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# Mometrix ## Positive Psoas and Obturator Signs * Positive psoas and obturator signs * Fever may develop after 24 hours ## Treatment Includes * Antibiotics (usually begun on diagnosis) * Surgical excision of the inflamed appendix * Note: In rare cases of confined appendicitis (with mild symptoms),...

# Mometrix ## Positive Psoas and Obturator Signs * Positive psoas and obturator signs * Fever may develop after 24 hours ## Treatment Includes * Antibiotics (usually begun on diagnosis) * Surgical excision of the inflamed appendix * Note: In rare cases of confined appendicitis (with mild symptoms), antibiotics alone may resolve the inflammation ## Bacterial Meningitis Bacterial meningitis may be caused by a wide range of pathogenic organisms, with the predominant agents varying with the child's age: * ≤1 month: *E. coli*, Group B streptococci, *Listeria monocytogenes*, and *Neisseria meningitidis* * 1-2 months: Group B streptococci * >2 months: *Streptococcus pneumoniae*, *Neisseria meningitidis*. Unvaccinated (Hib vaccine) children are at risk for *Haemophilus influenza* Bacterial infections usually arise from distant infections although they can enter the CNS from surgical wounds, invasive devices, nasal colonization, or penetrating trauma. The infective process includes inflammation, exudates, white blood cell accumulation, and tissue damage with the brain showing evidence of hyperemia and edema. Purulent exudate covers the brain and invades and blocks the ventricles, obstructing CSF and leading to increased intracranial pressure. Since antibodies specific to bacteria don't cross the blood/brain barrier, the body's ability to fight the infection is very poor. Diagnosis is usually based on lumbar puncture examination of cerebrospinal fluid and symptoms ## Age-Related Symptoms Are as Follows * **Newborns:** Signs may be very non-specific, such as weight loss, hypo- or hyperthermia, jaundice, irritability, lethargy, irregular respirations with periods of apnea. Specific signs include increasing illness, difficulty feeding with loss of suck reflex, hypotonia, weak cry, seizures, and bulging fontanels (usually late sign). Nuchal rigidity does not usually occur with neonates. * **Infants & Young Children:** Classic symptoms usually don't appear until ≥2 years. Signs may include fever, poor feeding, vomiting, irritability, and bulging fontanel. Nuchal rigidity and opisthotonic position in some children. * **Older Children & Adolescents:** Onset is usually abrupt, including fever, chills, headache, and alterations of consciousness with seizures, agitation, irritability, hemorrhagic rash beginning as petechiae and progressing to purpura or areas of necrosis, and increase risk of SIADH and DIC. Children may have photophobia, hallucinations, and aggressive behavior or become stuporous and lapse into coma. Nuchal rigidity may progress to opisthotonos. Reflexes are variable but positive Kernig and Brudzinski signs. Some signs (rashes, joint pains, ear drainage) may relate to particular bacteria.