Thomson 4-23-08 Sepsis And Bacterial Meningitis

Front 1

bugs causing meningitis in newborns

Back 1

Group B streptococci
Escherichia coli and other enteric gram-negative rods
Listeria monocytogenes

Front 2

bugs causing meningitis in Infants and young children
(2 months to 4 years):

Back 2

Streptococcus pneumonia
Neisseria meningitidis
Haemophilus influenza type b

Front 3

bugs causing meningitis in School-age children and adolescents

Back 3

Neisseria meningitidis
Streptococcus pneumonia

Front 4

viruses causing meningitis

Back 4

Enteroviruses: (echovirus, poliovirus coxsackie virus)
Herpes simplex virus (mostly neonatal)
Adenovirus

Front 5

What pts get meningitis caused by Mycobacterium tuberculosis

Back 5

HIV

Front 6

Spirochetes causing meningitis

Back 6

Treponema pallidum (Syphilis)
Borrelia burgdorferi (Lyme disease)
Leptospira interrogans

Front 7

Other causes of meningitis

Back 7

Fungi
Rickettsiae
Parasites

Front 8

_% of cases occur between 1 month and 5 years of age

Back 8

5% of cases occur between 1 month and 5 years of age

Front 9

Additional risks factors for meningitis include:

Back 9

Additional risks factors for meningitis include: crowding, poverty, African-American race, male sex

Front 10

Person to person transmission of meningitis-causing organisms is through ___________ ______ secretions

Back 10

Person to person transmission of meningitis-causing organisms is through respiratory tract secretions

Front 11

PATHOGENESIS of meningitis

Back 11

1. Hematogenous dissemination
2. Head trauma
3. Fractured paranasal sinuses
4. Splenic dysfunction
5. Immunocompromised patient

Front 12

What congenital immunosuppressive condition does Dr Thomson have?

Back 12

common variable immune deficiency
- makes no IgA
- very low IgG

Front 13

Clinical manifestations of meningitis in young infants

Back 13

a. Irritability
b. Restlessness
c. Poor feeding
d. Low grade fever < 1010 (rectal)
e. bulging fontanelle

Front 14

Clinical manifestations of meningitis in older children

Back 14

a. Fever (90 - 95%)
b. Headache
c. Photophobia
d. Nausea and vomiting
e. Anorexia and poor feeding
f. Meningeal irritation (nuchal rigidity, back pain, Kernig and Briedzinski)

Front 15

Dx of meningitis

Back 15

1. Lumbar puncture and analysis of cerebrospinal fluid confirms the diagnosis (see table #1)

Front 16

Contraindications to LP

Back 16

1. evidence of increased intracranial pressure

2. severe cardiopulmonary compromise

3. infection of the skin overlying the site of the L.P.

Front 17

Complications of meningitis

Back 17

1. Subdural effusion
2. Syndrome of inappropriate secretion of antiduretic hormone (SIADH)
3. Seizures
4. Arthritis/Arthralgia and Myalgia

Front 18

Discuss subdural effusion

Back 18

1. Subdural effusion
a. 50% of cases with persistent fever
b. H. influenza type B, meningococcal
c. children less than 12 months
d. symptoms include: bulging fontanel, diastasis of sutures, enlarging head circumference

Front 19

Discuss Syndrome of inappropriate secretion of antiduretic hormone (SIADH)

Back 19

2. Syndrome of inappropriate secretion of antiduretic hormone (SIADH)
a. Occurs in 30 - 50% of cases
b. May exacerbate cerebral edema

Front 20

Discuss Seizures

Back 20

3. Seizures
a. Occurs in 30% of cases
b. Permanent neurologic sequelae if they occur after the 4th day of illness or are difficult to control

Front 21

Discuss Arthritis/Arthralgia and Myalgia

Back 21

4. Arthritis/Arthralgia and Myalgia
a. Pyogenic infection may be present if arthritis occurs within the first 2-4 days
b. Late onset (> 5 days) is a sterile effusion and represents immune complex deposition
c. Manage late onset arthritis with anti-inflammatory agents

Front 22

Tx of meningitis

Back 22

1. Antibiotic therapy
2. Steroids
3. Fluids restriction

Front 23

Discuss Antibiotic therapy

Back 23

1. Antibiotic therapy
a. Therapy should be initiated within 2 hours of presentation in subacute illness or 30 - 6- minutes in rapidly progressive illness
b. Emperic therapy for suspected meningitis is based on the likely pathogens in each age group (see table #2)

Front 24

Discuss steroid treatment

Back 24

2. Steroids - Early administration of dexamethasone has been shown to decrease hearing loss associated with H. influenzae

Front 25

Discuss fluid restriction

Back 25

3. Fluids restriction
a. Initially the patient receives nothing by mouth
b. Intravenous fluid should be restricted to one-half maintenance
c. If the patient is in shock it must be treated aggressively

Front 26

Discuss prophylaxis for Hib

Back 26

1. Rifampin prophylaxis ALL HOUSEHOLD contacts if a child less than 4 years old is in the home
2. Daycare: if two cases occur within 60 days of the index case
3. Rifampin 20 mg/Kg times 4 days

Front 27

Discuss prophylaxis for Neisseria meningitis

Back 27

1. All household contacts and close contacts

2. Rifampin 20 mg/Kg/day times 2 days

Front 28

Abx for 0-2 month old with
possibly Group B streptococcus, E. coli, or Listeria

Back 28

Ampicillin + aminoglycoside
or
ampicillin + cefotaxime

Front 29

Abx for 2 month - 5 yr with possibly H. influenzae, Pneumococcus, meningococcus

Back 29

Vancomycin + cefotaxime

Front 30

Abx for >5 yr old with possible pneumococcus or meningococcus

Back 30

Vancomycin + cefotaxime