Meningitis

Question 1

What is the most common aetiology of meningitis in children?

Answer 1

> 2mo (bacterial meningitis):
• Streptococcus pneumoniae
• Neisseria meningitidis
• Haemophilus influenzaetype B (in unimmunised children)

<2mo (bacterial meningitis):
• Group B streptococcus
• E. coliand other Gram-negative organisms
• Listeria monocytogenes

Question 2

What symptoms might occur with meningitis in children?

Answer 2

• Non-specific: fever, irritability, lethargy, poor feeding, vomiting and diarrhoea
• Older children may complain of headache or photophobia
• Seizures
• Rare: septic arthritis, pneumonia, pharyngitis

Question 3

What kinds of signs might you see in a child with meningitis?

Answer 3

• General
○ Altered conscious state (late sign >12 hours)

• Head/Neck
○ In infants, the fontanelle may be full
○ Neck stiffness may or may not be present (not a reliable sign in young children)

• Cutaneous
○ Non-blanching petechial/purpuric rash

• Neurological
○ CSF shunts, spinal and cranial abnormalities (eg dermal sinuses)

• Peripheral
○ Kernig’s sign: hip flexion with an extended knee causes pain in the back and legs

• Signs of sepsis
• Dehydration

Question 4

Describe the rash seen in meningococcal septiciaemia

Answer 4

Can initially be macular/maculopapular before -> non-blanching, purpuric rash

Question 5

What investigations might you do in meningitis?

Answer 5

• Blood tests
○ Full blood count/differential
○ Glucose, urea and electrolytes
○ Blood cultures
○ Blood (or marrow) culture should be obtained prior to antibiotic administration if possible.
○ Meningococcal PCR (separate EDTA tube, minimum volume 0.2mL)

• CT
• Lumbar puncture (LP)

Question 6

What is the initial management of meningitis?

Answer 6

• Obtain IV access for abx