MD1TALK
Meningitis🌟
Meningitis: the inflammation of the meninges
Encephalitis: inflammation of the brain parenchyma
Meningoencephalitis: inflammation of brain + meninges
Epidemiology:
95% of the cases take place between 1 month - 5 years of age.
due to lack of immunity to specific pathogens associated with young
age.
Note 🚨 :
any infant bellow 18 month comes with poor feeding -
convulsion - fever - do LP without delay even if you suspect
febrile convulsion or neonatal sepsis because they all have
same manifestation
After 18 month: the classic symptoms of meningitis will be there and
LP making depends on clinical suspicion
Route: droplets, hematogenous from VP shunt, sinusitis or Skull
fracture.
neonatal meningitis: same neonatal sepsis in clinical picture and
organisms in neonatal period
Causes:🌟
1) 0-2 month *neonatal meningites*: group B strep(GBS) - E.coli -
kelebsiella - L.monocytogens - S.areus
2) 1y-5years: most common sterpt.Pneumonia then N.mengtides
then H.influenzae type b
3) >5y: N.mengtides most common then strept.pneomonia then
H.influenzae type b
Incubation period: 2-10 D
Clinical presentations: depend on the age of the child and cause of
the infection, Common symptoms are non-specific:
General toxic appearance:
• Fever
• Decreased oral intake and alertness
↑ intracranial pressure symptoms:
• Headache
• projectile Vomiting
• Papilledema
, MD1TALK
• Unilateral or bilateral 6th nerve palsy *pseodolocalization signs*
• cushing triad: irregular breathing, bradycardia and
hypertension
Meningeal irritation:
• Brudzinski’s
• Kernig’s sign
• Stiff neck
• photophobia
skin: petchiea - purport
Mental: delirium or coma
Other symptoms of meningitis in Neonates/infants can include:
• Apnea
• Abnormal temperature (hypo/hyperthermia)
• poor feeding /weak sucking
• a high-pitched cry
• bulging fontanelles
• Poor reflexes
Examination (OSCE): KWIPE
General: ABCDEVGH and GCS
1) mental status
2) Head: signs of ↑ ICP: 6th CNP - Papilledema and Cushing triad - if
child bulging of fontanels.
3) neck: nuchal rigidity? passive neck flexion give resistance
Brudzinski neck sign: neck flexion → hip & knee flexion
Brudzinski leg sign: movement of hip joint
kerings sign: hip flexion at 90 then knee extension → severe pain
in post thigh distribution
4) Skin: P/P
📝 : if you do LP and pt have high ICP pt will herniate → always
check for ICP sings as Papilledema
Meningococcal meningitis:
caused by Neisseria meningitidis
with chronic throat carriage
Outbreaks in households, high schools, dorms
Very good response of abx → 10-14 days of treatment
if not treated? will develop meningcoxemia → sepsis because its
capsulated organism → if not ttt → purpura fulminale within 12 h →
day after 3 days.
TB meningites:
microscopic granulomas on meninges
Meningitis🌟
Meningitis: the inflammation of the meninges
Encephalitis: inflammation of the brain parenchyma
Meningoencephalitis: inflammation of brain + meninges
Epidemiology:
95% of the cases take place between 1 month - 5 years of age.
due to lack of immunity to specific pathogens associated with young
age.
Note 🚨 :
any infant bellow 18 month comes with poor feeding -
convulsion - fever - do LP without delay even if you suspect
febrile convulsion or neonatal sepsis because they all have
same manifestation
After 18 month: the classic symptoms of meningitis will be there and
LP making depends on clinical suspicion
Route: droplets, hematogenous from VP shunt, sinusitis or Skull
fracture.
neonatal meningitis: same neonatal sepsis in clinical picture and
organisms in neonatal period
Causes:🌟
1) 0-2 month *neonatal meningites*: group B strep(GBS) - E.coli -
kelebsiella - L.monocytogens - S.areus
2) 1y-5years: most common sterpt.Pneumonia then N.mengtides
then H.influenzae type b
3) >5y: N.mengtides most common then strept.pneomonia then
H.influenzae type b
Incubation period: 2-10 D
Clinical presentations: depend on the age of the child and cause of
the infection, Common symptoms are non-specific:
General toxic appearance:
• Fever
• Decreased oral intake and alertness
↑ intracranial pressure symptoms:
• Headache
• projectile Vomiting
• Papilledema
, MD1TALK
• Unilateral or bilateral 6th nerve palsy *pseodolocalization signs*
• cushing triad: irregular breathing, bradycardia and
hypertension
Meningeal irritation:
• Brudzinski’s
• Kernig’s sign
• Stiff neck
• photophobia
skin: petchiea - purport
Mental: delirium or coma
Other symptoms of meningitis in Neonates/infants can include:
• Apnea
• Abnormal temperature (hypo/hyperthermia)
• poor feeding /weak sucking
• a high-pitched cry
• bulging fontanelles
• Poor reflexes
Examination (OSCE): KWIPE
General: ABCDEVGH and GCS
1) mental status
2) Head: signs of ↑ ICP: 6th CNP - Papilledema and Cushing triad - if
child bulging of fontanels.
3) neck: nuchal rigidity? passive neck flexion give resistance
Brudzinski neck sign: neck flexion → hip & knee flexion
Brudzinski leg sign: movement of hip joint
kerings sign: hip flexion at 90 then knee extension → severe pain
in post thigh distribution
4) Skin: P/P
📝 : if you do LP and pt have high ICP pt will herniate → always
check for ICP sings as Papilledema
Meningococcal meningitis:
caused by Neisseria meningitidis
with chronic throat carriage
Outbreaks in households, high schools, dorms
Very good response of abx → 10-14 days of treatment
if not treated? will develop meningcoxemia → sepsis because its
capsulated organism → if not ttt → purpura fulminale within 12 h →
day after 3 days.
TB meningites:
microscopic granulomas on meninges
