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

  • 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% • Bulging fontanel 30% • Stiff neck or nuchal rigidity • Meningismus (stiff neck + Brudzinski + Kernig signs)
  • Clinical clues in meningitis
  • CSF FINDINGS
  • Diagnosis – lumbar puncture
  • 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
  • Increased intracranial pressure (ICP) • Papilledema CUSHING’S TRIAD • Bradycardia • Hypertension • Irregular respiration • ICP monitor (not routine) • Changes in pupils
  • 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
  • • Diabetes insipidus • Cerebral salt wasting
  • 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
  • Pneumococcal meningitis – Mgmt • Vancomycin + cefotaxime or ceftriaxone, if > 1 month old. • If hypersensitive (allergic) to beta-lactam antibiotics, use vancomycin + rifampin.
  • 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
  • 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 • Blindness • Epilepsy
  • 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.
  • 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.
  • 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.
  • INVESTIGATIONS • CT and MR imaging show diffuse areas of oedema, often in the temporal lobes. • EEG. • CSF. • Viral serology . • Brain biopsy
  • TREATMENT • Acyclovir. • Supportive measures • Prophylactic immunization against Japanese encephalitis is advised for travelers to endemic areas in Asia.