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# Meningitis Patients with bacterial meningitis may exhibit signs to help support the diagnosis. These signs aren't always present but are specific to meningitis and are rarely positive with other disorders: - **Kernig's sign** - Flex each hip and then try to straighten the knee while the hip is f...

# Meningitis Patients with bacterial meningitis may exhibit signs to help support the diagnosis. These signs aren't always present but are specific to meningitis and are rarely positive with other disorders: - **Kernig's sign** - Flex each hip and then try to straighten the knee while the hip is flexed. Spasm of the hamstrings makes this painful and difficult with meningitis. - **Brudzinski sign** - With the child lying supine, flex the neck by pulling head toward chest. The neck stiffness causes the hips and knees to pull up into a flexed position with meningitis. - **Jolt accentuation maneuver** - (Used if nuchal rigidity is not present.) Ask child to rapidly move his/her head from side to side horizontally. Increase in headache is positive for meningitis. ## Management includes: - **Antibiotic therapy** - Antibiotics (IV X 7 to 21 days) are initiated on diagnosis but may be changed after return of cultures. Commonly used antibiotics include ampicillin, aminoglycosides, cefotaxime, ceftriaxone, penicillin G, and vancomycin. - **Corticosteroids** - Corticosteroids (for children > 6 weeks) to reduce neurological complications, especially with *Haemophilus influenzae B* infection, but may cause GI bleeding. - **Other (for increased ICP)** - Increase in intracranial pressure may be treated with antipyretics, mannitol, and barbiturates (high dose). - **IV fluids** - Careful monitoring of fluid intake is necessary to prevent or aggravate increased ICP. - **Na and Sp Gravity monitoring** - Careful monitoring is needed to observe for signs of SIADH, which requires fluid restriction and electrolyte therapy. - **Long-term** - Depending upon neurological sequelae, the child may require ongoing therapy after initial treatment of infection. Treatment may include extensive physical therapy, occupational therapy, and speech therapy. If brain damage is profound, the child may require long-term custodial care. ## Viral (Aseptic) Meningitis Viral (aseptic) meningitis (the most common infection of the central nervous system) usually results from enterovirus infection in children < 1 year although it can result from other organisms, such as rubella and herpes, and occur in older children. Long-term neurological sequelae associated with viral meningitis may result from progression to encephalitis. Children with viral meningitis have symptoms similar to bacterial meningitis, but symptoms are generally less severe. Diagnosis is per examination of spinal fluid (increased blood cells and protein) and PCR testing (to identify causative agent). Complete recovery may take weeks, but symptoms usually recede in 3 to 10 days. ### Symptoms include: - Fever - Irritability or lethargy - General malaise - Headache - Photophobia - Maculopapular rash - Upper respiratory symptoms - GI distress (nausea, vomiting, diarrhea) - Meningeal irritation