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Paediatrics COPY > 1: Infections - Meningitis > Flashcards

1: Infections - Meningitis Flashcards

(73 cards)

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1
Q

What is the main cause of meningitis in children

A

Viral

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2
Q

What proportion of meningitis in children is viral

A

2/3 cases

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3
Q

What is the most-common cause of bacterial meningitis in children 0-3 months

A

Group B Streptococcus

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4
Q

What are 3 organisms that cause meningitis in children 0-3 months

A
  1. Group B Streptococcus
  2. S. Pneumonia
  3. N. Meningitides
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5
Q

What is most common cause of meningitis in children 3-6 years

A

N. Meningitides

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6
Q

What are 3 organisms that cause meningitis in children 3-6 years

A
  1. N. Meningitides
  2. S. Pneumonia
  3. H.Influenza
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7
Q

What is the main cause of bacterial meningitis in 6-60 year-olds

A

N. Meningitides

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8
Q

What are two causes of bacterial meningitis in 6-60 year-olds

A

N. Meningitides

S. Pneumonia

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9
Q

When is Listeria Monocytogenes are more common cause of meningitis

A
  • 0-3 months
  • > 60 years
  • Immunocompromised
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10
Q

What can cause meningitis in immunocompromised patients

A

Cryptococcus Neoformans

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11
Q

What are 5 risk factors for Meningitis

A
  • Sinusitis
  • Otitis media
  • Immunocompromised
  • Maternal Group B Infection
  • Crowded Living Conditions
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12
Q

Explain order of septic signs to meningitis signs

A

Septic signs typically precede meningitis signs

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13
Q

What are the septic signs of meningococcal septicaemia

A
  • Fever
  • Abnormal skin colour
  • Rash
  • Shock: tachycardia, low RR, low BP
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14
Q

When does a non-blanching petechial rash occur

A

If caused by N. meningitides

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15
Q

What are 5 meningeal signs of meningitis

A
  • Photophobia
  • Neck stiffness
  • Kernig’s
  • Brundinzki’s sign
  • Opisthotonus
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16
Q

When is neck stiffness absent

A

Under 18-months

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17
Q

What is Kernig’s sign

A

Resistance to knee extension, when hips are flexed

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18
Q

What is Brudzinski’s sign

A

When neck is bent, hips will flex

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19
Q

What is opisthotonus

A

Spasm muscles - causing backward arching of head, neck and spine

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20
Q

What is problem with meningitis in children

A

Often quite non-specific symptoms

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21
Q

When should meningitis be suspected in infants

A

Any unwell infant with fever

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22
Q

What are 5 early symptoms of meningitis in infants

A 
Lethargy 
Vomiting 
Irritable 
Poor appetite 
Dyspneoa
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23
Q

What are 3 late-symptoms of meningitis in infants

A

Bulging fontanelle
Seizures
High-pitch cry

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24
Q

What are symptoms of meningitis in young children

A

Fever
Poor Feeding
Lethargy

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25
How do older children with meningitis present
Triad: - Headache - Neck Stiffness - Photophobia
26
If in the community and suspect meningitis, what should be given
IM (of IV) Benzylpenicillin
27
If in hospital, what 4 investigations are ordered for neonates (under 1 -month) with meningitis
1. FBC 2. CRP 3. Blood Culture 4. LP - send for culture
28
What is given to manage neonates under 1-month
Cefotaxime and Amoxicillin
29
Why is amoxicillin given
To cover for listeria - which is more common in younger patients
30
When is vancomycin added
If known MRSA | If from an area of known pneumococcal cephalosporin resistance
31
In an infant or child over 1-month with suspected meningitis, what 4 investigations are ordered
- FBC - CRP - LP - Blood Culture
32
What is first-line management for meningitis in children over 1-month
Ceftiraxone and IV Vancomycin
33
When is IV Vancomycin indicated
MRSA positive patients or from an area with known pneumococcal-cephalosporin resistance
34
What 3 medications are given for meningitis in children over 1-months
Ceftriaxone Amoxicillin Dexamethasone
35
What are the indications for dexamethasone
Child over 3-months with: - Cloudy CSF - Gram stain positive - WCC >100 - Protein >1
36
What age must a child be for dexamethasone to be given
> 3-months
37
List 6 contraindications for LP
1. Raised ICP - Low HR, Raised BP - Papilloedema - Significant bulge in fontanelle 2. Meningococcal septicaemia (Petechial rash) 3. DIC 4. Focal Neurological Signs 5. Shock 6. Infection at LP Site
38
How can DIC and meningococcal septicaemia be excluded
Absence petechial rash
39
What are the features of bacterial infection on LP
1. Cloudy Fluid 2. Low Glucose (Less than half of plasma) 3. High Protein 4. Polymorphs
40
What are the features of viral infections on LP
1. Clear Fluid 2. Normal Glucose 3. Normal Protein 4. High Lymphocytes
41
What are features of TB on LP
1. Fibrin Web 2. Low Glucose 3. High Protein 4. High Lymphocytes
42
What is used to test for TB in CSF and why
- PCR is preferred as Ziehl Neelsen Stain is only 20% accurate
43
Is meningitis a notifiable disease
Yes
44
What should all household contacts of someone with meningitis be given
Ciprofloxacin for all household contacts
45
What should be offered 4W following meningitis in children and why
Audiology assessment - as SNHL is the greatest complication of meningitis
46
If SNHL what is offered
Cochlear Implant
47
What endocrinological complication can occur post-meningitis
Waterhourse - Freiderichson
48
What is waterhourse - friederichson syndrome
Coagulopathy triggered by meningitis results in ischaemic necrosis of adrenal glands
49
What are 3 neurological complications of meningitis
Seizures SNHL Paralysis
50
What are 2 infective complications of meningitis
Sepsis | Brain abscess
51
What can meningitis lead to
Raised ICP - brain herniation
52
What do NICE state on using CT to check for raised ICP before lumbar puncture
Do not use CT to check for raised ICP prior to LP. ICP is a clinical diagnosis
53
When may a CT performed in children
- Fluctuating consciousness: GCS less than 9 or change of more than 3
54
What is bacteraemia
Bacteria in the blood
55
What is septicaemia and what does it lead to
Bacteria proliferating in the blood that release toxins which bind and causes vasodilation resulting in shock
56
What is meningococcal septicaemia
Proliferation meningococcal bacteria in the blood stream, without meningitis
57
What causes meningococcal septicaemia
N. meningitides
58
Describe clinical presentation of meningococcal septicaemia
Non-Specific: - Malaise - Fever - Signs shock: poor urine output Haematological: - DIC CNS: - Meningitis (20-30%)
59
When should someone be suspected of having meningococcal septicaemia
Unwell child with petechial or purpuric rash
60
What is glass test used for
Determine if rash is non-blanching
61
How is suspected meningococcal septicaemia managed
Community: IM benzylpenicillin Hospital: IV Ceftriaxone If in shock - manage with fluid resuscitation
62
If individual with meningococcal septicaemia is in shock what may be required
Inotropes
63
Name two inotropes
Dopamine | Dobutamine
64
What is given as prophylaxis for contacts of patients with meningococcal septicaemia
Ceftriaxone
65
How does meningococcal septicaemia lead to DIC
Proliferation of bacteria in the blood stream causes release of endotoxins - these trigger systemic DIC
66
What is DIC
Systemic activation of coagulation cascade leading to formation or micro thrombi. Micro thrombi formation results in use of clotting factors causing bleeding
67
What are 3 causes of DIC
Sepsis Trauma Malignancy
68
How can presentation of DIC be divided
Clotting Symptoms | Bleeding Symptoms
69
What are bleeding manifestations of DIC
- Ecchymosis - Petechiae - Purpura - Haematuria - Haemtemesis
70
What are clotting symptoms of DIC
``` Oliguria: kidneys Jaundice: liver ARDS: lungs Pupura fulminans: skin Waterhouse-Friederichson ```
71
What is purpura fulminans
DIC with skin necrosis
72
How will DIC present on coagulation studies
Prolonged APTT, PT and Bleeding time
73
How do d-dimers present in DIC
Raised

Paediatrics COPY (61 decks)

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