Problem 6

Question 1

Which bacteria are the most common for meningitis

Answer 1

heamophilus influenzae
neisseria meningitidis
streptoccocus pneumoniae

Question 2

What are the most common viruses causing meningitis

Answer 2

enterovirus
parechoviruses
herpes
epstein-barr virus

Question 3

What are the risk factors for meningitis

Answer 3

genetic predisposition (race)
acquired or congenital immunodeficiencies
functional or anatomical asplenia
cochlear implantation
penetrating head trauma
recent neurosurgical procedure
crowding (creche)
A CSF leak (fistula), resulting from congenital anomaly
or following a basilar skull fracture

Question 4

What are the clinical manifestations of meningitis

Answer 4

Apnea
Stiff or Painful Neck
Headaches
Hearing Loss
Fever Without a Source
Irritable Infant
Nausea/Vomiting
Photophobia
Focal neurological signs
seizures
arthralgia
myalgia
petechial or purpuric lesions
sepsis
shock
coma
bulging fontanelle because of increased intracranial pressure

Question 5

Which signs in the clinical exams

Answer 5

Kernig and Brudzinski

Question 6

Examens complementaires pour meningite

Answer 6

prise de sang
ponction lombaire (white blood cell count, glucose, protein, gram stain

Question 7

What is the treatment for meningitis

Answer 7

empiric: ceftriaxone + vancomycine
adjunctive therapy: dexamethasone
iv perfusion for rehydration

Question 8

What is the duration of treatment

Answer 8

depends on the bacteria but could be 10-14 days (for pneumoccoques)

Question 9

Complications

Answer 9

up to 30% have sequelae, including deafness, seizures, blindness, paresis, ataxia, or hydrocephalus

Question 10

What is encephalitis

Answer 10

inflammation of the brain’s parenchyma which usually presents with fever, headache, and mental status changes

Question 11

What are 2 ways by which organisms can cause encephalitis

Answer 11

(1) direct infection of the brain parenchyma via an extension of meningitis, secondary to viremia, or retrograde spread via peripheral nerves
(2) a postinfectious, immune-mediated response in the CNS that usually begins several days to weeks after clinical manifestations of the infection

Question 12

Which organisms are the most frequent cause of encephalitis

Answer 12

viruses: enteroviruses, arboviruses, herpesviruses and HIV

Question 13

What is acute disseminated encephalomyelitis

Answer 13

the abrupt development of multiple neurological signs related to an inflammatory, demyelinating disorder of the brain and spinal cord.
ADEM can follow childhood viral infections (such as
measles and chickenpox) or vaccinations, and can clinically resemble multiple sclerosis.

Question 14

What is autoimmune encephalitis

Answer 14

Autoimmune encephalitis is a relatively common cause
of encephalitis and is associated with specific autoantibodies directed to brain antigens, such as anti-N-methyl-D-aspartate receptor antibodies. The presentation is often subacute with psychological manifestations, cortical dysfunction, movement disorders, autonomic dysfunction, and seizures.

Question 15

What are the clinical manifestations of encephalitis

Answer 15

Stiff or Painful Neck
Headaches
Ataxia
Altered Mental Status
Hearing Loss Query
Polyuria

Question 16

Examens complementaires pour encephalite

Answer 16

ponction lombaire (lymphocytic pleocytosis, elevation in protein content, normal glucose)
prise de sang
MRI or CT
electroencephalogram

Question 17

Treatment of encephalitis

Answer 17

acyclovir if herpes
ganciclovir if CMV
ADEM is treated with corticosteroids
autoimmune encephalitis is treated with steroids, intravenous immunoglobulin (IVIG), and rituximab

Question 18

How can meningitis happen

Answer 18

bacteria cross the blood-brain barrier from the blood

trans, para or in macrophages

Question 19

How is Kernig sign done

Answer 19

flexing the hip and extending the knee to elicit pain in the back and legs

Question 20

How is Brudzinski sign done

Answer 20

passive flexion of the neck elicits flexion of the hips

Question 21

What is a late sign of intracranial pressure

Answer 21

The constellation of systemic hypertension, bradycardia, and respiratory depression (Cushing’s triad)

Question 22

Which pathogens for neonatal meningitis

Answer 22

streptocoque B
herpes
E Coli (Gram-)
Listeria

Question 23

Risk factors for neonatal meningitis

Answer 23

rupture prolongee des membranes
infection maternelle intra-partum
prematurite
poids<2.5 kg

Question 24

Clinique des nouveau-nes pour meningite

Answer 24

fievre et hypothermie
irritabilite, lethargie
vomissements, troubles alimentaires
fontanelle bombante
apnee

Question 25

When to do prophylaxie de l’entourage

Answer 25

meningocoque
pour enfant rifampicine
pour adulte ciprofloxacine
pour femme enceinte ou si allergie ceftriaxone

Question 26

If vomiting, what do we suspect for neonates

Answer 26

common congenital GI anomalies that cause obstruction, such as esophageal or intestinal atresia or web, malrotation, meconium ileus, or Hirschsprung’s disease.

Question 27

Indication pour une ponction lombaire pour un nouveau-ne de <1 mois

Answer 27

tout état infectieux

Question 28

Indication pour une ponction lombaire pour un enfant entre 1 mois et 3 mois

Answer 28

• si état toxique, à discuter si enfant présentant un état fébrile avec irritabilité, enfant amorphe ou si symptômes neurologiques avec à la biologie une PCT ≥ 0.5, des polynucléaires neutrophiles >10G/L et/ou une CRP
  >20mg/L.

Question 29

Indication pour une ponction lombaire pour un enfant entre 3 et 9 mois

Answer 29

• tout état infectieux avec une atteinte neurologique ou psychique (irritabilité, somnolence, apathie, convulsions, mauvais tonus, mauvaise succion)

Question 30

Indication pour une ponction lombaire pour un enfant >9 mois

Answer 30

• état infectieux et signes méningés

Question 31

Caracteristiques d’une ponction lombaire a meningite bacterienne

Answer 31

• pression augmentee
• aspect: trouble
• > 1000 GB 80% PMN
• hyperproteinorachie
• hypoglycorachie

Question 32

Caracteristiques d’une ponction lombaire a meningite virale

Answer 32

• pression normale
• aspect clair
• 10-500 GB >50 % lympho
• glucose normale
• moins de proteines que dans la bacterienne

Question 33

ttt pour 0 jour de vie à 1 semaine de vie et non prématuré

Answer 33

Amoxicilline 200 mg/kg/j en 4 doses iv

+ Cefotaxime 150mg/kg/j en 3 doses iv

Question 34

ttt pour 1 semaine - 1 mois de vie

Answer 34

Amoxicilline 200mg/kg/j en 4 doses iv + Cefotaxime 200mg/kg/j en 4 doses iv

Question 35

ttt pour 1 a 3 mois

Answer 35

Amoxicilline 200 mg/kg/j en 4 doses iv + Ceftriaxone 100 mg/kg/j en 1x/j iv (injecter en 30 min)
Durée du traitement : 14-21 jours selon le germe

Question 36

ttt pour > 3 mois

Answer 36

Ceftriaxone 100mg/kg/j en 1 dose/24h, IV (max. 4 g )
(+/- Vancomycine 60 mg/kg/j en 4 doses si diplocoques Gram + à la coloration du Gram, notamment si enfant issu/en provenance des EtatsUnis, en attendant le résultat de la culture et de l’antibiogramme).

Question 37

Effets indesirables de la rifampicine

Answer 37

• coloration des urines et des larmes (verres de contact)
• interaction avec contraceptifs oraux, anticoagulants, digitale, quinidine, antidiabétiques oraux, méthadone, stéroïdes.

Question 38

Quand avertir le medecin cantonal

Answer 38

Méningite à méningocoque, à mycobactérie tuberculeuse et à Haemophilus influenzae du groupe b. Si méningocoque, Haemophilus ou méningite tuberculeuse avec atteinte pulmonaire associée:
Avertir également le SSEJ via Nathalie Farpour-Lambert au 022.546.43.40 (standard 022.546.41.00)