Overview

• Meningitis → inflammation of the meninges (lining of the brain and spinal cord).
  • Neisseria Meningitidis → gram-negative diplococci.
  • Meningococcul Septicaemia → meningococcus bacterial infection in the bloodstream.
  • Bacterial Meningitis → most common cause in neonates is group B strep (GBS). Most common causes in children and adults are Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus).
    • Neonates → GBS, e.coli, listeria.
    • 1 months - 6 years → neisseria meningitidis, streptococcus pneumoniae, haemophilus influenzae.
• Encephalitis → inflammation of the brain.
  • Most commonly viral, due to herpes simplex virus (HSV).

Making Diagnosis

Clinical Features

• Meningitis → fever, neck stiffness, vomiting, headache, photophobia, altered consciousness, seizures.

  • Meningococcal Septicaemia → non-blanching rash (RASH = MENINGOCOCCAL SEPTICAEMIA). Rash is due to DIC.
  • Neonates and babies may prevent very non-specifically → hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.

  <aside> 💡 An infant with poor feeding, irritability, fever, and poor urine output should always be initially treated for meningitis until further investigations prove otherwise.

  </aside>

• Encephalitis → altered consciousness, altered cognition, unusual behaviour, acute onset of focal neurological symptoms, acute onset of focal seizures, fever.

Investigations

• Meningitis

  • Lumbar Puncture → if <1 month presenting with fever, 1-3 months with fever and unwell, or <1 year with fever and other features of serious illness.

    <aside> 💡 Do not do LP in meningococcal septicaemia due to potential DIC (DO COAGULATION SCREEN FIRST) → MENINGOCOCCAL SEPTICAEMIA IS A CONTRAINDICATION TO AN LP (due to coagulopathy).

    </aside>

  • Assessing for meningeal irritation → kernig’s test (pain on leg straightening) and brudzinski’s test (supine neck flexion causes knee/hip flexion).

• Encephalitis → lumbar puncture, CT scan, MRI scan, EEG recording, swabs, HIV testing.

Management Plan

• Bacterial Meningitis ⇒
  • <3 months old → IV amoxicillin + cefotaxime. (additional amoxicillin to cover for listeria). (cefotaxime = meningitis).
  • >3 months old → IV ceftriaxone.
    • May also give dexamethasone in those >3 months.
    • Administer anitbiotics as early as possible after lumbar puncture once clinical suspicion of meningococcal meningitis is present. Empirical treatment should also be considered if a lumbar puncture cannot be performed within 30 mins of hospital admission.
  • Supportive Therapy → analgesia, antipyretics, oxyen, anticonvulsant therapy, IV fluids.
  • Presinting in Primary Care → single dose of IM/IV benzylpenicillin. (Phone for an urgent ambulance first).
  • Notify Health Protection Unit.
  • Follow-Up → all children reviewed by paediatrician 4-6 weeks after discharge. Require audiological assessment.
  • Treating Contacts → ciprofloxacin for anyone who had close contact in 7 days before onset.
• Encephalitis ⇒
  • IV Aciclovir. (Treats HSV and VZV - give Ganciclovir for CMV).
  • Follow-Up → supportive, rehabilitation and monitoring should continue for at least 1 year after discharge from hospital.

Complications → meningitis: sensorineural hearing loss, seizures, cerebral palsy.

Prognosis →