Meningitis

• V. MENINGITIS

  ● Inflammation of meninges of brain and spinal cord caused by bacteria such as:

  ○ Streptococcus pneumoniae

  ○ Group B Streptococcus

  ○ Escherichia coli

  ○ Pseudomonas

  ○ Haemophilus influenzae

  
  

  ● Pathologic organisms usually spread to the meninges:

  • From and upper respiratory tract infections
  • By lymphatic drainage through mastoid or sinuses
  • By direct introduction through lumbar or skull fracture

  ● Once organisms enter the meningeal space they multiply rapidly and spread throughout the CSF and brain, and they cause inflammation.
• MENINGEAL SIGNS OF IRRITATION

  ● The symptoms of meningitis occur either insidiously or suddenly. There are 4 general signs of irritation

  1. Nuchal rigidity: Stiff neck
  2. Brudzinki’s sign: Flexion at the hip and knee in response to forward flexion of neck
  3. Kernig’s sign: Contraction and pain in hamstring muscles when attempting to extend leg when hip is flexed
  4. Opisthotonos: Head and heels bent backward and body arched forward
• ● Aside from these meningeal signs of irritation there are other signs seen in meningitis as well such as a child is irritable because of headache, there could be febrile seizures, cranial nerve paralysis, the fontanelles if they are open they are bulging and tense if they are closed the fontanelles can cause papilledema, there could also be septic arthritis, petechiae, there’s poor sucking, a child has weak cry, and there is lethargy.
• DIAGNOSIS

  ● CSF analysis by lumbar puncture shows increased white blood cell and protein and decreased glucose.

  ● Blood culture reveals causative bacteria.

  ● Tuberculin skin test rules out tuberculosis meningitis.

  ● CT scan, MRI, or ultrasound can check for abscesses.

  ● ICP is severely elevated.
• Antibiotic administration

  1. Antibiotic IV or INTRATHECAL, as indicated by sensitivity studies

  2. Given 8 to 10 days
• Large dose of antibiotics

  • Given IV or intrathecal injection directly into the CSF
  • Intrathecal injection may be necessary because the blood brain barrier may prevent an antibiotic from passing freely into the CSF
• Antibiotics indicated by sensitivity studies

  • ampicillins
  • cefotaxime
  • ceftriaxone
• These antibiotics may also be prescribed prophylactically to family members or others who have been in close contact with a child
• 2. CORTICOSTEROIDS and OSMOTIC DIURETICS can reduce ICP and help prevent hearing loss.

  ● Give corticosteroids or osmotic diuretics to reduce ICP and this can also help prevent hearing loss. Corticosteroid such as dexamethasone or osmotic diuretics such as mannitol.
• 3. Place on respiratory precautions for 24 hours after the start of antibiotic therapy to prevent transmission of the infection

  ● as meningitis is highly contagious

  Meningitis is always a serious disorder because it is fatal however if symptoms are recognized early and treatment is effective a child will recover with no sequelae but if ever, the possible neurologic sequelae are:

  ● Possible Neurologic Sequelae:

  ○ Learning problems

  ○ Seizures

  ○ Hearing difficulties

  ○ Cognitive challenges