meningitis Flashcards
(26 cards)
most common causes of neonatal meningitis
GBS (predominantly type 3)
E.coli (predominantly those containing the K1 polysaccharide) .
Listeria Monocytogenes .
These 3 categories constitute about 75% of the causes .
The 25 % ( peusomonas ,proteus ,klibsella ….)
Neonatal Meningitis (Etiology) :
bacteremia
scalp lesions
direct extension to the CNS from a contagious otic focus (otits media) .
most important symptom
poor feeding
Neonatal Meningitis (S & S) :
Usually , manifestations are those associated with neonatal sepsis : temperature instability, respiratory distress, jaundice, apnea .
CNS signs : lethargy , seizures (particularly focal) , vomiting and irritability more specifically suggest meningitis .
A bulging or full fontanelle occurs in about 25% and nuchal rigidity in only 15% .
Cranial nerve abnormalities ( especially the 3rd , 6th and 7th ) may also be present .
high bitched cry , staring expression , lethargy
normal value in csf
0 - 5 (Lymphocytes Protein 20-40 Glucose 50 – 100 ½ - 2/3 blood glcous
ABM csf value
100 - 10,000 PMNs
protein > 100
glucose > 25
in gram stain result you find gram – bacilli
what is the organism ?
E coli
in gram stain result you find Gram + bacilli
what is the organism ?
Listeria
in gram stain result you find Gram - cocobacilli
what is the organism ?
H.Infulenza
in gram stain result you find Gram – diplococi
what is the organism ?
N.Meningitidis
in gram stain result you find Gram + coci
what is the organism ?
GBS
in gram stain result you find Gram + dipolccoi
what is the organism ?
Strep pneumonia
Neonatal Meningitis (Treatment) :
Empiric treatment is begun with :
ampicillin plus cefotaxime
Drug should be
Cross BBB .
I V .
Broad spectrum .
Bactericidal
Neonatal Meningitis (Treatment duration)
Parenteral therapy for gram-positive meningitis is given for a minimum of 14 days, and for complicated gram-positive or gram-negative meningitis , a minimum of 21 days .
Neurological sequelae that can occur with neonatal meningitis
hydrocephalus , hearing loss, mental retardation , cognitive impairment , cp
In post-neonatal period , the most common organisms causing meningitis are :
Neisseria meningitidis (meningococci).
Streptococcus pneumoniae (pneumococci).
Hemophilus influenza type b
postnatal meningitis s and s
A respiratory illness or sore throat often precedes the more characteristic symptoms of fever, headache, stiff neck and vomiting.
Brudzinski’s and Kernig’s signs are present in ½ of patients
Waterhouse-Friderichsen syndrome
septicemia, profound shock, cutaneous purpura and adrenal hemorrhage
Post-Neonatal Meningitis (Complications) :
Systemic complications include hyponatremia due to SIADH , DIC and septic shock .
Survivors occasionally have deafness , other cranial nerve deficits , cerebral infarction , recurrent seizures or mental retardation .
and death
meningococcal septicemia clinically
rash (glass test) , rapid breathing , abs cramps , diarrhea
Post-Neonatal Meningitis (Treatment):
If meningitis is suspected, antibiotics and corticosteroids are given as soon as blood cultures are drawn or even before .
Dexamethasone (0.15 mg/kg IV q 6 hrs.) should be given 15 min before the 1st dose of antibiotics and continued for 4 days .
3 generation cephalosporin
(Cefotaxime or ceftriaxone)
B- vancomycin
Post-Neonatal Meningitis (Treatment Duration)
If N .MENINGITIDS : 5 -7 DAYS .
IF H.INFLUENZA : 7- 10 DAYS .
PNEUMPCOCUS : 10 – 14 DAYS .
Dexamethasone dose
0.15 mg/kg IV q 6 hrs (4 doses for 4 days = 16 dose)
