
•...
Meningitis - Fluid management
• Restore intravascular volume & perfusion.
• RESTRICTED I/V fluids to 2/3rd of
maintainance...
• Diabetes insipidus
• Cerebral salt wasting
Bacterial Meningitis - Treatment
Neonatal (<3 mo)
• Ampicillin (covers Listeria)
+
• Cefotaxime.
• Corticosteroids therapy...
Pneumococcal meningitis – Mgmt
• Vancomycin + cefotaxime or ceftriaxone, if > 1
month old.
• If hypersensitive (allergic) ...
Antibiotic use in
Pneumococcal meningitis
• PenG 250,000 - 400,000 U/kg/day … Q 4 - 6 h
• Ceftriaxone 100 mg/kg/day ..Q 12...
Vancomycin use in
pneumococcal meningitis
• Vancomycin 60 mg/kg/day …Q 6 h
Complications of meningitis
• Hydrocephalus
• Cranial nerve palsies
• Mental retardation
• Subdural effusion
• Deafness
• ...
PROPHYLAXIS
• Meningococcal infection with rifampicin or
ciprofloxacin.
• MenC, a meningococcal C conjugate vaccine.
• A c...
ENCEPHALITIS
• Encephalitis means inflammation of brain
parenchyma, usually viral.
Acute viral encephalitis: The usual org...
CLINICAL PICTURE
• Many encephalitides are mild .
• In a minority, serious illness develops with
high fever, headache, moo...
INVESTIGATIONS
• CT and MR imaging show diffuse areas of
oedema, often in the temporal lobes.
• EEG.
• CSF.
• Viral serolo...
TREATMENT
• Acyclovir.
• Supportive measures
• Prophylactic immunization against Japanese
encephalitis is advised for trav...
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr
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Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr

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Lec meningitis dr saima batool .associate professor pediatrics ucm,lhr

  1. 1. Definition • Meningitis – inflammation of the meninges • Encephalitis – infection of the brain parenchyma
  2. 2. Signs and symptoms • Fever • Altered consciousness, irritability, photophobia • Vomiting, poor appetite • Seizures 20 - 30% • Bulging fontanel 30% • Stiff neck or nuchal rigidity • Meningismus (stiff neck + Brudzinski + Kernig signs)
  3. 3. Clinical clues in meningitis
  4. 4. CSF FINDINGS
  5. 5. Diagnosis – lumbar puncture
  6. 6. Bacterial meningitis - Organisms Neonates • Most caused by Group B Streptococci • E coli, enterococci, Klebsiella, Enterobacter, Samonella, Serratia, Listeria Older infants and children • Neisseria meningitidis, S. pneumoniae, tuberculosis, H. influenzae
  7. 7. Increased intracranial pressure (ICP) • Papilledema CUSHING’S TRIAD • Bradycardia • Hypertension • Irregular respiration • ICP monitor (not routine) • Changes in pupils
  8. 8. Meningitis - Fluid management • Restore intravascular volume & perfusion. • RESTRICTED I/V fluids to 2/3rd of maintainance. • Monitor serum Na+ (osmolality, urine Na+) • If severely hyponatremic, give 3% NaCl • SIADH 4 - 88% in bacterial meningitis 9 - 64% in viral meningitis
  9. 9. • Diabetes insipidus • Cerebral salt wasting
  10. 10. Bacterial Meningitis - Treatment Neonatal (<3 mo) • Ampicillin (covers Listeria) + • Cefotaxime. • Corticosteroids therapy (Dexametazon 0.6мg/kg /dose every 4 hrs for 2 days. The first doses is prescribe 10-15 min before a/b injections
  11. 11. Pneumococcal meningitis – Mgmt • Vancomycin + cefotaxime or ceftriaxone, if > 1 month old. • If hypersensitive (allergic) to beta-lactam antibiotics, use vancomycin + rifampin.
  12. 12. Antibiotic use in Pneumococcal meningitis • PenG 250,000 - 400,000 U/kg/day … Q 4 - 6 h • Ceftriaxone 100 mg/kg/day ..Q 12 - 24 h • Cefotaxime 200 - 300 mg/kg/day .. Q 8 h • Chloramphenicol 50 - 100 mg/kg/day .. Q 6 h
  13. 13. Vancomycin use in pneumococcal meningitis • Vancomycin 60 mg/kg/day …Q 6 h
  14. 14. Complications of meningitis • Hydrocephalus • Cranial nerve palsies • Mental retardation • Subdural effusion • Deafness • Blindness • Epilepsy
  15. 15. PROPHYLAXIS • Meningococcal infection with rifampicin or ciprofloxacin. • MenC, a meningococcal C conjugate vaccine. • A combined A and C meningococcal vaccine is sometimes used prior to travel to endemic regions, e.g. Africa, Asia; and a quadrivalent ACWY vaccine . • pneumococcal vaccine is used after recurrent meningitis, e.g. after a CSF leak following skull fracture. • Hib (Haemophilus influenzae).vaccine.rifampin prophylaxis.
  16. 16. ENCEPHALITIS • Encephalitis means inflammation of brain parenchyma, usually viral. Acute viral encephalitis: The usual organisms are • herpes simplex, • ECHO, • Coxsackie, • mumps and • Epstein-Barr viruses • Adenovirus, varicella zoster, influenza, measles and other viruses are rarer.
  17. 17. CLINICAL PICTURE • Many encephalitides are mild . • In a minority, serious illness develops with high fever, headache, mood change and drowsiness over hours or days. • Focal signs, seizures and coma ensue. Death, or brain injury follows.
  18. 18. INVESTIGATIONS • CT and MR imaging show diffuse areas of oedema, often in the temporal lobes. • EEG. • CSF. • Viral serology . • Brain biopsy
  19. 19. TREATMENT • Acyclovir. • Supportive measures • Prophylactic immunization against Japanese encephalitis is advised for travelers to endemic areas in Asia.

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