This document discusses acute bacterial meningitis in children. It begins with definitions and descriptions of the common causative bacteria for both neonatal and post-neonatal meningitis. It then covers risk factors, pathogenesis, symptoms and signs, investigations including lumbar puncture findings, treatment, and complications. The document is from a lecture on acute bacterial meningitis for undergraduate medical students, given by Dr. S. Srinivasan, Professor of Pediatrics.
Still's disease, sometimes referred to as Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash.
Systemic lupus erythematosus (SLE) is the prototypic multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues.
The extreme heterogeneity of the disease has led some investigators to propose that SLE represents a syndrome rather than a single disease.
Lupus was first recognised as a systemic disease with visceral manifestations by Moriz Kaposi (1837–1902).
Still's disease, sometimes referred to as Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash.
Systemic lupus erythematosus (SLE) is the prototypic multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues.
The extreme heterogeneity of the disease has led some investigators to propose that SLE represents a syndrome rather than a single disease.
Lupus was first recognised as a systemic disease with visceral manifestations by Moriz Kaposi (1837–1902).
This lecture was prepared as a continuing medical education (CME) activity for the Philippine Obstetrical and Gynecological Society (POGS) Cebu chapter to update maternal health providers regarding the danger of Zika virus infection, particularly during pregnancy. This is a compilation of different literature materials available on the ongoing outbreaks of Zika virus infection in Latin America.
CPG adaptation project for Childhood CSE.
(Dissemination and Implementation Phase)
Training session for Pediatrics resident at King Khalid University Hospital, King Saud University Medical City
Clinical Case of Post-Vaccination Measles Followed By Severe Neutropeniainventionjournals
We present a 13 - month old girl, who develop a post vaccination measles infection after a MMR vaccine , followed by a severe neutropenia. The hematological changes last more than one year and resolved spontaneously. We report the clinical case as an extremely rare and unknown side effect of the vaccine.
Pierre Robin syndrome PRS is characterized by micrognathia, ptosis, and palatal malformations. Infants often have immature mandibles and difficulty breathing. A small lower jaw pushes the tongue backward, leading to PRS. A wide, U shaped cleft palate is also commonly associated with this abnormality. PRS is not just a syndrome, it is a range of disorders, one abnormality leading to another. We report the case of a 10 day old neonate who complained of malnutrition and dyspnea and was later diagnosed with Pierre Robin syndrome PRS . Parimala L | Kathiravan N "Pierre Robin Syndrome: A Case Report" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52699.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/52699/pierre-robin-syndrome-a-case-report/parimala-l
Role of soluble urokinase plasminogen activator receptor (suPAR) as prognosis...IOSR Journals
Biological marker suPAR was used in many pathological conditions, including infection. suPAR
was correlated with the severity of sepsis. The purpose of this study to determine levels of suPAR infants with
risk of infection as a prognostic indicator for sepsis. Groups of infants with the risk of infection (n = 43) were
followed prospectively on days 0, 3rd and 7th and observed for the incidence of sepsis compared to the control
group (n = 10). suPAR was measured by ELISA and the course of infection measured by clinical criteria.
Results suPAR day 0, 3 and 7, displayed in the form of bloxpot and AUC as prognostic power. suPAR control
levels 9.32 ng / mL, sepsis cutoff 15, 41 ng / mL and AUC of 80.3% [95% CI 65.7%, 94.9%, p = 0.00]. Graph
shows ROC AUC sepsis suPAR day 0, the 3rd and 7th respectively 61.9%, 66.6% and 94.4%. Sepsis with
improved output 16.53 ng / mL and worsening 22.19 ng / mL and AUC of 80.8% [95% CI (0.62 to 0.99), p =
0.02]. suPAR levels was increased in neonatal sepsis patients. suPAR could be used as a prognostic factor for
neonatal sepsis.
OPTIMIZATION OF THE TREATMENT OF ROTAVIRUS INFECTION IN CHILDREN BY USING BAC...Alexander Smiyan
ABSTRACT Introduction: Rotavirus infection is a leading place in the structure of acute intestinal infections in children. Rotavirus is excreted in 40-60 % of children hospitalized with gastroenteritis all over the world. Every year, 2 million patients are hospitalized with a severe form of RVI, 25 million need medical help from a doctor and 111 million cases are treated at home. The aim: The purpose of our study was to optimize the treatment of rotavirus infection in children by using Bacillus clausii. Materials and methods: There were 65 children with a rotavirus infection under supervision. The control group was consisted of 28 practically healthy children. The study of humoral immunity was carried out on the basis of determining the serum content of immunoglobulin G, immunoglobulin M, immunoglobulin A, and secretory immunoglobulin A in coprofiltrate. In the process of treatment, the children were divided into two groups: the first received standard treatment, the second group were added to standard treatment with a probiotic drug (Bacillus clausii). Results: In children with RVI with modified treatment main symptoms were reduced compared with the children receiving standard treatment, (p <0.001). In patients with rotavirus infection in the acute period of the disease, a decrease in the concentration of IgA (p < 0.001) and an increase in IgM (p < 0.001) in serum and a decrease in sIgA (p < 0.001) in coprofiltrate was observed in comparison with children in control group. In the period of reconvalescence in children after the traditional treatment, it wasn't revealed normalization of the immunoglobulins. Patients receiving a probiotic drug in addition to traditional treatment it was revealed normalization of the parameters of serum immunoglobulins A, M, G and sIgA in coprofiltrate. Conclusions: So, the probiotic drug containing Bacillus clausii has a positive effect on the humoral immune system in children with rotavirus infection. KEYWORDS: rotavirus, humoral immunity, children, IgA, sIgA, IgM, IgG
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Acute bacterial (Pyogenic) meningitis - Dr. S. Srinivasan, Professor of Pediatrics
1. Acute Bacterial (Pyogenic)
Meningitis
S.Srinivasan
Professor of Paediatrics
MGMCRI, Pillayarkuppam
Puducherry
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February 2016
2. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial
(Pyogenic) Meningitis
in Children
3. • Definition
• Etiology
• Predisposing
Factors
• Pathogenesis
• Symptoms &
Signs
Acute Bacterial (Pyogenic)
Meningitis in Children
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Diagnosis
Differential
Diagnosis
Complications
Prognosis
Treatment
Follow Up
4. Definition
Acute Inflammation
of the meninges
( the protective membranes covering the
brain and spinal cord ) caused by
Bacterial ( pyogenic )
organisms
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial (Pyogenic) Meningitis in Children
5. Neonatal Meningitis:
Causative Bacteria
Age Most Common Bacteria
<1 month • Escherichia coli
• Group B streptococci
• Enterobacteria
• Listeria monocytogenes
•Haemophilus influenzae
• Coagulase negative staphylococci
(in hospital)
•Streptococcus pneumoniae
Acute Bacterial (Pyogenic) Meningitis in Children
6. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
AGE Bacteria causing Ac.Bact.Meningitis
Neonates &
Infants < 2
mths
Escherichia coli, Staph.aureus,
Gram Negative bacteria
(hospital flora); Listeria
monocytogenes, Gp.B Strep.,
2 mths –
3 to 5 years
H.influenzae, Strep. pneumoniae,
Neisseria memingitides
Beyond
5 yrs
Strep. pneumoniae( 1,3,6,7),
Neisseria meningitides (A,B,C),
H.influenzae
Acute Bacterial Meningitis
7. Post-Neonatal Childhood
Bacterial Meningitis
1 to 23
months
•Strep. pneumoniae
•Neisseria meningitides
•Group B streptococci
•Haemophilus influenzae
2 to 18
years
•Neisseria meningitides
•Streptococcus pneumoniae
•Haemophilus influenzae
Causative Bacteria
Acute Bacterial (Pyogenic) Meningitis in Children
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
8. Bacterial Culture positivity rate
in Post Neonatal
Childhood Bacterial Meningitis
Hemophilus influenzae 40 - 70%
Streptococcus
pneumoniae
30 - 40%
Neisseria meningitides 10 -20 %
Streptococcus pyogenes <10 %
Culture Negativity <20%
< Varies with age of the child >
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
9. Predisposing Risk Factors
Sinusitis, Mastoiditis, Otitis.
Spleen : Asplenia, Functional /
Anatomical Trauma, or Removal :
Pneumococcal Bacterial Meningitis.
Compromised Immune System: HIV
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Others
Neurosurgery
Head Trauma,
Parameningeal Infection,
Anatomical Def. of cranium ,
Spinal cord & Meninges
10. Risk Factors in Neonatal
Meningitis
• Maternal
infections
during delivery
• PROM
• Prolonged,
diffcult delivery
with frequent
PV Exams
• Preterm babies
• Neural tube
Defects –Spina
Bifida Occulta,
Pilonidal Sinus
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
11. Pathogenesis
Inflammation of Spinal
Nerves & Roots
Signs of Meningeal irritation
Adhesive thickening of
Arachnoid in basal
cisterns
Hydrocephalus
Fibrosis & Obstn of
Aqueduct of Sylvius &/or
Foramina of Luschka &/or
Magendie
Endarterial & small
cortical venous
Thromboembolic episodes
Cerebral infarctions
and atrophy
Neuronal membrane
depolarization
Seizures
12. Pathogenesis of Ac.Bacterial Meningitis
Haematogenous ( mostly ); Spread from local site infections
Entry of bacteria through BBBarrier Ac.Bacterial Meningitis
Cellular reaction with outpouring of Polymorphs & fibrin
Release of Cytokines , Chemokines & Inflammatory Mediators
Release of cell wall & membrane debris on cell death
Meningeal Exudative Inflammation
Vascular Compromise
Inflammatory Cerebral Oedema
Increased Intracranial tension and pressure ( coning ) effects
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
13. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Symptoms & Signs
Acute Bacterial Meningitis
14. • Altered
sensorium
• Bulging
fontanelle
• Headache
• Convulsions
• Nuchal rigidity
• Opisthotonus
• Hypothermia
• Coma
Symptoms in infants and children
• Fever
• Irritability
• Excessive
fussiness
• Altered Behaviour
• Refusal of feeds
• Lethargy
• Anorexia
• Nausea
• Vomiting
• Photophobia
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
15. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
16. General Physical Examination
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Breathing, Airway &Circulation :
Adequate/Compromised
Altered Sensorium and Severity , Coma Scale
Vital Parameters: Temperature,Pulse,BP, Respn:
Rate,Type, Regularity, CFT, Hydration Status
Skin : Mottling, Color change,of vascular
compromise Purpura, Infections, Dermal sinus, &
other stigma of Spina Bifida Occulta,
17. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
18. Skin in Acute Bacterial Meningitis
Complications
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
19. Examination for
signs of
Meningeal
Irritation
Meningismus
Nuchal stiffness /
rigidity
Kernig’s Sign
Brudzinski’s neck –
leg sign
Brudzinski’s crossed
leg sign
Higher
Functions
Cranial Nerves
Motor-
coordination
Neurological
Signs
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
20. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Elicitation of Meningeal Signs
Brudzinski’s contralateral reflex sign
The childt’s hip and knee are passively flexed
on one side
Contralateral leg bends in reflex response
21. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
22. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
23. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Investigations in
Acute Bacterial Meningitis
Complete Blood Count
LP: CSF Examination
Microscopy- Colour, Cells, opening Pressure
Biochemistry: Glucose, Proteins
Gram staining
Blood & CSF Culture
Electrolytes; ABG in severe cases
Chest x-ray
CT/MRI Scans
EEG
PCR
Others
24. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
CONTRAINDICATIONS FOR PERFORMING LUMBAR
PUNCTURE IN CHILDREN
Increased ICP
Papilloedema
Unstable Child –
Shock, Resp.depression,
low GCS
Infection in the local site
Severe Thrombocytopenia
/ DIC
25. CSF Findings in CNS Infections
infection Pressure WBC /µL Glucose Protein
Ac Bacterial
meningitis
200-300 100-5000;
> 50%PMN
< 40mg/dl > 100 mg/dl
TBM 100 - 300 100 – 500
Lymphocytes
Low; <40
mg/dl
Elevated;
>100mg/dl
Viral
meningitis
90-200 10-300;
Lymphocytes
Normal or
Less in
Mumps /LCM
Normal or
slight rise
Aseptic
Meningitis
50 - 200 10 – 300
Lymphocytes
Normal Normal or
slight rise
Cryptococcal 100-300 <500;
Lymphocytes
Low 50-200
NORMAL 80-200 <5 Lympho-
cytes
50-75mg/dl 15-40mg/dl
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
26. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
27. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
28. Non-motile Gram-negative,
coccobacillary, facultatively
anaerobic bacterium, and it’s
Oxidase and Catalase postive
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
29. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH
February2016
30. Other Investigations
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Detects
Latex Particle
Agglutination Of C.S.F
Specific Bacterial
Antigen
H.influenzae,
S.pneumoniae,
N.memingitidis,
E.coli , etc
Countercurrent
ImmunoElectrophoresis
Smears from purpuric
spots –Grams staining
S.pneumoniae,N.memingitidis,
DNA Sequencing Advanced centers Bacterial
identification
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
th th TH
33. ? Complication
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
34. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
35. Complications
Commoner after bacterial meningitis
than after viral meningitis
Sensorineural hearing loss: partial or total
Seizure and Epileptic State
Cognitive problems: Memory and concentration;
Learning difficulties and behavioural problems
Motor Problems involving co-ordination and balance
Speech problems
Visual disturbances
Cerebral Palsy
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
36. Greatest risk for hearing loss
1 Males
2 Nuchal Rigidity
3 Increased ICP
4 Low CSF glucose levels
5 S Pneumoniae Infection
6 Abnormal CT Scan Findings
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
37. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
S pneumoniae : 26.3-30%
Hib : 7.7-10.3%;
N meningitidis : 5-10.3%.
Overall mortality for bacterial
meningitis 5-10%
Neonates: 15-20%
Older children: 3-10%.
Neurologic Sequelae : 30%
38. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Age: Neonates, Preterms
Organisms: Pneumococci>
H.imfluenzae> Meningococci
Gm –ve Organisms, Salmonellae
and Enterobacteriaceae
DIC
Endotoxic shock
Neural tube Anomalies
Immunosuppresse individuals.
Poor Prognostic Factors
39. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Poor Prognosis for Bilateral
Sensoryneural Hearing Loss
Males
Increased
Nuchal Rigidity
Prolonged Sezures
Low Coma Score
Low CSF glucose levels
S pneumoniae infection
Abnormal CT findings
40. 4% -6% of all bacterial
meningitis cases
1 in 4 survivors had :
Serious and disabling sequelae
Functionally important
behavior disorder or
neuropsychiatric problem
Auditory dysfunction that
impaired their performance
in school
Prognosis
41. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
42. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
43. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
44. Empiric Antibiotic Treatment in
childhood Acute Bacterial Meningitis
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
45. Organism Age Group Antibiotic
Unknown
Infants less
than 1 month
Ampicillin Cefotaxime
Gentamicin
Children over 1
month of age
and Adults
Ampicillin Cefotaxime
Vancomycin
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Unidentified
Gram-negative
bacilli
Children and
Adults
Cefazidime
Gentamicin
-Unidentified
Gram positive
organisms
Children and
Adults
Ceftriaxone
Vancomycin
Ampicillin
46. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Haemophilus
influenzatype b Ceftriaxone
Meningococci
Penicillin G plus
ceftriaxone
47. STREPTOCOCCI
Vancomcin Nafcillin (with or without
rifampin)
LISTERIA SP
Ampicillin Gentamicin Trimethoprim-
sulfamethoxaxzole
ENTERIC GRAM-
NEGATIVE
BACTERIA(ESCHERI
CHIA COLI,
PROTEUS SP,
KLEBSIELLA SP)
Ceftriaxone Gentamicin
PSEUDOMONAS
Ceftazidime Cefepime *These may
be used with the addition of
aminoglycoside
STAPHYOCOCCI
Vancomycin Nafcillin *May be
prescribed with or without rifampin
S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
48. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial (Pyogenic) Meningitis in Children
Treatment of Complications
1) Convulsions: I.V.Diazepam
2) Cerebral Oedema: Mannitol ;
i.v.dexamethasone
3) Drainage of Subdural Empyema
4) Surgical management of
Hydrocephalus
49. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial (Pyogenic) Meningitis in Children
Supportive Treatment
1) Correction of Fluid and
Electrolyte Disturbances
2) Control & Maintenance of
normal body temperature
3) Control of Convulsions
( Anticonvulsant drugs)
4) Control of increased intracranial
pressure and cerebral odema
5) Care of comatose /unconscious
child ( Skin, Eyes, Bladder ,
Bowel, Lungs )
50. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial (Pyogenic) Meningitis in Children
Supportive Treatment
6) Protocol based Management of
Septic Shock with Fluids,
Electrolyte & Inotropes
7) Management of Disseminated
Intravascular Coagulation
8) Nutritional Support
9) Monitoring of head circumference,
vital parameters, Intracranial
tension, response to drugs
51. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Acute Bacterial (Pyogenic) Meningitis in Children
Supportive Treatment
10) Treatment of Complications like
hydrocephalus, subdural empyema,
etc.,
52. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Immunization
Routine Immunization with available vaccines
against Haemophilus, Pneumococcus
Meningococcus ( Routine or in, High Risk
Children)
Vaccination before travelling to endemic areas
53. S.Srinivasan, Professor of Paediatrics, MGMCRI, Pillayarkuppam, Puducherry
8th &9th SEMESTER UNDERGRADUATE CLASS IN PAEDIATRICS - 19TH February2016
Prevention of Acute Bacterial
Meningitis
Antibiotic Chemoprophylaxis with Antibiotics
given to close contacts
H.influenzae
type B
Rifampicin 20mg/kg/day for 4
days
N. Meningitidis Rifampicin 20mg/kg/day or
600mg oral for 2 days in older
children
Ceftriaxone single dose
Ciprofloxacin single dose