Date post: | 16-Jun-2015 |
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MENINGITISMENINGITIS
Dr. Carlos Azañero Inope
Dr. Carlos Azañero Inope
CausativeCausative organismsorganisms
bacterial bacterial viral viral occasionallyoccasionally fungalfungal
-- meningococcimeningococci,,-- pneumococcipneumococci, , -- Haemophilus Haemophilus influenzaeinfluenzae, , -- Listeria Listeria andand TBTB
Dr. Carlos Azañero Inope
ClinicalClinical featuresfeatures ofof bacterial meningitisbacterial meningitis
thethe classicclassic featuresfeatures
headacheheadache neckneck stiffnessstiffness
Dr. Carlos Azañero Inope
ClinicalClinical featuresfeatures ofof bacterial meningitisbacterial meningitis
thethe classicclassic featuresfeatures
photophobiaphotophobia feverfever andand drowsinessdrowsiness
Dr. Carlos Azañero Inope
……HoweverHowever, , thethe clinicalclinical diagnosis diagnosis ofof meningitis meningitis may be may be veryvery difficultdifficult in in earlyearly cases cases
NeonatesNeonates
anorexia, anorexia, apnoeaapnoea ororfitsfits
Dr. Carlos Azañero Inope
Meningitis may Meningitis may startstart as a as a ““fluflu--likelike”” illnessillness, , especiallyespeciallyin in thethe immunosuppressedimmunosuppressed oror elderlyelderly..
Dr. Carlos Azañero Inope
MeningococcalMeningococcal meningitismeningitis isis causedcausedby by NeisseriaNeisseria meningitidismeningitidis. . ItIt can can resultresultin in septicaemiasepticaemia, coma , coma andand deathdeathwithinwithin a a fewfew hrshrs ofof thethe firstfirst symptomssymptoms. .
Dr. Carlos Azañero Inope
TheThe characteristiccharacteristic skin skin rashrash ofof meningococcalmeningococcal septicaemiasepticaemia, , causedcaused by by NeisseriaNeisseria meningitidismeningitidis. (. (CourtesyCourtesy ofof WellcomeWellcome Trust Trust PhotographicPhotographicLibraryLibrary))
Skin Skin rashesrashes occuroccur in 50% in 50% ofof patientspatients, , oftenoften startingstarting as a as a maculopapularmaculopapularrashrash, , beforebefore thethe characteristiccharacteristic petechialpetechial rashrash developsdevelops. . ThereThere may be may be DIC DIC andand adrenal adrenal haemorrhagehaemorrhage (Waterhouse(Waterhouse--FriderichsenFriderichsen syndromesyndrome).).
Dr. Carlos Azañero Inope
-- ResuscitateResuscitate ifif necessarynecessary andandobtainobtain venousvenous accessaccess..
-- StartStart antibioticsantibiotics immediatelyimmediately((withoutwithout waitingwaiting forfor investigationsinvestigations) ) ifif::
**thethe patientpatient isis shockedshocked//deterioratingdeterioratingoror ifif therethere isis anyany suspicionsuspicion ofofmeningococcalmeningococcal infectioninfection ((especiallyespeciallya a petechialpetechial oror purpuricpurpuric rashrash))
Management
Dr. Carlos Azañero Inope
GiveGive IV IV cefotaximecefotaxime (2g in (2g in anan adultadult; 80mg/; 80mg/kgkg in a in a childchild) ) oror IVIV ceftriaxoneceftriaxone (2g (2g in in anan adultadult; 80mg/; 80mg/kgkg in a in a childchild).).
Management
Dr. Carlos Azañero Inope
Management
ChloramphenicolChloramphenicol isis ananalternativealternative ifif therethere isis a a historyhistory ofof anaphylaxisanaphylaxis totocephalosporinscephalosporins. .
Dr. Carlos Azañero Inope
LPLP isis requiredrequired ifif meningitis meningitis isis suspectedsuspected, , butbutensureensure CT CT scanscan isis performedperformed firstfirst ifif therethere are are focal focal neurologicalneurological signssigns oror suspicionsuspicion ofof ICP ICP ((confusionconfusion/coma, /coma, hypertensionhypertension, , bradycardiabradycardia ororpapilloedemapapilloedema). ).
Dr. Carlos Azañero Inope
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