Meningitis_Flash_Cards Flashcards
Contraindications to lumbar puncture in children with suspected meningitis
Focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, signs of cerebral herniation.
Investigation for patients with meningococcal septicaemia instead of lumbar puncture
Blood cultures and PCR for meningococcus should be obtained.
Antibiotic treatment for meningitis in children under 3 months
IV amoxicillin (or ampicillin) + IV cefotaxime.
Antibiotic treatment for meningitis in children over 3 months
IV cefotaxime (or ceftriaxone).
NICE’s advice on giving corticosteroids in children younger than 3 months with meningitis
NICE advise against giving corticosteroids in children younger than 3 months.
Conditions under which dexamethasone should be considered in meningitis treatment
Frankly purulent CSF, CSF white blood cell count greater than 1000/microlitre, raised CSF white blood cell count with protein concentration greater than 1 g/litre, bacteria on Gram stain.
Initial fluid treatment in meningitis management
Treat any shock, e.g., with colloid.
When is mechanical ventilation considered in meningitis management?
Mechanical ventilation if respiratory impairment.
Current preferred antibiotic for public health notification and antibiotic prophylaxis of contacts in meningitis cases
Ciprofloxacin is now preferred over rifampicin.
summarise meningitis
Meningitis in children: investigation and management
Investigations
Contraindication to lumbar puncture (any signs of raised ICP)
focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
For patients with meningococcal septicaemia a lumbar puncture is contraindicated - blood cultures and PCR for meningococcus should be obtained.
Management
- Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone) - Steroids
NICE advise against giving corticosteroids in children younger than 3 months
dexamethsone should be considered if the lumbar puncture reveals any of the following:
frankly purulent CSF
CSF white blood cell count greater than 1000/microlitre
raised CSF white blood cell count with protein concentration greater than 1 g/litre
bacteria on Gram stain - Fluids
treat any shock, e.g. with colloid - Cerebral monitoring
mechanical ventilation if respiratory impairment - Public health notification and antibiotic prophylaxis of contacts
ciprofloxacin is now preferred over rifampicin
An 8-week-old boy has been brought to the emergency department by his mother. She noticed this morning that he was very drowsy and not feeding very much. When she measured his temperature it was 38.4ºC. He was born at 35 weeks gestation with an uncomplicated delivery. There is no past medical history or family history and he does not require any regular medications.
On examination he is lethargic but responds to voice by opening his eyes. He is mildly hypotonic and febrile. There is a non-blanching rash on his torso that his mother says was not there this morning.
What is the most appropriate management?
IV amoxicillin
IV amoxicillin + IV cefotaxime
IV cefotaxime
IV ceftriaxone
IV ceftriaxone + IV amoxicillin
IV amoxicillin + IV cefotaxime
Meningitis in children < 3 months: give IV amoxicillin in addition to cefotaxime to cover for Listeria
The patient is presenting with symptoms of meningitis: pyrexia, lethargy, and poor feeding. He also has a meningitic rash. Amoxicillin should be given in conjunction with cefotaxime to cover for listeria, a potential cause of meningitis in babies under 3 months.
Ceftriaxone is contraindicated in babies <3 months because it displaces bilirubin from albumin binding sites, resulting in higher levels of bilirubin that accumulate in the tissues.
A 2-month-old infant was brought into the emergency department two days ago with a purpuric rash, fever, vomiting, and reduced wet nappies. In the department, he had an episode of seizure activity which self-resolved spontaneously. He was admitted and was investigated for meningitis. Lumbar puncture was performed and a non-turbid sample was sent to the laboratory which showed increased protein levels, raised white cells, and a gram positive organism.
What is the correct management for this infant?
IV amoxicillin and IV cefotaxime
IV amoxicillin and IV dexamethasone
IV amoxicillin only
IV dexamethasone only
Supportive management only
IV amoxicillin and IV cefotaxime
Do not use corticosteroids in children younger than 3 months with suspected or confirmed bacterial meningitis
This infant has a lumbar puncture result in keeping with bacterial meningitis.
The antibiotic choice for this infant who is less than 3 months old is with IV amoxicillin and IV cefotaxime- this is to provide adequate gram positive and gram negative coverage until a specific pathogen has been identified and microbiological advice can be given. It would be inappropriate to just prescribe amoxicillin as this would not give sufficient coverage.
Children younger than 3 months should not receive corticosteroids.
As the lumbar puncture has shown a gram positive organism and the patient is being managed for bacterial meningitis, it would be inappropriate to not prescribe any antibiotics.
