ANC

1. Case Presentation”
12 years old child
Brought by his parents with c/o fever
since 4 days
He was treated for acute tonsillitis with no
improvement
Today he was sleepy, refused eating
………..

2. MENINGITIS
Done by Dr Ibtisam

3. Meningitis is an acute inflammation of the
protective membranes covering the brain
and spinal cord, known collectively as the
meninges

4. CAUSES
Bacterial
Viral
Fungal

5. Bacterial Meningitis -
Organisms
• Birth - 4 wks: GBS, E.coli
• 4 - 12 wks: GBS, E.coli, Pneumococcus
Salmonella, Listeria, H. Influenza
• 3 mths - 3 yrs: Pneumococcus, Meningococcus
H. Influenza
• 3 yrs+ adult: Pneumococcus, Meningococcus

6. Bacterial Meningitis -
Pathogenesis
• Infection of upper respiratory tract
• Invasion of blood stream (bacteraemia)
• Seeding & inflammation of meninges

7. Meningitis: Clinical features
Newborn & Infants: non-specific
• Fever
• Irritability
• Lethargy
• Poor feeding
• High pitched cry, bulging AF
• Convulsions

8. Meningitis: older children

9. Kernig’s sign

10. Brudzinski’s sign

11. Purpura fulminans

12. Clinical features

13. Clinical features

14. DIAGNOSIS
• Hx & PE
Investigations:
• FBC
• LP
• CRP
• Coag
• Blood gas
• Glucose
• Blood C/S
• PCR
• CXR+ Mantoux if
TB suspected

15. Diagnosis

16. CSF FINDINGS
 Bacterial Viral TB
 Cells 10-100,000 <2,000 250-500
 polys lymphs lymphs
 Glucose low normal very low
 Protein N-INC N-INC N-INC
 G-Stain gen +ve -ve +ve Zn

17. Bacterial Meningitis
Management
• Medical emergency
• Early diagnosis essential
• Immediate optimum treatment
• Intensive supportive therapy
• Rehabilitation
• Prophylaxis to family
• Notification to GP & Public Health

18. Bacterial Meningitis/Meningococcaemia
Management
• ABC
• PICU
• Fluid management: aggressive resuscitation
• Dexamethasone: only in Pneumococcal and
HiB, given before antibiotics
• Inotropes: increasing aortic diastolic
pressure and improving myocardial
contractility

19. Antibiotics
Less than 2 months of age:
• Ampicillin + Cefotaxime+/- Gentamicin
• Treat for 3 weeks (neonate)
Over 2 months:
• Cefotaxime
• Treat for 7-10 days

20. Prophylaxis
• Rifampicin:
Children 5mg/kg bd x 2/7
Adults: 600 mg bd x 2/7
Pregnant contact:
Cefuroxime IM x 1 dose
OR
Just do T/S and await result

21. Meningitis - Complications
• Septic shock - DIC
• Cerebral oedema
• Seizures
• Arteritis/venous thrombosis
• Subdural effusions
• Hydrocephalus . Abscess . Brain damage
• Deafness

22. Viral meningitis
• Most common infection of CNS especially in <1yr
• Causes: enterovirus (commonest, meningitis
occurring in 50% of children <3mth ) herpes,
influenza, rubella, echo, coxsackie, EBV,
adenovirus
• Mononuclear lymphocytes in CSF
• Symptomatic treatment. Complications associated
with encephalitis and ICP

23. TB Meningitis
• Usually insidious: difficult to diagnose in early
stages (fever 30%, URTI 20%)
• Rare in children in developed countries
• If untreated is usually fatal
• Meningitis usually occurs 3-6mths after primary
infection
• 1 stage-lasts 1-2wk, fever malaise, headache
• 2 stage-+/- suddenly, meningeal signs
• 3 stage-worsening neurological condition, death

24. Mortality/Morbidity
• Bac meningitis: Overall mortality 5-10%
• Neonatal meningitis: 15-20%
• Older children: 3-10%
• Strep. pneumonia: 26-30%
• H. influenza type B: 7-10%
• N. meningitidis: 3.5-10%
• 30% neurological complications
• 4% Profound b/l hearing loss
(sensorineural) in all bac meningitis

25. VACCINATE!