Meningitis and encephalitis

Question 1

key poionts - meningitis and encephalitis peads

Answer 1

Making a clinical distinction between meningitis and encephalitis can be difficult, but is important, as the common causative pathogens differ. If there is any doubt, initial empiric management should cover both
If meningitis or encephalitis is clinically suspected and lumbar puncture is contraindicated or will be delayed more than 30 minutes, give empiric intravenous antimicrobials and consider steroids
Consider herpes simplex virus (HSV) encephalitis in any child with encephalopathy, and in neonates. Treat with aciclovir

Question 2

history and examination - meningitis vs encephalitis in peads

Answer 2

https://www.rch.org.au/clinicalguide/guideline_index/Meningitis_encephalitis/

Question 3

RF for meningitis paeds

Answer 3

Maternal group B streptococcus colonisation in infants <3mo
Unimmunised
Immunocompromised
History of neurosurg or penetrating head injury
VP shunt
Cochlear implant
Younger age, esp <5yo

Question 4

Ix- meningitis peads

Answer 4

https://www.rch.org.au/clinicalguide/guideline_index/Meningitis_encephalitis/

Question 5

mng meningitis peads

Answer 5

https://www.rch.org.au/clinicalguide/guideline_index/Meningitis_encephalitis/

Question 6

Kernig sign

Answer 6

Child is supine
One hip and knee are flexed to 90 degrees by the examiner
The examiner then attempts to passively extend child’s knee
Positive if there is pain along spinal cord, and/or resistance to knee extension

Question 7

Brudzinski sign

Answer 7

Child is supine with legs extended
The examiner grasps child’s occiput and attempts neck flexion
Positive if there is reflex flexion of child’s hips and knees with neck flexion