This quiz is based on the implementation of the current National Institute for Health and Clinical Excellence (NICE) UK Guideline for the management of bacterial meningitis and meningococcal septicaemia in children and young people in primary and secondary care.
4–6 weeks
2-3 months
2 -3 weeks
4-6 months
6-8 months
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1-2%
2-11%
15-20%
25-50%
Less than 1%
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Jan 2010
June 2010
Jan 2009
Dec 2009
Oct 2010
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Whole blood real-time PCR testing (EDTA sample) for N meningitides
Lumbar puncture
FBC
CRP
Blood Culture
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Children under 2 years
2 to 5years
School age between 5 and 10 years
Adolescence and early adulthood
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Capillary refill time longer than 2 seconds
Unusual skin colour
Tachycardia or hypotension
Respiratory symptoms or breathing difficulty
Leg pain
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N meningitidis (meningococcus)
S agalactiae (group B streptococcus)
E coli
S pneumoniae (pneumococcus)
Haemophilus influenzae type b
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Spreading petechiae
The rash becoming purpuric or necrotic
The rash becoming pustular
Neck stiffness
Signs of shock
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Intravenous
Intraosseous
Subcutaneous
Intratracheal
Oral
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Toxic or moribund state
Shock
Hypotension
Leg pain
Sore throat or coryza
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Photophobia
Kernig’s sign or Brudzinski’s sign
Bulging fontanelle
Diarrhoea, abdominal pain, or distension
Focal neurological deficit
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Hearing loss
Hepatosplenomegaly
Damage to bones and joints
Skin scarring from necrosis
Psychosocial problems
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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
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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
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S agalactiae (group B streptococcus)
E coli
N meningitidis (meningococcus)
Strep pneumoniae
Listeria monocytogenes
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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
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Signs suggesting raised intracranial pressure
Shock
Extensive or spreading purpura
Extreme preterm neonate
After convulsions until stabilised
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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
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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
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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
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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
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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
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