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presenter:MOHD AJIB (090100385)ESMETH (090100381)
TUTOR:Dr johannes harlan saing sp.a(k)
PAEDIATRICS DEPARTMENTRSUP H ADAM MALIK MEDANCASE REPORT: MENINGOENCEPHALITISINTRODUCTIONMeningitis is a clinical syndrome characterized by inflammation of the meningesEncephalitis, an inflammation of the brain parenchymaMeningoencephalitis is inflammation of both the brain and the leptomeningesCDC: 20,000 cases of viral encephalitis occur in the US/year.ETIOLOGYMost viral infections in childhood are able to cause encephalitisHerpes simplex virus (HSV)herpes zoster,Epstein-Barr virus,mumps, measlesand enteroviruses.cytomegalovirus,adenovirus, influenza virus,poliovirus, rubella,rabies, arbovirus (eg California virus,Japanese B encephalitis, St Louis encephalitis, West Nile encephalitis, Eastern and Western equine encephalitis), reovirus (Colorado tick fevervirus),parvovirus B19.bacterial:tuberculosis(TB),mycoplasma,listeria,Lyme disease,Bartonella henselae(cat scratch fever), leptospira, brucella,legionella,neurosyphilis, all causes of bacterial meningitis.Rickettsial:Rocky Mountain spotted fever, endemictyphus, epidemic typhus,Q fever, human monocytic ehrlichiosis.Fungal:cryptococcosis, coccidiomycosis,histoplasmosis, North American blastomycosis,candidiasisParasitic:African trypanosomiasis,toxoplasmosis,echinococcus,schistosomiasisSIGNS AND SYMPTOMSTypically, children with aseptic meningitis have:IntenseheadacheMeningismusPhotophobia, but a clear sensoriumIn contrast, amoebae, fungi, and the viruses causing Eastern equine encephalitis, HSV, or rabies may cause:Cerebral or brain stem dysfunctionSeizuresIncreased intracranial pressureDeath
Presenting signs and symptoms produced by viruses are often protean and include:FeverChillsMyalgiaHeadacheIf the spinal cord is involved, the patient may have:Symmetrical limb paralysisTransverse sensory symptomsBowel and bladder dysfunction
PATHOPHYSIOLOGY(VIDEO)*DIAGNOSISHistory takingPhysical examinationLaboratory findingsImaging
Typical CSF findings:Viral meningoencephalitisLeukocytesInitial predominance of polymorphonuclear neutrophils, followed by shift to mononuclear cellsRange, 02000 cells/mm3Glucose> 50% of serum concentrationProteinMild to moderate increaseRange, usually < 200 mg/dLGram stainNegative
Bacterial meningitisLeukocytesPredominantly neutrophilsRange, 0200,000 cells/mm3ProteinMarked increaseRange, usually > 150 mg/dLGram stainUsually reveals bacteria
MANAGEMENTGoals: reduce morbidity and prevent complicationsTreatment is supportive and includes:Reducing high intracranial pressureProviding respiratory supportTreatingseizuresMaintaining fluid and electrolyte balanceImmediate parenteral antibiotics for possible diagnosis of meningitisThere is no specific treatment for other viral causes and the emphasis of treatment is supportive.Intravenous broad-spectrum antibiotics may be given to treat secondary bacterial infections.Amphotericin is usually given for primary amoebic meningoencephalitis.
PROGNOSISDepends on the age of the patient and the underlying etiologyThe poorest prognosis for viral encephalitis occurs in patients with untreated herpes simplex encephalitis and subacute sclerosing panencephalitis.
Case Report SPMale8 years oldDOB: 16th January 2006Body weight: 19kgBody length: 113cmHistory taking Chief Complaintloss of consciousnessHistoryExperienced by patient in the past 3 days before entering hospital. Loss of consciousness preceded by drowsiness. Vomit (-), fever (+), experienced 4 days before admited into hospital. High fever, down with fever-lowering drugs. seizures (+), experieced 1 day before entering hospital. History of seizures (-)History of cough (+), 12 hours before entering hospital. History of weight loss (+). Complete imunization.
Patient was refered from RSU Binjai, diagnosed with meningitis. Status presensSens: GCS 8 (E2 V1 M5) Temp: 37,5Weight: 19kgLength: 113cm
Localized statusHeadRC (+/+), pint point pupil, conjunvtiva palpebra inferior pale (-/-)Ear : within normal limitNose : NGT insertedMouth: oxygen maskThoraxSymmetrical fusiformChest retraction(+) epigastrial, suprasternalHR: 126 bpm, reg, murmur(-) RR: 32x/i , reg, ronchi (-)
AbdomenSoepel, Normal peristaltic, liver & spleen unpalpableExtremitesPulse 126 bpm, reg, adequate pressure and volume, warm, CRT