Pediatric Bacterial Meningitis in the PhilippinesCecilia C. Maramba-Untalan, MD Maramba-

Bacterial Meningitis in the PhilippinesOne of the top leading causes of mortality in children 0-4 yrs old Pathogens and susceptibility patterns are different from those identified in other countries Management recommendations must be appropriate for the Philippine setting Task Force on Meningitis convened in order to address this problem

Signs and Symptoms of Meningitisare variable and depend on the age of the patient, and the duration of illness before treatment neonates and young infants may have minimal signs and symptoms signs of symptoms of neonatal sepsis are indistinguishable from neonatal meningitis all neonates being evaluated for sepsis should be evaluated for meningitis

Signs and Symptoms of Bacterial MeningitisSigns and symptoms Nonspecific Neonates Fever or hypothermia, abnormally sleepy or lethargic, disinterest in feeding, poor feeding, cyanosis, grunting, apneic episodes, vomiting Neck rigidity, Bulging fontanel, diastasis of sutures, convulsions, opisthotonus Older infants and children Fever, anorexia, confusion, irritability, photophobia, nausea, vomiting, headache, seizure Neck rigidity, Kernig and Brudzinski sign Headache, bulging fontanel, diastasis of sutures in infants, papilledema, mental confusion, altered state of consciousness Hemi paresis, ptosis, deafness, facial nerve palsy, optic neuritis

Meningeal inflammation Increased intracranial pressure

Focal neurologic signs

Hemiparesis, ptosis, facial nerve palsy

Laboratory Diagnosis of Bacterial MeningitisLumbar puncture is essential Cornerstone in the diagnosis should be performed in all cases whenever the diagnosis of meningitis is known or suspected on the basis of clinical signs Contraindications to doing a lumbar tap1. presence of significant cardio-pulmonary compromise and shock 2. signs of increased ICP 3. suspected case of space occupying lesion 4. infection in the area that the spinal needle will traverse to obtain CSF 5. hematologic problems

CSF Findings in Bacterial Meningitisa. CSF pressure - usually elevated b. CSF cells count and chemistry leukocytosis- >1000/cu mm % PMN - 90% Glucose-