Paediatric Meningitis and Encephalitis
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define bacterial and viral meningitis/encephalitis.
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Identify the common causative organisms in paediatric patients.
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Recognize clinical signs and symptoms of meningitis and encephalitis.
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Outline initial assessment and supportive care, including airway, hydration, and seizure management.
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Describe pharmacological treatment according to age and severity.
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Implement monitoring strategies and complication prevention.
Bacterial Meningitis
Description:
Bacterial meningitis is inflammation of the meninges covering the brain and spinal cord. It can cause severe morbidity and mortality if not recognized and treated promptly.
Clinical Features:
| Symptom Category | Signs and Symptoms |
|---|---|
| General | Fever, irritability, lethargy, refusing to feed or suck |
| Neurological | Headache, neck stiffness, seizures, altered consciousness |
| Gastrointestinal | Nausea, vomiting |
Investigations:
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Lumbar puncture (CSF analysis) if no contraindications
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Blood cultures
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Full blood count
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Electrolytes and renal function
Treatment — Supportive:
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Control fever and pain
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Manage seizures
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If low GCS: insert NGT for feeding and aspiration prevention, insert urethral catheter for monitoring
Pharmacological Treatment (Children >1 month old):
| Regimen Option | Dose / Frequency |
|---|---|
| Dexamethasone | 0.15 mg/kg STAT IV |
| Cefotaxime / Ceftriaxone | 50 mg/kg IV daily (single dose), can increase to 80 mg/kg in severe infection |
| Alternative regimen | Benzylpenicillin 50,000–100,000 IU IV every 6 hours + Chloramphenicol 50–75 mg/kg IV every 6 hours |
Viral Meningitis / Encephalitis
Description:
Viral meningitis or encephalitis is inflammation of the meninges and/or brain parenchyma caused by viral infections, including Herpes Simplex Virus, Epstein-Barr Virus, Cytomegalovirus, and Adenovirus. Mortality is lower than bacterial meningitis but morbidity can be significant.
Clinical Features:
| Symptom Category | Signs and Symptoms |
|---|---|
| General | Fever (may be low-grade or absent), lethargy, irritability, refusing to feed |
| Neurological | Headache, neck stiffness, seizures, altered consciousness |
| Gastrointestinal | Nausea, vomiting |
Treatment — Supportive:
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Control fever, pain, and seizures
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If low GCS: insert NGT to reduce aspiration risk and for feeding
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Maintain good hydration; IV fluids at 2/3 of maintenance to avoid fluid overload
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Insert urethral catheter to monitor input/output
Pharmacological Treatment (Infants >1 month old):
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Acyclovir IV 30–60 mg/kg/dose three times daily
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Continue empirical antibiotics for bacterial meningitis until bacterial infection is excluded
Summary
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Meningitis and encephalitis are life-threatening in children and require early recognition.
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Bacterial meningitis requires rapid empirical antibiotics and dexamethasone.
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Viral causes are primarily managed supportively, with antiviral therapy for HSV or suspected viral encephalitis.
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Low GCS necessitates airway protection, NGT insertion, and close monitoring of input/output.
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Hydration must be cautious; overhydration may worsen cerebral oedema.
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Monitor for complications such as seizures, raised intracranial pressure, and septic shock.