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During neonatal period etiology of meningitis
caused by mother¶s microbial flora.
Incidence of meningitis a newborn infants is
0.2 ± 0.4 cases per 1000 live births and is
higher in preterm infants. Bacterial
meningitis may be associated with sepsis or
may occur as a focal infection.
Õ

 

 
a whe most common bacterial causes of neonatal
meningitis are ë

 


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.
a ëther

, non-typable 


   
 
, both
coagulase-positive and negative

,
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 may also produce
meningitis.
a G
 "
 is an important cause of brain
abscess.

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whe same etiology that in neonatal group.
Meningitis bacterial in children 2 mo ± 12 yr of
age is usually caused by

 


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"
  
or 

 type b.
Before beginning widespread use of
vaccination from 
 type b near
70% of cases of BM among children younger
than 5 yr were due to 
 type b.
 
a Õlso meningitis may caused by some
viruses ( enteroviruses more than 80% of
all cases of meningoencephalitis,
arboviruses, HSV-1, HSV-2 ± in sexually
active adolescents, VZV, CMV, EBV,
MUMPS, occasionally by rubeola, rubella,
rabies ), nozocomial infection in children
who hospitalized for a long time.
Chronic meningitis - Etiology
a wuberculosis
a Fungi
a ÕIDS
a Syphilis
a woxoplasma
a Focal infection ( brain abscess, spinal
epidural abscess )
a Malignancy, collagen vascular syndromes,
toxins
 
a Specific host defense defects ( defect
of complement system C5-C8 have
been associated with recurrent
meningococcal infection+ defects of
the properdin system ± significant
risk of lethal meningococcal disease.
a Õ major risk factor for meningitis is
the lack of immunity to specific
pathogens associated with young
age.
 

a In addition colonization of pathogen, close
contact with sick children ( with 

  type b & 


"
 )
crowding, poverty, male gender.
a wransmission ± person to person or
droplets.
  
a Splenic dysfunction or asplenia is
associated with an increased risk of
pneumococcal, 
  type b, and
rarely meningococcal sepsis & meningitis. w
- lymphocyte defects are associated with an
increased risk of  
infections.
a Congenital or acquired CSF leak are
associated with staphylococcal and gram-
negative enteric bacterial meningitis.
 !
 isk factors for pneumococcalàmeningitisà otitis
media, sinusitis, pneumonia, CSF otorrhea
or rhinorrhea, and chronic graft versus host
disease.
a 


"
à Meningitis may be
sporadic or epidemic. usually epidemic
disease caused by serogroup Õ. It¶s occure
more common in the winter and spring.
Nasopharyngeal carriage of N.meningitidis
occurs in 1-15% of adults.Colonization
places nonimmune younger children at
greatest risk for meningitis.
 !
a meningococci
’ 
a INFLÕMMÕwIëN.
a wH ëMBëSIS.
a HEMë  HÕ E.
a INFÕ CwIëN.
a INC EÕSED ICP.
a CYwëwë
IC EDEMÕ.
a HYD ëCEPHÕLUS.
a HYPë
IÕ.
G
  
a Shock
a Purpura (
especially in
meningococc )
a DIC
a  educed levels of
consciousness
G
  

a 0ernig sign ( flexion of the hip 90 degrees with subsequent

pain with extension of the leg )
a Brudzinski sign ( involuntary flexion of the knees and hips
after passive flexion of the neck )
a Nuchal rigidity, back pain.

a Headache,photophobia, emesis, bulging fontanel or

diastasis of the sutures, oculomotor or abducens nerve
paralysis, hypertention with bradycardia, apnea or
hyperventilation, decorticate or decerebrate posturing
stupor, coma, or signs of herniation
G
  
a Papilledema is more
common for cronic
process (intracranial
abscess, subdural
empyema or occlusion
of adural venous
sinus)
a Cranial neuropathies
may be also due to
focal inflammation.
a Seizures occur in 20-
30% of patients.
’
a Seizures that persist after the 4th day of illness and
those that are difficult to treat may be associated with
a poor prognosis.
a Comatose patients have a poor prognosis.
a whe highest mortality rates occurred with
pneumococcal meningitis.
a Severe neurodevelopmental sequelae may occur in
10-20% - hearing loss, mental retardation, seizures,
delay in acquisition of language, behavioral problems.
a whe prognosis is poorest among infants < 6 mo
a Õbsence of pleocitosis in patients with severe sepsis
and meningitis is a poor prognostic sign.
3 
a Diagnosis of bacterial meningitis is
confirmed by analysis of the CSF, which
reveals microorganisms on ram stain and
culture, a neutrophilic pleocytosis, elevated
protein, and reduced glucose consentration.
a Contraindications for LP :
Increased ICP
Sever cardiopulmonary compromise
Infection of the skin
whrombotcytopenia
If an LP is delayed, empirical antibiotic
therapy should be initiated.
33
a Focal infections of CNS
a Noninfectious illnesses ( malignancy,
collagen vascular syndromes, toxins )
  
a  ecommended empirical therapy is vancomycin ( if
pneumococc resists to ǃ- lactam drugs ) in combination
with or third-generation cephalosporin's ( cefotaxime or
ceftriaxone )
a If L.monocytogenes infection is suspected in infants 1 ± 2
mo or patients with a w-lymphocyte deficiency, ampicillin
should be given with cephalosporin's
a If a patient is immunocompromised and is suspected,
initial therapy might include ceftazidime and an
aminoglycoside. gram-negative bacterial meningitis should
be treated for 3 wk or for at least 2 wk after CSF
sterilization, which may occur after 2-10 days of
treatment.
a If we suspect HSV meningitis treatment with acyclovir
should be started. PC  to HSV should be performed.
a If PC  to HSV positive the treatment should be given for
14-21 days.
à3      
"
 ecommended wreatments for
Õseptic Meningitis
 
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a Meningococcal meningitis
Chemoprophylaxis is recommended for all close contacts
with meningococcal meningitis regardless of age or
immunization status. close contacts should be treated
with rifampin for 2 days.

"%"
&


Meningococcal vaccine against serogroups Õ, C, Y and W
135 is recommended to high-risk children older than 2
years.
whe vaccine may be used as an adjunct with
chemoprophylaxis.
’
a Haemophilus influenza type B.
 ifampin prophylaxis should be given to
all family members if there is a child
younger than 48 mo who has not
been fully immunized or if an
immunocompromised child resides in.
 ifampin dose is 20 mg/ kg/d once a
day for 4 days.
a Vaccine.
’
a Sterp. Pneumoniae.
a Õ heptavalent conjugate vaccine is
recommended for all children younger
than 2 yr.(from 2 mo). Children with
anatomic or dysfunctional asplenia
,immunocompromised persons (HIV,
primary immunodeficiency , receiving
immunosupressive therapy should
also receive the vaccine.