acute meningitis, etiology, treatment and prophylaxis

1. Meningitis
in Pediatric Age Group

2. Acute Bacterial Meningitis
• Meningitis is an
inflammation of the
meninges, the lining
that protects the brain
and spinal cord.

3. Meninges
3

4. inflammation
Meningitis Encephalitis
or
both (meningeoencephalitis)
4

5. Meningitis
• Inflammation of the
protective membranes
covering the brain and
spinal cord , known
collectively as the meninges.
• The inflammation may be caused by
infection with viruses, bacteria, or other
microorganisms, and less commonly by
certain drugs .
5

6. Causative organisms
(in Neonates)
Group B Streptococcus Escherichia coli
Listeria monocytogenes Non-Group B Streptococcus
6
Gram
negative
bacteria

7. Causative organisms (in children)
Haemophilus Influenzae
Streptococcus Pneumoniae
Neisseria Meningitidis
7

8. Clinical picture (in infants)
Irritability
High pitched
cry
Temperature
Instability
lethargy
8

9. Clinical picture (in infants)
Refusal to
eat
weak
suckling
response
Vomiting diarrhea
9

10. Clinical picture (in infants)
Respiratory
distress Seizures Bulging
fontanelle
10

11. Clinical picture (in older children)
Classic triad of symptoms
Headache Fever
Neck
stiffness
11

12. Other Presenting Symptoms
Disturbed
level of
conscious
-ness
vomiting Seizures
12

13. Clinical signs
Meningeal signs
Skin rash lead to infection
Other neurological signs
Atypical presentations
13

14. Treatment
14
Treatment
supportive
Antibiotics
or
Antiviral drugs
Treatment
of
complication
Prevention
and
vaccination
HOSPITALIZATION
SPECIFIC

15. Curative SPECIFIC treatment
1- specific treatment:
 (antibiotic therapy) OR ANTIVIRAL (CYCLOSPORINE)
 .
 The choice of antibiotic
depends on the infecting organism.
HIB: AMPICIILIN
MENINGEOCOCCI: PENICILLIN
PNEUMOCOCCI: PENICILLIN
 If cause of pyogenic meningitis is still unknown OR RESISTANT TO USUAL
ANTIBIOTIC
give cefotaxime (claforan) or ceftriaxone 100-200 mg per kg per day intravenous.
• WHEN : Once meningitis is suspected treatment should be started immediately
even before culture
 DURATION : Treatment for 5 days after fever ends and at least for 2 weeks
 DOSE : at least 2 OF USUAL (100 MG/KG/DAY CEPHALOSPORINE)
 Route: IV
15

16. If the organism is known
Drug of choice Alternative agents
Meningeococcal Benzyl penicillin Chloramphenicol or
cefotaxime
Pneumococcal Benzyl penicillin or
cefotaxime
chloramphenicol
H-influenza cefotaxime chloramphenicol
16

17. 2- non specific treatment
General care:
Proper nursing
Adequate fluids and food
 antipyretics as paracetamol
Convulsions: anticonvulsant as valproate
17

18. prophylaxis
Prophylactic treatment:
• WHOM?
• HOW ?.
18

19. Prophylaxis
Prophylactic treatment:
• WHOM?
Close contacts:
1- mouth to mouth breather as doctor or nurse
after mouth to mouth breathing
2- contacts for 4hrs per 6 days or 6 hrs per 4
days: as home contact or class contact
(but not transient contacts )
19

20. Chemoprophylaxis
• H. influenzae: (rifampicin) for 4 days
• N. meningitidis: rifampicin for 2 days
DOSE: 50 MG/KG/DAY
others: co-trimoxazole, ceftriaxone

21. Prevention and prophylaxis:
Vaccination :
• H. influenzae: H. influenzae type b (Hib) conjugate
vaccine
• N. meningitidis: quadrivalent meningococcal
vaccine (active against serogroups A, C, Y, and
W135) start from 2 y age
• S. pneumoniae: 23-valent pneumococcal vaccine