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- Neisseria meningitis, Streptococcus pneumoniae, and Haemophilus influenza type b (Hib) are the most common causative organisms of acute bacterial meningitis in children aged 3 months or older and adults.
- In neonates (younger than one month of age), Streptococcus agalactiae, Escherichia coli, S. pneumoniae, and Listeria monocytogenes are the most common causative organisms
- stiff neck
- risk factors
- non-blanching rash
- normal -> altered LOC -> coma
- head jolt accentuation test (lateral head rotation worsens headache = very sensitive)
- Kernig’s sign
- Brudzinski’s sign
- papilloedema (indicates raised ICP)
- tense fontanelle in babies
- focal neurological deficit
- Bloods – FBC and CRP
- Blood cultures
- Blood PCR testing for N. meningitidis and S. pneumoniae
- CT Head first if:
- Abnormal mental states
- new onset seizures
- GCS < 10 focal neurological signs in keeping with a space occupying lesion.
- Signs suggesting raised intracranial pressure.
- Perform a lumbar puncture unless contraindicated.do not delay antibiotics
- Contraindications for LP
- GCS 8 or less or deteriorating
- Focal neurological signs or abnormal posture
- Prolonged seizure lasting 10 minutes or more and a GCS of 12 or less
- Systemic meningococcal disease
- Signs of raised intracranial pressure: unilateral or bilateral dilated pupils or sluggish pupillary reaction
- Bradycardia or hypertension Abnormal breathing pattern
- Contraindications for LP
- out of the hospital, a single dose of benzylpenicillin (IM or IV)
- Empirical antibiotics for suspected bacterial meningitis (ideally following LP, but do not delay > 30 minutes):
- All adult patients should receive their first dose of 2G Ceftriaxone
- For adults aged over 50 years or immunocompromised, add IV ampicillin PLUS Gentamicin
- Children < 3 months – Cefotaxime 80 mg/kg IV + amoxicillin/ampicillin
- Children ≥ 3 months – Ceftriaxone 80 mg/kg IV
- If herpes simplex meningoencephalitis is part of the differential diagnosis give appropriate antiviral treatment
- Give dexamethasone (0.15 mg/kg to a maximum dose of 10 mg)-with or before the first dose of antibiotics.
- If dexamethasone was not given before or with the first dose of antibiotics, but was indicated, try to administer the first dose within 4 hours of starting antibiotics, but do not start dexamethasone more than 12 hours after starting antibiotics.
- Do not use corticosteroids in children younger than 3 months with suspected or confrmed bacterial meningitis.
Control of Infection Action
- The patient should be admitted to a side-room and barrier nursed
- requires droplet precautions
- Contact the Hospital Control of Infection team.
- Arrange for treatment of patient and prophylaxis of appropriate contacts
- Contact Community Health Service appropriate to the residence of your patient
Prophylaxis is recommended for
- Family contacts.
- Kissing contacts.
- Children under five who have attended a party at which a child was incubating the infection.
- Children under five in the same crèche (not school) class.
- Health care workers only recommended chemoprophylaxis if “mouth or nose is directly exposed to respiratory droplets and/or secretions from a case of meningococcal disease”.
Prophylactic Drugs: Either rifampicin or ciprofloxacin
- Hearing loss
- Motor deficit
- Cognitive impairment
- Visual disturbance