Bacterial Meningitis in Children

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Questions and Answers

What is the commonest cause of non-traumatic coma in children?

Cerebritis

Acute bacterial meningitis (correct)

Cerebral abscess

Otitis media

What are among the most common causes of fever associated with neurologic signs and symptoms in children in the tropics?

Otitis media

Skull fractures

Cerebral abscess

CNS infections (correct)

Why do micro-organisms proliferate much faster in the sub-arachnoid space than in plasma?

Blood-brain barrier breach

Presence of polymorphs in CSF

Strong complements in CSF

Lack of host defence mechanisms in the sub-arachnoid space (correct)

What is the result of CNS infections in children in the tropics?

Death within a few hours or severe neurologic sequela Signup and view all the answers

What is the usual landmark for the L4-L5 vertebra during lumbar puncture?

An imaginary line drawn across both illac crest, cutting thru the 5th & 6th ICS Signup and view all the answers

What are the relative contraindications to lumbar puncture?

Infection at the site of LP, thrombocytopenia, DIC, seizures occurring less than 2hrs prior Signup and view all the answers

What does a turbid appearance of CSF suggest during analysis?

Acute bacterial meningitis Signup and view all the answers

What is the normal appearance of CSF in older infants, children, and adults?

Clear and colourless Signup and view all the answers

What is the usual range for opening pressure (LP) during lumbar puncture in adults?

50-180mmH2O Signup and view all the answers

What is the normal range for CSF protein in adults?

15-40 mg/dl Signup and view all the answers

What is the glucose estimation in CSF relative to plasma glucose?

CSF glucose is measured relative to plasma glucose Signup and view all the answers

What cells are usually predominant in the CSF during partially treated bacterial meningitis?

Polymorphonuclear cells Signup and view all the answers

Which organism is a common infecting agent in infants and older children with bacterial meningitis?

Streptococcus pneumoniae Signup and view all the answers

What is the approximate mortality rate for bacterial meningitis worldwide?

11% Signup and view all the answers

Where does the geographical 'meningitis belt' experiencing epidemics of meningococcal meningitis every 5-10 years exist?

Sub-Saharan Africa Signup and view all the answers

What is the most common route through which neonatal meningitis is often caused?

Organisms colonizing the maternal birth canal Signup and view all the answers

Which of the following is a viral cause of meningitis in children?

Non-polio enterovirus Signup and view all the answers

What is the approximate range of risk for developing meningitis by 5 years of age in developing countries?

1:400 to 1:20,000 Signup and view all the answers

Which type of meningitis is one of the most challenging pediatric emergencies?

Acute bacterial meningitis Signup and view all the answers

What is the usual route through which acute bacterial meningitis is spread?

Hematogenously following systemic bacteremia Signup and view all the answers

How is a definitive diagnosis of bacterial meningitis made?

Lumbar puncture and analysis of the cerebrospinal fluid Signup and view all the answers

What is the percentage of hospital admissions accounted for by acute bacterial meningitis in Nigeria?

0.9-5.1% Signup and view all the answers

What are the common clinical features of bacterial meningitis in children, varying by age?

Non-specific symptoms in neonates and signs of meningeal irritation in older children Signup and view all the answers

Which of the following is a rare cause of meningitis in children with weakened immune systems?

Fungal and parasite causes Signup and view all the answers

Match the CSF characteristic with the corresponding normal range in neonates:

Appearance = Clear, colourless Opening pressure (LP) = 50-180mmH20 Lymphocytes/ul = 0-30 Protein, mg/dl = Upto 150 (full term), upto 170 (preterm) Signup and view all the answers

Match the CSF characteristic with the corresponding normal range in older infants, children & adults:

Appearance = Clear, colourless Opening pressure (LP) = 70-180 (average 125mmH20) Lymphocytes/ul = 0-4 Protein, mg/dl = 15-40 Signup and view all the answers

Match the CSF characteristic with the corresponding condition:

Cells: total & type = Normal Pressure (mmH2O) = 50-80 Leukocyte = 75% Protein (mg/dl) = 20-45 Signup and view all the answers

Match the CSF characteristic with the corresponding condition for partially treated bacterial meningitis:

Cells: total & type = Normal or elevated Pressure (mmH2O) = 510,000 Leukocyte = PMNs usually predominate but mononuclear cells may if pretreated for extended period of time Protein (mg/dl) = Usually 100-500 Signup and view all the answers

Match the CSF characteristic with the corresponding condition for acute bacterial meningitis:

Cells: total & type = Usually elevated (100-300) Pressure (mmH2O) = 100-1000 Leukocyte = Usually >3002,000, PMNs decreased usually Protein (mg/dl) = Usually >100-500 Signup and view all the answers

Match the following geographical regions with their association to meningococcal meningitis:

Sub-Saharan Africa = Experiences epidemics of meningococcal meningitis every 5-10 years Developing countries = Range of risk for developing meningitis by 5 years of age Nigeria = Accounts for 0.9-5.1% of hospital admissions for acute bacterial meningitis Worldwide = Approximately 1.2 million people contract bacterial meningitis annually Signup and view all the answers

Match the following descriptions with their association to the diagnosis of bacterial meningitis:

Lumbar puncture = Method for definitive diagnosis of bacterial meningitis Cerebrospinal fluid analysis = Part of the definitive diagnosis of bacterial meningitis Leptomeninges inflammation = Resulting from spread of acute bacterial meningitis Increased intracranial pressure = Resulting from spread of acute bacterial meningitis Signup and view all the answers

Match the following CNS infection types with their characteristics:

Diffuse CNS infections = Involving the entire central nervous system Focal CNS infections = Involving specific areas of the central nervous system Direct invasion = Penetrating the leptomeninges, sub-arachnoid space, and superficial cortical structures Haematogenous spread = Resulting from infections in other parts of the body and spreading through the bloodstream Signup and view all the answers

Match the following protective components of the CNS with their descriptions:

Skull = Bony structure protecting the brain Dura (pachymeninx) = Tough outermost layer surrounding the brain and spinal cord Pia and arachnoid (leptomenings) = Layers surrounding the brain and spinal cord Blood-brain barrier = Protective barrier comprising the blood-CSF, vasculo-endothelial, and arachnoid barriers Signup and view all the answers

Match the following outcomes of CNS infections with their descriptions:

Severe neurologic sequelae = Long-term neurological complications Death within a few hours = Fatal outcome within a short timeframe Diffuse CNS infections = Involving the entire central nervous system Focal CNS infections = Involving specific areas of the central nervous system Signup and view all the answers

Study Notes

Bacterial Meningitis in Children: Key Facts

Approximately 1.2 million people worldwide contract bacterial meningitis annually, with an 11% mortality rate.
In developing countries, the risk of developing meningitis by 5 years of age ranges from 1:400 to 1:20,000, accounting for 1-6% of hospital admissions.
The geographical "meningitis belt" in sub-Saharan Africa experiences epidemics of meningococcal meningitis every 5-10 years.
Bacterial meningitis is more common in children and is caused by invasion by microbes, including bacteria, viruses, fungi, and protozoa.
Neonatal meningitis is often caused by organisms colonizing the maternal birth canal or nasally transmitted bacteria.
Common infecting agents in infants and older children include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
Viral causes of meningitis include non-polio enterovirus, mumps virus, influenza virus, and others.
Fungal and parasite causes of meningitis are rare but can occur in children with weakened immune systems.
Acute bacterial meningitis (ABM) is one of the most challenging pediatric emergencies, accounting for 0.9-5.1% of hospital admissions in Nigeria.
ABM is usually spread hematogenously following systemic bacteremia, leading to inflammation of the leptomeninges and increased intracranial pressure.
Clinical features of bacterial meningitis in children vary by age and may include non-specific symptoms in neonates and signs of meningeal irritation in older children.
A definitive diagnosis of bacterial meningitis is made through a lumbar puncture and analysis of the cerebrospinal fluid.