Acute bacterial meningitis

Clinical manifestations

Meningococcemia

Meningial irritation signs

Nuchal rigidity,

Brudzinski sign: Involuntary flexion of the knees and hips follows flexion of the neck in the supine child.

Increased intracranial pressure

Bulging anterior fontanel is a sign of Increased intracranial pressure

Seizures due to:

- Cerebritis 

- Infarction

-          Electrolyte disturbances

-           may be associated with poor prognosis

-          Diagnosis

-          Lumbar puncture: should be performed when bacterial meningitis is suspected.

-          - The microorganisms on gram stain and culture is positive in 70-90% of the cases.

-          - Neurtophilic pleocytosis (>1000/mm3) is present.

-          - Elevated CSF proteins

-          - Reduced glucose concentrations.

-          Treatment

-          Antibiotics

-          Initial antibiotic therapy

-          Cefotaxime 200-300 mg/kg/24hr for 10-14 days IV or ceftriaxone100mg/kg/24 hr is usually used. Vancomycin (60 mg/kg/24 hr, given every 6 hr) may be added in suspected resistant strain infection.

-          Chloramphenicol: 100mg/kg/24 hr in 4 divided doses IV is used in patients allergic to          β-lactam antibiotics.

-          · Penicillin 300,000 U/kg/24hr, IV in 4-6 divided doses is used for penicillin sensitive N. meningitides infection.

see the pictures

Nuchal rigidity

Brudzinski sign

Dialated pupil

Increased intracranial pressure (

Lumbar puncture

The child is seen in convulsion