BACTERIAL MENINGITIS
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BACTERIAL MENINGITIS
Section 1: Epidemiology and Aetiology:
Bacterial meningitis is a potentially life threathening illness that results from bacterial infection of the meninges . Acute meningitis is a notifiable disease. Bacteria probably invade the blood stream via tonsils and then the meninges by direct haematogenesis spread.Less commonly ,they spread from an infected area such as the sinuses.Patients often have bacteraemia and may have symptoms and signs of sepsis.The meningeal inflammation aswell as abnormal cerebral circulation lead to irritability ,reduced level of consciousness and raised intracranialpressure.
The impact of vaccines: the tree most common organisms are;Neisseria Meningitides,streptococcus pnuemonia and haemophilus influenza type b(Hib). Since the introduction of the conjugat Hib, pneumococcal and meningococcal C vaccines , the incidence on meningititis has decreased . Bacteria meingitis needs to be separated from infective cause of meningitis in children , including viral,myco-bacterial(TB), fungal and protozoal, as well as encephalitis and non-infective causes , such as Kawasaki disease
Making the Diagnosis:
in children under two years of age , the clinical features of meningitis are not always present .
Symptoms and signs of meningitis: fever ,lethargy,apathy,reduced mental state ,irritability,listlessness,shrill cry, anorexia D&V,bulging fontanellein <1 year old, pallor,shock,poor capillary refill time,headache, reduced level of conciousness,neck stiffness,kernig's sign,and Brudzinsi's sign,photophobia,seizures ,cranial nerve pasy ,rash: may be flea bitten petechiae or purpura.kernig's sign:knee extension leads to neck pain .Brudzinski's sign:flexing of hips when flexing patient's head
Lumbar puncture: Most patients over two years of age should be diagnosed clinically ,CRP as well as neutrophils are often elevated in people with bacterial meningitis,but will not differentiate from other patients with other infections. A lumbar punture is necessary for a definitive diagnosis. if a diagnosis of meiningitis is high on the differential list and the LP is likely to be delayed parenteral antibiotics should be adminstered.
Management: Treatment of bacterial meningitis initally follows the ABC logarithmn airway ,breathing,circulation.IV access and blood should be taken.Correction of dehydration and poor perfuasion is vital ,but care should be taken that fluid overload and worsening of cerebral oedema doesn't occur. antibiotics:if access is impossible and LP is delayed, IM penicillin or ceftriaxone is an option in primary care, in secondary care first line therapy is cefotaxime or ceftriaxone .
chemoprophylaxis:
All household contacts within the past 7 days should be offered chemoprophylaxis (rifampicin,ciprofloxacin). Family members(same household ) should be treated in secondary care.If contacts are un-immunised children,meningococcal C,pneumococcal conjugate vaccine and/or Hib vaccine should be offered.
prognosis;
death from meningitis in children in most developed countries is uncommon: it raanges from <1% to >10%. Complications are learning difficulties,neurodisabilities,seizure disoders,hearing loss,visual disoredrs,speech and language problems,behavioural problems.
All children should have a hearing assesment soon after discharge.Early referral for cochlear implant assessment is vital in patients with severe hearing loss,before the inner ear ossifies.
