Meningococcal Meningitis And Septicaemia

1-2%

2-11%

15-20%

25-50%

Less than 1%

Neonates

Infants and toddlers

2 to 5years

School age between 5 and 10 years

Adolescence and early adulthood

Children under 2 years

2 to 5years

School age between 5 and 10 years

Adolescence and early adulthood

Jan 2010

June 2010

Jan 2009

Dec 2009

Oct 2010

S agalactiae (group B streptococcus)

E coli

N meningitidis (meningococcus)

Strep pneumoniae

Listeria monocytogenes

N meningitidis (meningococcus)

S agalactiae (group B streptococcus)

E coli

S pneumoniae (pneumococcus)

Haemophilus influenzae type b

A heterotrophic gram-negative diplococcal

A heterotrophic gram-positive diplococcal

First discovered by Anton Weichselbaum in 1887

It exists as normal flora in the nasopharynx of up to 5-15% of adults.

Can be is spread through the exchange of saliva and chewing on toys

Spreading petechiae

The rash becoming purpuric or necrotic

The rash becoming pustular

Neck stiffness

Signs of shock

Whole blood real-time PCR testing (EDTA sample) for N meningitides

Lumbar puncture

FBC

CRP

Blood Culture

Photophobia

Kernig’s sign or Brudzinski’s sign

Bulging fontanelle

Diarrhoea, abdominal pain, or distension

Focal neurological deficit

Toxic or moribund state

Shock

Hypotension

Leg pain

Sore throat or coryza

Signs suggesting raised intracranial pressure

Shock

Extensive or spreading purpura

Extreme preterm neonate

After convulsions until stabilised

Capillary refill time longer than 2 seconds

Unusual skin colour

Tachycardia or hypotension

Respiratory symptoms or breathing difficulty

Leg pain

20 ml/kg 0.9% sodium chloride fluid bolus over 5–10 minutes if there are signs of shock

20 ml/kg 10% Glucose fluid bolus over 5–10 minutes if there is hypoglycaemia

A second bolus of 20 ml/kg of sodium chloride 0.9% if the signs of shock persist

A second bolus of 10 ml/kg of sodium chloride 0.9% if the signs of shock persist

A second bolus of 20 ml/kg of human albumin 4.5% solution if the signs of shock persist

Intravenous

Intraosseous

Subcutaneous

Intratracheal

Oral

Immediately give a third bolus of 20 ml/kg of 0.9% sodium chloride or human albumin 4.5% solution over 5–10 minutes

Call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation

Start treatment with vasoactive drugs and discuss further management with a paediatric intensivist

Avoid giving more than 40 ml/kg of fluid over a short period of time even if there is inadequate circulating volume

Consider giving further fluid boluses at 20 ml/kg normal saline or human albumin 4.5% solution over 5–10 minutes based on clinical signs and appropriate laboratory investigations including urea and electrolytes

Ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that penetrate sufficiently into CSF from blood and are useful in the treatment of bacterial meningitis

Meningococci, are susceptible to chloramphenicol, rifampin, erythromycin, and tetracyclines and ciprofloxacin

Treat children aged older than 3 months with intravenous ceftriaxone

Most patients with uncomplicated meningococcemia defervesce within the first 24 hours of antibiotic therapy

Treat children younger than 3 months with intravenous cefotaxime plus amoxicillin or ampicillin

Mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children

A well child who has been exposed to a patient with meningococcal meningitis in the past 7 days

More specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia

Symptoms and signs may become more severe and more specific over time

Shock

Hearing loss

Hepatosplenomegaly

Damage to bones and joints

Skin scarring from necrosis

Psychosocial problems

All recent significant contacts of the infected patient over the 7 days before onset of symptoms

Possible chemoprophylaxis with rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin

Chemoprophylaxis is not recommended during epidemics because of multiple sources of exposure and prolonged risk of exposure

Children could receive either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days, according to body weight

Ciprofloxacin is not recommended in persons older than 18 years

Prophylaxis should be given to contact young children and their carers or nursery-school contacts

Anyone who had direct exposure to the patient through kissing, sharing utensils, or medical interventions such as mouth-to-mouth resuscitation

Anyone who frequently ate, slept or stayed at the patient's home during the 14 days before the onset of symptom

A person who sat beside the patient on an airplane flight of more than 8 hours

Co-workers and school classmates

Children younger than 3 months

Dose is 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days

Frankly purulent cerebrospinal fluid

CSF wbc count greater than 1000/μl count with protein concentration greater than 1 g/l

Bacteria CSF on Gram stain

4–6 weeks

2-3 months

2 -3 weeks

4-6 months

6-8 months