Paediatrics - Queensland Health - Queensland Government

Meningitis
Meningitis
Recommend
Consult MO immediately:
- - if a sick looking child has no obvious source of infection, which would explain
their symptoms - the diagnosis is meningitis until proven otherwise
- - if the child has been treated with antibiotics but is still not well (they may have
partly treated meningitis with masking of signs)
-- if the child is unwell with prolonged URTI symptoms
Restrict fluids to 50% of maintenance (10mg / kg) unless there are signs of shock -
MO to discuss as soon as possible with a Paediatrician
Parents or carers may notice early, subtle changes in the child’s conscious state.
Their concerns should not be ignored
Perform hearing test 3 months after discharge from hospital
Background
Mortality is probably 5 - 10% in bacterial meningitis. Most children will make
a full recovery, if appropriately treated. Deafness is the most common long term
complication
Hyponatraemic solutions e.g. 4 % dextrose and one-fifth normal saline or one-quarter
normal saline, have no place in the management of meningitis as they may worsen
hyponatraemia and increase the risk of cerebral oedema [1]
Related topics
Fits / convulsions / seizures
Upper respiratory tract infection -
child
Immunisation program
DRS ABCD resuscitation / the collapsed
patient
O 2 delivery systems
1. May present with
• URTI type symptoms, fever, lethargy, poor feeding
• In young children - non specific signs and symptoms including fever, irritability,
refusing feeds, pallor and a high pitched moaning cry may be present
• In older children - headache, photophobia, neck stiffness [2]
• Leg pain, cold hands and feet
• Abnormal skin colour - pallor or sweating
• Rash in meningococcal disease: usually non blanching petechiae (fine dark red
spots) but may be purpura (like bruises), or less commonly, a ‘flea bitten’ pink / red
maculopapular rash. The rash often develops rapidly, however meningococcal
disease can occur without a rash
• Muscle / joint pains, vomiting, diarrhoea
• Confusion, drowsiness, loss of consciousness
• Bulging fontanelle, fitting
2. Immediate management
• Consult MO immediately
• If altered level of consciousness See DRS ABCD resuscitation / the collapsed
patient
• If fitting see Fits / convulsions / seizures
• Give O 2 to maintain O 2 saturation >95%. If >95% not maintained consult MO.
See O 2 delivery systems
• Insert IV / IO cannula and take FBC, U/E, blood cultures, PCR for Neisseria
meningitis (meningococcal bacteria)
Primary Clinical Care Manual 2011 Controlled copy V 1.0 559