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admin | Herbal Remedies For Bv | 11.02.2015
Initial ApproachThe initial approach to the child with suspected meningitis is the same as that for any seriously ill child. Get full access to all EB Medicine articles published 3 years (or more) ago, including evidence-based, peer-reviewed diagnosis and treatment recommendations. Immediate medical attention is necessary for a prompt diagnosis of meningitis when symptoms are observed. The patient will usually be isolated after being recognized as a potential case of meningitis so as to protect other patients and hospital staff.
A spinal tap is conducted as the patient lies on one side and an anaesthetic is injected locally in the lower back to numb the area. Meningitis is an inflammation of the meninges which can be associated with modification of the cerebrospinal fluid which is contained between this membranes. Please note that we are unable to respond back directly to your questions or provide medical advice. As the fastest growing consumer health information site a€” with 65 million monthly visitors a€” Healthlinea€™s mission is to be your most trusted ally in your pursuit of health and well-being. Many diseases, like cancer or connective tissue diseases, like lupus erythematosus or sarcoidosis may be accompanied by an inflammatory reaction of the meninges. Meningitis can occur due to allergies to medicines, some cancers and autoimmune diseases such as lupus. Both of which will support, guide, and inspire you toward the best possible health outcomes for you and your family.
For children with significant depression of consciousness level, suctioning and placement of an oropharyngeal or nasopharyngeal airway may be required. Meningitis is a very serious disease and requires urgent diagnosis and initiation of treatment.
A group of viruses known as the enteroviruses, causing stomach problems, are responsible for approximately 90% of recorded viral meningitis. In the absence of treatment, the infection will spread to the brain (meningo-encephalitis) and can lead to coma, behavioral disorders, paralysis and convulsions.
Infants and children treated for meningitis should always be monitored after they healed and should be checked to prevent long-term complications such as hearing loss. How about an easy, affordable way to promote your business, class reunion or favorite hobby? Supplemental oxygen by face mask is indicated and should be guided by continuous pulse oximetry. Endotracheal intubation may be required if the child has insufficient muscle tone to maintain the airway, respiratory failure, profound shock, markedly depressed mental status, or evidence of increased ICP.Intravenous access should be achieved rapidly.


If attempts are unsuccessful, intraosseous access should be established and used as the initial resuscitative route.
The initial fluid for resuscitation should be an isotonic crystalloid, with the rate of administration determined by the physical assessment. If there is insufficient response to aggressive fluid resuscitation, vasoactive agents may be required.Once the child is stabilized, the rate of fluid administration should be reduced, since overhydration may contribute to the development of cerebral edema. However, fluid restriction to one half to two thirds of maintenance, as was often recommended in the past, may also contribute to poor outcomes.21 Patients given full maintenance fluids during treatment for bacterial meningitis were not found to develop any adverse outcomes. Therefore, those patients who are judged to be normovolemic with normal blood pressure should probably receive full maintenance fluid administration.20The use of hypotonic fluids may contribute to overhydration and the development of edema. Giving full maintenance levels with hypotonic fluids will result in edema in up to one quarter of children with bacterial meningitis.
This has led to recommendations for the use of isotonic fluids only, but this area remains controversial and needs further study.20Neurologic ComplicationsSeizures may occur during the course of bacterial meningitis. Useful alternatives include rectal administration of diazepam and intramuscular administration of midazolam. Clinical chemistries must be assessed, since hypoglycemia, hypocalcemia, and hyponatremia may all occur in the setting of bacterial meningitis, leading to seizures. Some degree of increased intracranial pressure is probably present in nearly all cases of bacterial meningitis.23 When uncontrolled, increased ICP can lead to seizures and brainstem herniation.
Further increases in ICP can be prevented during intubation by the use of intravenous lidocaine and fentanyl prior to intubation. Recommendations for hyperventilation to maintain the PaCO2 as low as 25 mmHg have been made in the past.
Lumbar puncture is a stressful and sometimes lengthy procedure, and critically ill children may develop respiratory compromise, shock, seizures, or signs of increased ICP during the procedure. Initiation of antibiotics prior to obtaining CSF for analysis may prevent recovery of the organism on culture, but a reasonable procedure is to obtain specimens for blood culture and then to proceed with antibiotic administration.
In addition, antibiotics must have good penetration into the CSF, must maintain high concentrations in the CSF, and must have good intrinsic activity in the infected fluid. This recommendation is based on the increased prevalence of Streptococcus pneumoniae resistant to penicillin, cefotaxime, and ceftriaxone, and in addition provides coverage for disease due to Haemophilus influenzae and Neisseria meningitidis. Twenty to 45% of pneumococcal strains worldwide have been reported to be resistant to penicillin, and many of these strains are also resistant to chloramphenicol and third-generation cephalosporins.82 An alternative approach is to hold the administration of vancomycin if CSF is negative for gram-positive diplococci. For children with significant hypersensitivity reactions to penicillin and cephalosporins, the combination of vancomycin and rifampin can be used. These two should be used in combination and must never be used alone, since it is difficult to maintain bactericidal CSF concentrations with vancomycin, and resistance to rifampin during therapy may develop.


An advantage of trovafloxacin is that it has excellent antimicrobial activity against beta-lactam–resistant pneumococci, potentially obviating the need to use vancomycin to cover for resistant pneumococci.30 However, the clinical usefulness of trovafloxacin is limited, due to other reports of serious liver toxicity. As more clinical trials are performed, the newer fluoroquinolones may find a role in the therapy of bacterial meningitis, especially when pneumococcus is a potential pathogen.
84In many developing countries, the availability and high cost of third-generation cephalosporins prevent their use. Eighteen randomized, controlled trials, including 993 patients, mostly conducted in the decade of the 1980s, were included in the review. No statistically significant differences between the groups were found in the risk of death, deafness, treatment failure, neutropenia, or rash. Cultures of CSF after 10-48 hours of treatment were less likely to be positive in the cephalosporin group, but diarrhea was more likely in the cephalosporin group.
With the emergence of aminoglycoside- resistant, gram-negative enteric bacilli, concerns regarding the renal and auditory side effects of the aminoglycosides, and their low bactericidal activity in CSF, the use of aminoglycosides has been supplanted by cefotaxime, which has a better safety profile and achieves high bactericidal activity in CSF against most coliforms. Ceftriaxone, although equivalent in activity to cefotaxime, is not recommended in the neonatal period, because of the potential for displacement of bilirubin from albumin binding sites, and due to its profound inhibitory effect on the growth of bacterial flora in the intestinal tract.85 SteroidsRecognition that the immunologically mediated inflammatory response is central to the pathophysiology of bacterial meningitis has stimulated interest in adjunctive treatment with steroids for many years. Not all studies have found steroids to be beneficial, especially when the cause of meningitis is S pneumoniae.89-91 Studies involving the use of steroids in bacterial meningitis have been the subject of meta-analysis and extensive review. The data are reasonably conclusive that, when given in close proximity to the first dose of antibiotics, dexamethasone reduces the incidence of hearing loss in patients with meningitis caused by H influenzae type b.
Things are not so clear in children with pneumococcal meningitis; there may be a trend toward a decrease in hearing loss.
In the clinical setting the obvious problem confronting the physician is that the decision to use or not use steroids must in general be made concomitant with the decision to use or not use antibiotics. Literature emphasizes prompt treatment in cases of suspected bacterial meningitis, without waiting for confirmatory laboratory tests. In most cases, this would involve administering dexamethasone and antibiotics immediately after a lumbar puncture, while awaiting the results of the CSF cell count and Gram stain.
Since in developed countries H influenzae type b meningitis has virtually disappeared and pneumococcal meningitis in children is becoming increasingly uncommon, and considering that the benefit of treating pneumococcal meningitis in pediatric patients with dexamethasone remains controversial, empiric treatment with dexamethasone in cases of suspected meningitis in pediatric patients in whom the offending organism is unknown remains an evolving question.



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