Bacterial Meningitis
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| Bacterial Meningitis |
Is an inflammation of the meninges that follows the invasion of the spinal fluid by a bacterial agent.
Aetiology:
The organisms most commonly causing bacterial meningitis are E.coli, streptococcus pneumonia, Hemophilus influenza and Neisseria meningitides.Pathophysiology:
It is almost always preceded by an upper respiratory infection, bacteria circulating in the blood invade the CSF.May occur as the extension of a local bacterial infection such as otitis media or mastoiditis.
Also gain direct entry through a penetrating wound, spinal tap, surgery or anatomic abnormalities.
The infective process results in inflammation, exudation and varying degree of tissue damage in the brain.
Clinical manifestations:
Signs and symptoms are variables depending on the patient's age, the etiologic agent and the duration of the illness when diagnosed.1- Infant less than 1 month of age:
Hypothermia or fever, irritability, weight loss, seizures, jaundice, cyanosis, apnea, poor suckling, vomiting, full tense and bulging fontanel, neck usually supply.
2- Infants and up to 2 years of age:
Neck rigidity, bulging fontanel, fever, vomiting, positive kerning's and brudzinski's signs.
3- Children over 2 years:
Vomiting, headache, mental confusion, lethargy, neck rigidity, positive kernings and chills.
Diagnostic evaluation:
History.Physical examination.
Diagnosis usually established by the performance of lumbar puncture to examine the CSF.
1.cloudy or turbid.
2. elevated CSF pressure.
3. high cell count.
4- low glucose level ( CSF).
5- an elevated protein level (CSF).
6-gram stain.
7- culture and sensitivity.
CBC ( elevated WBCs ).
Serum glucose, urea, creatinine, electrolytes.
Blood culture.
Complications:
Seizures , cerebral edema , subdural effusion , hydrocephalus.Brain abscess .
Treatment:
1- I.V antibiotic.2- supportive management of the comatose child or the child with seizures.
3- Appropriate prophylactic provided for contacts if indicated.
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