Case Report
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
