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Meningitis/ Encephalitis

Meningitis/ Encephalitis. Dr Mostafavi SN Department of Pediatric Infectious Disease Isfahan University of Medical Science 1394. Definition. Meningitis: Inflammation of pia mater, arachnoid and cerebrospinal fluid Encephalitis: Inflammation of brain parechyma. Etiology. Meningitis.

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Meningitis/ Encephalitis

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  1. Meningitis/ Encephalitis Dr Mostafavi SN Department of Pediatric Infectious Disease Isfahan University of Medical Science 1394

  2. Definition • Meningitis:Inflammation of pia mater, arachnoid and cerebrospinal fluid • Encephalitis: Inflammation of brain parechyma

  3. Etiology Meningitis Encephalitis • < 2 mo: • Enteric g- s, • Group B streptococcus • viruses:enteroviruses • L. monocytogen • > 1 mo: • Pneumococcus • H.flu type b • Meningococcus • Viruses: enteroviruses, mumps, … • Enteroviruses • Mump • HSV

  4. Transmission • Meningitis: • Hematogenous • Direct invasion: • Surgery:Staphylococcus aureus, Coagulase negative staphylococci • Trauma: Pneumococcus • CSF shunt:Coagulase negative staphylococci, Staphylococcus aureus, enteric gram negatives • Encephalitis: • Hematogenous • Ascending: HSV

  5. When we suspect? • Meningitis: • Fever+ • Meningeal sign especially after 18 mo • ↓level of consciousness, poor feeding • Psychosis, Irritability • Focal neurological signs • Seizure except in <5 yr • Brain edema signs • Encephalitis: • ↓level of consciousness/ psychosis + • Fever • Focal neurological signs • Seizure • lymphocytic pleocytosis • Ab NL EEG • Ab NL CT or MRI

  6. Brain edema signs • Bulging fontanel • Papilledema • Oculomotor or abdocent nerve palsies • Altered level of consciousness • Seizure • Cushing's response( HTN +Bradycardia+ apnea or hyperventilation) • Signs of herniation ( unequal pupils, irregular respiration, ↓ level of consciousness, unresponsive pupils ( • Severe headache, vomiting?

  7. When we suspect meningitis in febrile convulsion patients? • Another indication • Age< 1 yr • Status FC • Seizure after 24 hr. of fever • Previous use of antibiotics( 1 week)

  8. How can we confirm the diagnosis? • Meningitis: • CSF analysis • CSF gram stain: 70-90% • CSF culture • Blood culture: up to 80-90% • PCR for viruses • ESR, CRP • Encephalitis: • CSF analysis • CSF PCR • EEG • MRI

  9. Contraindications for LP • Cardiopulmonary compromise • Increased ICP signs except ( only) bulging fontanel • Infection at the site of needle entry • Thrombocytopenia (Plts <50, 000/mm3)/ Coagulopathy

  10. CSF finding in CNS infections

  11. How can we treat it? • Meningitis • Antibiotic: ceftriaxon+ vancomycine( > 1mo)+ ampicillin in (< 2mo) • Dexamethason in >6 wk, prior to ABs • Supportive care( SIADH, hydration, seizure, …) • Encephalitis • Acyclovir until R/o HSV • Supportive care( SIADH, hydration, seizure, …)

  12. Choice of ABs after culture

  13. Complications • Behavioral problems • Hearing loss • Mental retardation & decreased IQ • Delay language • Epilepsy • Visual impairment

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