Meningitis (peds): Difference between revisions
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*0 points: Aseptic meningitis likely<ref>Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007;297:52–60.
</ref> | *0 points: Aseptic meningitis likely<ref>Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007;297:52–60.
</ref> | ||
*1 point: Aseptic meningitis less likely | *1 point: Aseptic meningitis less likely<ref>Fine AM, Nigrovic LE, Reis BY, Cook EF, Mandl KD. Linking surveillance to action: incorporation of real-time regional data into a medical decision rule. J Am Med Inform Assoc 2007;14: 206–11. </ref> | ||
*≥2 points: Bacterial Meningitis more likely | *≥2 points: Bacterial Meningitis more likely<ref>Dubos F, Korczowski B, Aygun DA, et al. Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules. Arch Dis Child 2010;95:963–7.
</ref> | ||
==DDx== | ==DDx== | ||
Revision as of 13:16, 26 November 2014
Background
- Meningismus is difficult to discern if <6mo, (esp if <2mo)
- <3months old
- 1% incidence of bacterial meningitis
- E. coli, Group B strep, listeria
- >3months old
- S. pneumo, meningococcus, staph
Diagnosis
Bacterial Meningitis Score for >2mo and well-appearing
- Risk Factor
- Peripheral blood ANC >10K
- Seizure
- CSF
- CSF ANC >1000
- CSF protein >80
- CSF Gram stain (if + 61% Sn, 99% Sp)
- Any risk factor = high risk for bacterial meningitis
- Very low risk if infant lacks all risk factors
Work-Up
- CBC
- CSF
Pediatric Bacterial Meningitis Score[1]
| Bacterial Meningitis Score | ' |
| Criteria | Point Score |
| Positive CSF Gram Stain | 2 |
| CSF protein > 80mg/dL | 1 |
| Blood Absolute neutrophil count > 10,000 cells/mm3 | 1 |
| Incidence of seizures with illness | 1 |
| CSF neutrophil count ≥ 1000 cells/mm3 | 1 |
- 0 points: Aseptic meningitis likely[2]
- 1 point: Aseptic meningitis less likely[3]
- ≥2 points: Bacterial Meningitis more likely[4]
DDx
Treatment
- Neonates - IV ampicillin + gentamicin
- If suspecting S. pneumoniae, add vancomycin
- Empiric therapy for late-onset includes anti-staph agent plus ceftazidime, amikacin, or meropenem
- Ceftriaxone may cause bilirubin encephalopathy in neonates
- Infants and children - Vancomycin 60 mg/kg/d q6h plus Ceftriaxone 100 mg/kg/d q12h
- Length of Tx depends on organisms isolated
Disposition
- Admit despite negative meningitis score if:
- Age <2mo w/ any degree of pleocytosis
- Appear ill
- Infants w/ aseptic meningitis
- If likely viral meningitis still give ceftriaxone x 1, f/u in 24hr
See Also
Source
- ↑ Chavanet P, Schaller C, Levy C, et al. Performance of a predictive rule to distinguish bacterial and viral meningitis. J Infect 2007;54: 328–36.
- ↑ Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007;297:52–60.
- ↑ Fine AM, Nigrovic LE, Reis BY, Cook EF, Mandl KD. Linking surveillance to action: incorporation of real-time regional data into a medical decision rule. J Am Med Inform Assoc 2007;14: 206–11.
- ↑ Dubos F, Korczowski B, Aygun DA, et al. Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules. Arch Dis Child 2010;95:963–7.