11meningits ppt(1).pptx

Meningitis in children
By:- Destaye Guadie (Bsc, Msc )
University of Gondar
College of Medicine & Health
Science School of Nursing
Department of Pediatrics and
Child Health ,2009 E.C
E-mail-dstgd32@gmail.Com . 1
5/12/2023
(MENINGITIS IN CHILDREN ) PPT By
Destaye G.

Learning Objectives
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After the end of this session the students should be able to:
Define Meningitis in children.
Describe the anatomy & physiology of Meningitis in children
Explain Epidemiology and etiology of Meningitis in children
Describe the pathogenesis of Meningitis in children.
Identify the clinical manifestations of Meningitis in children.
Recognize the RX,DX & DDX of Meningitis in children.
Describe the nursing care of a patient with Meningitis.
List the complications of Meningitis in children.

Presentation outlines
Anatomy & physiology
Introduction
Etiology
Epidemiology
Pathophysiology
Risk factors of meningitis
Types of meningitis
Mode of transmition
Clinical feture
Dx & DDX
Rx
Nursing managements
Preventions
5/12/2023 (MENINGITIS IN CHILDREN ) PPT By
Destaye G.
3

Anatomy and Physiology
Meningitis, in general, is the inflammation of the
protective membranes surrounding the brain and
spinal cord.
In order to inflame these protective membranes,
the bacteria must somehow enter the bloodstream
and bypass the blood-brain barrier.
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Anatomy and….
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Physiology
The intracranial compartment is protected by the
skull, a rigid structure with a fixed internal volume.
 Brain parenchyma — 80 %
 CSF — 10 %
 Blood — 10 %
Because the overall volume of the cranial vault
cannot change, an increase in the volume of one
component, or the presence of pathologic
components, necessitates the displacement of other
structures, an increase in ICP, or both.
Ward JD
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BLOOD-BRAIN BARRIER / BBB
The BBB mainly consists of tight junctions, which
seals the endothelial cells that line the brain
capillaries.
Astrocytes, a type of neuroglia from the brain,
closely attached to the endothelial cells and release
chemicals to regulate the permeabilities of the tight
junctions.
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Introduction
8
Infection of the central nervous system is the most
common cause of fever associated with signs and
symptoms of CNS disease in children.
Bacteria meningitis is one of the most potentially
serious infections occurring in infants and older
children.
This infection is associated with a high rate of acute
complications and risk of long term morbidity.
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Introduction…
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Annual incidence in the developed countries is
approximately 5-10 per 100,000.
Approximately 90 per cent of cases occur in
children during the first 5 years of life.
Despite the effectiveness of current antibiotics in
clearing bacteria from the cerebrospinal fluid (CSF),
bacterial meningitis continues to cause significant
morbidity and mortality worldwide. Up to date
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Defnitiion of terms
Meningitis – inflammation of the meninges
Encephalitis – infection of the brain
parenchyma
Meningoencephalitis – inflammation of
brain + meninges
Aseptic meningitis – inflammation of
meninges with sterile CSF

Etiology
Generally could be Bacteria, viruses, fungi,
parasites.Bacterial meningitis
categorize by age
1.Neonates -infants
Escherichia coli
Listeria monocytogenes
B-haemolytic streptococci
Staphylococcus aureus
Staphylococcus
epidermidis
2. I2mth-2yrs
 Hib,
 Strep pneumoniae &
 Neisseria meningitis
3. 2-21yrs
 Neisseria meningitis
A, B, C, Y, and W 135,
 Hib and
 Strep pneumoniae
The 3 main bacterial
species that contribute
to this disease
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Epidemiology
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After the introduction of the Hib and pneumococcal conjugate
vaccines to the infant immunization schedule, the incidence of
bacterial meningitis declined in all age groups except children younger
than two months.
The peak incidence continues to occur in children younger than two
months.
Thigpen MC, Whitney CG, Messonnier NE, et al 2011
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Epidemiology …
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The highest incidence is among neonates, who are usually
infected by bacteria found in the birth canal at the time of
parturition.
 90% of cases occur before 5 yr.
 Mortality 20-40% in neonates
 Mortaility 5-10% in infants and children.
Group B streptococci account for the majority of cases (50%),
followed by E. coli (25%)
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Pathogenesis
 Susceptibility of bacterial infection on CNS in the
children:
 Insufficient barrier (Blood-brain barrier)
 Immaturity of immune systems
 Insufficient complement activity
 Insufficient chemotaxis of neutrophils
 Insufficient function of monocyte-macrophage
system
 Diminished Blood levels of interferon (INF) –γ and
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Pathogenesis…
Specific immune
 Immaturity of both the cellular & humoral
immune systems
 Insufficient antibody-mediated protection
 Diminished immunologic response
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Pathogenesis…
Bacterial virulence-Offending bacterium from blood
invades the meninges.
Bacterial toxins and Inflammatory mediators are
released.
Bacterial toxics:
 Lipopolysaccharide, LPS
 Teichoic acid
 Peptidoglycan
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Pathophysiology
The causative organism enters the bloodstream,
crosses the blood–brain barrier, and triggers an
inflammatory reaction in the meninges.
Independent of the causative agent, inflammation of
the subarachnoid and pia mater occurs. Increased
intracranial pressure (ICP) results.
Meningeal infections generally originate in one of
two ways: either through the bloodstream from
other infections (cellulitis) or by direct extension
(after a traumatic injury to the facial bones).
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Risk factors of meningitis
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Extremes of age (< 5 or >60 years)
Immunosuppression, which increases the risk of opportunistic
infections and acute bacterial meningitis.
HIV infection, which predisposes to bacterial meningitis caused
by encapsulated organisms,
Crowding (such as that experienced by military recruits and
college dorm residents), which increases the risk of outbreaks of
meningococcal meningitis
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Risk factors
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Recent exposure to others with meningitis.
Contiguous infection (eg, sinusitis)
Dural defect (eg, traumatic, surgical, or congenital)
Bacterial endocarditis
Modes of transmission
Close contact with a person who is sick with the
disease
Contact with carriers
Living in close quarters, such as college dormitories
Being in crowded situations for prolonged periods of
time
Sharing drinking glasses, water bottles, or eating
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Types of meningitis
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1. Bacterial meningitis bacterial infection.
2. Viral meningitis caused by viruses (enterovirus)
3. Tuberculosis meningitis: Tuberculosis infection
due to M. tuberculosis.
4.Cryptococcal meningitis: Infection from a yeast
called Cryptococcus. Often associated with AIDS.
5. Neoplastic meningitis: spread of solid tumors to the
brain or spinal cord.
6. Syphilitic meningitis: due to infection with the
bacterium that causes syphilis.
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Clinical feature
High grade fever , Feeding problems & Irritability
High-pitched crying
Bulging fontanels & Severe persistent headache.
Neck stiffness : infants may not develop a stiff neck
Seizures: is correlative with the inflammation of brain
parenchyma, cerbral infarction and electrolyte disturbances.
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Clinical features…
Nausea and vomiting, sometimes along with
diarrheal
Confusion and disorientation can progress to
stupor, coma, and death
Drowsiness or sluggishness
Eye pain or sensitivity to bright light
Numbness and tingling
Pong A, Bradley JS, 2010
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Increased intracranial pressure
Headache
Projectile vomiting
Hypertension
Bulging fontanel
Cranial sutures diastasis/separation
Coma
Cerebral hernia
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The Kernig sign is +ve
BRUDZINSKI
SIGN is +ve
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Selected Bedside Signs of
Meningitis
Bedside Test Description
Nuchal rigidity
or neck stiffness
Inability to flex the head forward due to
rigidity of the neck muscles; however,
nuchal rigidity is absent if flexion of the
neck is painful but there is full range of
motion
Kernig's sign
Inability to flex the head forward due to
rigidity of the neck muscles; however,
nuchal rigidity is Extension in the knee is
painful (leading to resistance) when the
leg is fully bent at both the hp and knee
Brudzinski's Lifting a patient's head causes
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Diagnosis
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CM
INVESTIGATIONS(Lab)
CSF analysis (LP - A thin needle is inserted between L4/L5 to
withdraw a sample of CSF).
Blood test
Chest X-ray
CT scan or MRI
Cultures of samples of CSF, blood, urine, mucus from the nose and
throat, and pus from skin infections.
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Laboratory Findings
Examination of cerebrospinal fluid (CSF):
Cloudiness
Evident increased protein level
Evident decreased glucose (<1.1mmol/l)
Increased pressure of cerebrospinal fluid
Evident increased total WBC count (>1000×109/L)
Evident increased neutrophils in leukocyte differential count
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Differential Dx
Cerebral malaria
TBc meningitis
Aseptic meningitis
Brain abscess
Brain tumer
Bacterial infections
Viral infections
Trauma
Malignancy
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Prevention
Immunization
Prophylaxis
Reduced over crowded
Health education
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Treatment antibiotic therapy
Therapeutic principle
Good permeability for Blood-brain barrier
Drug combination
Full dosage
Full course of treatment
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Treatment of acute bacterial
meningitis in children
32
Suspected bacterial meningitis is a medical
emergency, and immediate diagnostic steps must be
taken to establish the specific cause so that appropriate
antimicrobial therapy can be initiated.
The mortality rate of untreated bacterial meningitis
approaches 100 % and, even with optimal therapy,
morbidity and mortality may occur.
Neurologic sequelae are common among survivors.
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Treatment of acute bacterial Cont…
33
Despite the effectiveness of current antibiotics in
clearing bacteria from the CSF, bacterial meningitis
continues to cause significant morbidity and
mortality worldwide.
Empiric treatment should be begun as soon as the
diagnosis is suspected using bactericidal agent(s) that
achieve significant levels in the CSF
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Empiric treatment
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Ceftriaxone 50-100 mg/kg/day IV/IM q12 hr
Vancomycin 60 mg/kg/day IV q6h.
Convulsive management
 Diazepam
 Phenobarbital
Treatment of increased intracranial pressure
 Dehydration therapy
• 20%Mannitol 5ml/kg iv q6h
• Lasix 1-2mg/kg iv
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General and Supportive Measures
Treatment of septic shock and DIC
Volume expansion
Dopamine
Corticosteroids
Heparin
Fresh frozen plasma
Platelet transfusions
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Therapy for specific pathogens
Microorganism Recommended
therapy
Duration of
treatment
Streptococcus
pneumoniae
Penicillin G or Ampicillin
OR
Vancomycin + Third-
generation cephalosporin (eg,
ceftriaxone or cefotaxime)
2 weeks
Neisseria
meningitidis
Penicillin G
OR
Third-generation
cephalosporin (eg, ceftriaxone
or cefotaxime)
7 days
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Haemophilus
influenzae
Third-generation
cephalosporin (eg,
7 days
Listeria
monocytogenes
Ampicillin or Penicillin G 3 weeks
Escherichia coli Third-generation
cephalosporin (eg,
21 days or 2
weeks
Group B
streptococci
Ampicillin or Penicillin G 14-21 days
Therapy for specific …
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Organism Drug of choice
Gr. B strep coccus Cefotaxim
Ceftriaxone and Gentamicin
L. Monocytogenes Ampicillin
H.Influenzae Cefotaxim
Ceftriaxone and CAF
N.Meningitides Benzile pens, Ceftriaxone
S.pneumoniae Vancomicin, Benzile pens,
Ceftriaxone
S.Aureus Ceftazidime, Vancomicin
Pseudomonas Ceftazidime
Drug of choice according to the culture
isolates
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Prognosis
Prognosis depends largely on the supportive care
provided.
Appropriate antibiotic therapy reduces the mortality rate
for bacterial meningitis in children, but mortality remain
high.
Overall mortality in the developed countries ranges
between 5% and 30%.
50 percent of the survivors have some sequelae of the
disease.
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Prognosis…
 Prognosis depends upon many factors:
Age
Causative organism
Number of organisms and bacterial virulence
Duration of illness prior to effective antibiotic therapy
Presence of disorders that may compromise host response
to infection
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Complications of bacterial meningitis
Can be divided into acute and late.
1. Acute Complications
Increased ICP
Hydrocephalus
Hypoglycemia
Myocarditis
Brain damage
severe vomiting
Internal bleeding
Low blood pressure
Shock
Death
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Late complications:
Development delay
Cerebral palsy
Microcephaly
Seizure disorder
Hemiparesis
Hearing loss
Blindness
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Nursing Management
Assess neurologic status and vital signs constantly.
Determine oxygenation from arterial blood gas
values and pulse oximetry.
Insert cuffed endotracheal tube (or tracheostomy),
and posi-position patient on mechanical ventilation as
prescribed.
Assess blood pressure (usually monitored using an
arterial line) for incipient shock, which precedes
cardiac or respiratory failure.
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Nursing Management…
Protect the patient from injury secondary to seizure activity
or altered level of consciousness (LOC).
Monitor daily body weight; serum electrolytes; and urine
volume, specific gravity, and osmolality, especially if syndrome
of inappropriate antidiuretic hormone (SIADH) is suspected.
Prevent complications associated with immobility, such as
pressure ulcers and pneumonia.
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Destaye G.

Nursing Management…
Rapid IV fluid replacement may be prescribed,
but take care not to overhydrate patient because of
risk of cerebral edema.
Reduce high fever to decrease load on heart
and brain from oxygen demands.
Inform family about patient’s condition and
permit family to see patient at appropriate
intervals.
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Summary
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Definition
Etiology
Clinical manifastation
Management
Complication
Nursing management
Prevention

Any questions?
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References
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Nelson Textbook of Pediatrics, 19th ed.

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Thanks for your attention

11meningits ppt(1).pptx

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11meningits ppt(1).pptx