Meningitis-Encephalitis Flashcards Preview

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Flashcards in Meningitis-Encephalitis Deck (20):
1

Commonest organism in encephalitis

Enterovirus Herpes->HSV, EBV, CMV, VZV Arboviruses

2

Important history

photophobia headache neck stiffness fever altered mental status confusion focal neurological deficit abnormal eye movement bulging fontanelle in infants photophobia vomiting seizures hypothermia (infants) irritability (infants) lethargy (infants) poor feeding (infants) apnoea (infants)

3

Risk factors

Strong ≤5 years of age ≥60 years of age male gender low socio-economic status crowding exposure to pathogens non-immunised infants immunosuppression asplenia cranial anatomical defects ventriculoperitoneal shunt cochlear implants sickle cell disease

4

Examination

Vital signs Mental state Nuchal rigidity (less reliable in younger children Rash Papilloedema Buldging fontanelle in children Evidence of infection as primary source->sinusitis, pneumonia, mastoiditis, UTI CN palsies-> 3, 4, 6 Kernig's and brudzinski's signs

5

Explain kernig's and brudzinski's signs

Kernig's sign: with the patient supine and the thigh flexed to a 90° right angle, attempts to straighten or extend the leg are met with resistance. Brudzinski's signs: flexion of the neck causes involuntary flexion of the knees and hips, or passive flexion of the leg on one side causes contralateral flexion of the opposite leg.

6

Investigations

Lumbar puncture->follow LP guidelines FBE Glucose UEC Blood cultures

7

When does sterilisation of the CSF occur

within 2 hours after a dose of Ceftriaxone 50 mg/kg/dose (2g) iv 12H /Ceftriaxone for N. meningitidis and within 4 hours for S. pneumoniae

8

Antibiotics and steroids in 2 months

2 months: Ceftriaxone 50mg/kg IV 12 H Dexamethasone 15 minutes prior to antibiotics if possible or within one hour of first dose

9

If encephalitis suspected

Give Aciclovir

10

Purpose of giving steroids

To reduce the risk of hearing loss

11

Management of seizure in setting of meningitis

Need immediate benzodiazepines followed by loading with phenytoin

12

Fluid management when N serum Na, hyponatremia, deH, or raised ICP/seizures

Normal serum [Na+] and no signs of hypovolaemia, dehydration or raised intracranial pressure -->Fluid guideline based on giving 3ml/kg/hour up to a weight of 10kg (about 70% of 'maintenance fluid requirements') as 0.9% (normal) saline + 5% dextrose. Hyponatraemia ([Na+]Fluid guideline based on giving 2ml/kg/hour up to a weight of 10kg (about 50% of 'maintenance fluid requirements') as normal saline + 5% dextrose. If the serum [Na+] is very low (Give repeated boluses of 10ml/kg of normal saline until hypovolaemia is corrected. Refer to ICU if signs of hypovolaemia persist. Ongoing fluid guideline based on giving 3ml/kg/hour up to a weight of 10kg as 0.9% (normal) saline + 5% dextrose. Signs of raised intracranial pressure or generalised oedema -->Fluid guideline based on giving 1-2ml/kg/hour up to 10kg (about 25-50% of 'maintenance fluid requirements') as normal saline + 5% dextrose

13

Ongoing management in bacterial meningitis

Neurological Weight and head circumference Electrolytes and glucose Adequate analgesia Fluid management Chemoprophylaxis

14

Chemoprophylaxis to those exposed to index case

Rifampicin

15

Causes of persistent fever in bacterial meningitis

Nosocomial infection Subdural effusion Other foci of infection Inadequately treated meningitis

16

Managment in adults and children >2m

ABC

1. History/examination

2. 2 large bore IV cannula

3. BC, FBC, UEC, CRP, glucose, clotting, ABG, PCR testing for meningicoccal

5. Consider need for CT prior to LP (if purpuric rash, it may delay treatment->Start antibiotics ASAP)

6. dexamethasone 10 mg (child: 0.15 mg/kg up to 10 mg) IV, starting before or with the first dose of antibiotic, then 6-hourly for 4 days

7. ceftriaxone 4 g (child: 100 mg/kg up to 4 g) IV, daily or ceftriaxone 2 g (child: 50 mg/kg up to 2 g) IV, 12-hourly If suspect listeria->add benzylpenicillin If suspect S. pneumoniae->OM/Sinusitis, pneumococcal antigen in CSF add vancomycin

8. Analgesia + antiemetic

9. IVF

10. Insert urinary catheter is septic/not passing urine

11. Consultant review

12. Admit

13. Infection precaution

14. Notification

15. Chemoprophylaxis

16. Followup with audiology and development

17

When to suspect Listeria

Immunocompromised >50 Pregnant Debilitated ++Alcohol

18

CSF findings in bacterial, viral, herpes, TB: pressure, WCC, glucose, protein, RCC

1. Bacterial: High pressure, +WCC neutrophils, low glucose, +protein, no RCC 2. Viral: N pressure, +WCC lymphoC, N glucose/protein/RCC 3. Herpes simplex: N/+ pressure, +WCC lymphoC, N glucose/protein, +RCC 4. TB: N/+ pressure, +monocytes, very low glucose, ++Protein, no RCC

19

tests done on CSF

Gram stain PCR Culture

20

Etiology neonate,

Neonate= GBS, E coli, Listeria 1-2= S. penumoniae, N. Meningitidis, HiB 2-18yo, Adult= N. meningitidis, S pneumoniae, HiB Elderly= S penumonia, Listeria, GBS

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