meningitis%20-%20acute,%20bacterial%20(pediatric)
MENINGITIS - ACUTE, BACTERIAL (PEDIATRIC)
Acute meningitis is the bacterial infection of the subarachnoid space and cerebrospinal fluid that may cause local and systemic inflammatory response.
Common symptoms in newborns are lethargy, fever, seizures, irritability and bulging fontanelle. While in children the common symptoms are fever, nuchal rigidity (incidence increases with age) and altered consciousness.
Meningeal signs are stiff neck, Kernig's or Brudzinski's signs) are not reliably present in infants <6 months of age.
It may also observe the presence of persistent vomiting, changes in behavior or other psychological/neurologic signs.

Prevention

  • Aside from giving antibiotic prophylaxis to susceptible at-risk contacts, vaccination also helps reduce the likelihood of bacterial meningitis
    • Meningococcal vaccine is recommended in adolescents age 11-12 years of age or children >2 years old with anatomic or functional asplenia or with terminal complement protein deficiencies
      • Children aged 2 months-6 years with persistent increased susceptibility to meningococcal disease should receive a booster dose at 3 years post-vaccination & every 5 years thereafter
    • H influenza type B conjugate vaccine should be given to all children starting at 2 months of age
    • Routine administration of conjugate vaccine against S pneumoniae is advised in children <2 years old

Follow Up

General Follow-up Principles

  • Magnetic resonance imaging (MRI) with contrast should be performed for neonates with uncomplicated meningitis 7-10 days after treatment initiation to ensure that no complicating pathology is present
  • All recovering patients, especially newborns, should have auditory evoked potential studies to screen for hearing impairment
  • Careful neurologic, visual & hearing tests should be done; results must be reviewed with parents so that they may be aware of any deficits

Outpatient management

  • Since complications are exceedingly rare after 3-4 days of treatment, it may be appropriate for some patients
  • This may lead to less hospitalization costs, decreased risk for nosocomial infections & improved quality of life
  • Selection of qualified patients must be careful & close medical follow-up is essential

Chemoprophylaxis of Contacts

H influenzae

  • Chemoprophylaxis eradicates nasopharyngeal colonization in 95% of carriers
  • Chemoprophylaxis is recommended for all household contacts with at least 1 unvaccinated or incompletely vaccinated child <48 months, or with an immunocompromised child (regardless of age & immunization status)
  • Recommended agent: Rifampicin

N meningitidis

  • Recommended for all high-risk contacts:
    • All household contacts
    • Childcare or nursery school contact during 7 days before illness onset
  • Administer promptly, ideally within 24 hours after the index case is identified
  • Recommended agents: Rifampicin, Ciprofloxacin or Ceftriaxone
    • Alternative agent: Azithromycin

S pneumoniae

  • Chemoprophylaxis are limited to those with specific medical conditions

Maneuvers to Address Increased Intracranial Pressure (ICP)

  • Hyperventilation (w/ possible endotracheal intubation) to cause cerebral vasoconstriction & reduction in cerebral blood volume
  • PCO2 must be maintained at approximately 25 mmHg
  • Intravenous (IV) osmotherapy may be started (w/ Furosemide or Mannitol)
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