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Meningitis is an inflammation of the meninges which can be associated with modification of the cerebrospinal fluid which is contained between this membranes.
More than a Spot Check – What does the NICE Quality Standard for bacterial meningitis and meningococcal septicemia in children and young people mean for the Emergency Dept? If you work in the UK, I’m sure you’ve heard of NICE – the National Institute for Clinical Excellence. NICE quality standards are “a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.” They are considered to be the “Gold standard” of care delivered within the NHS.
The quality standard for bacterial meningitis and meningococcal septicaemia in children and young people was published by NICE in June 2012, and has been endorsed by the Meningitis Research Foundation, the Meningitis Trust and (rather morbidly) the Royal College of Pathologists.
NICE is central to clinical governance in the NHS, ensuring that the right care is given by the right people at the right time.
Bacterial meningitis and meningococcal disease are reasonably rare (660 cases of invasive meningococcal disease in the UK in under-19s in 2010) but carry high mortality (10% quoted by NICE) and morbidity. The quality standard covers 14 quality statements, 10 of which are directly related to or raise issues relevant to ED care.
Let’s not beat about the bush; this is a nasty, aggressive disease, and for all we let the media malign our colleagues for missing it, sometimes the diagnosis just isn’t obvious until it’s barn-door. So, this quality statement is about communicating the paragraph above to the child’s parents without scaring the life out of them (not all that easy, actually!). NICE wants us to communicate, specifically, where and when parents should access further care.
The parent or carer feels that the child is less well than when they previously sought advice. The parent or carer is distressed, or concerned that they are unable to look after the child.
How can you communicate this without the parents point-blank refusing to leave the department even though their snotty two-year-old is running around, cackling and breaking everything in sight? This is more likely to be delivered by nursing staff, but it’s important to be aware of this standard.
This statement references the bacterial meninigitis and meningococcal septicaemia clinical guideline. I’ve read around this quite a bit for my MSc in Emergency Medicine, and I think it’s probably worth drawing your attention to the work of Downes who found that 27.6% of babies at a “well baby” clinic had petechiae.
As a result of this, a lot of kids get admitted for 48h antibiotics pending blood culture and PCR results (see statement 7); but remember my personal horror story and don’t be dissuaded by pushy specialty doctors. This statement is useful for two reasons; firstly, advocating IO administration (great advice here although please don’t give children 2mls of 1% lidocaine down the IO!
Secondly, the target of administration within an hour; with time-related targets in every ED in the UK, wouldn’t it be nice to get your blood results back within 60mins for the well-looking feverish children with petechiae, so you can give them antibiotics? All you really need to know about this standard is that there are enough exclusion criteria that unless you are skilled enough and particularly want to do so, this probably doesn’t need to be done by the ED doc.
This is a slightly odd statement, as it has no rationale attached to it and no specified timeframe, but in essence it’s a reminder that sick kids should be seen by consultants. There’s quite a long statement of indications for intubation and ventilation attached to this.
Again, common sense; don’t transfer kids unless you are trained to deal with the potential consequences of their illness, including intubation, ventilation, seizure management, cardiac arrest and a whole host of other unpleasant situations.
The consultant paediatrician statement does seem odd without a time frame and it would be scary, if this day and age, at some point in the admission of a really sick child with meningococcal disease they weren’t assessed by a consultant.
A little thought for you about the mentality of the use of ABs in kids with petechial rashes in the ED.
There seems to be a feeling that if you give one dose of IV ABs for a kid who might have septicaemia then you HAVE to keep the child on IVs, in hospital (usually) for 48 hours.
I have a problem with this as it can induce a mindset that in the equivocal case where suspicion is low, but not zero, clinicians might delay ABs until the bloods are back, the child has been observed, reviewed etc.
I believe when we are talking about ABs in suspected septicaemia we should shoot first and ask questions later. It’s important that we put no real, or imagined barriers in place to encouraging all our clinicians to give antibiotics early if we suspect this devastating and humbling disease.
I agree with Simon I think there is a tendency with some (usually more junior staff but not exclusively so) to not use antiobiotics in the well petechial patient incase it mandates 48hours of antibiotics.
A clinical problem that just won’t go away…vaccination improves, rates of serious bacterial illness [SBI] fall, presentations of children continue to increase, perception of risk of SBI rightly remains high and diagnostic conundrum remains unchanged!
Enter your email address to subscribe to this blog and receive notifications of new posts by email. Description: Meningococcal meningitis is caused by one of the serotypes (A, B, C, W135, Y) of Neisseria meningitidis bacteria. Todos los anos se repite en algun momento: los medios periodisticos comienzan a dar difusion a la aparicion de nuevos casos de meningitis y se provoca una intensa preocupacion tanto en la poblacion como en las autoridades sanitarias.
Se escuchan entonces opiniones disimiles, como la de asegurar que existe una epidemia, que deben cerrarse escuelas, que todo debe ser desinfectado y que debe vacunarse masivamente a la poblacion.
La gente esta sensibilizada y desconfiada de las instituciones oficiales y estas amenazas son vividas con una alta dosis de temor y de incertidumbre. De los medios periodisticos seria deseable una actitud menos sensacionalista, que informen con objetividad y no solo el hacer notas con el objetivo de aumentar su propia audiencia. De las autoridades sanitarias una adecuada evaluacion para determinar la condicion y el tipo de agente infeccioso que provoca los casos, si es viral o bacteriana y el serotipo, pues las decisiones de control son diferentes segun esas circunstancias.
Este atento a presencia de signos que pueden ser indicativos de esta enfermedad y consulte al medico ante: FIEBRE con dolores de cabeza o de nuca y vomitos. Los germenes que contagian meningitis no se transmiten desde los pupitres, ni desde el banco de la escuela, sino desde la garganta de un portador (en general un individuo sano). La higiene y ventilacion de las casas, aulas, dormitorios y espacios cerrados favorece las condiciones ambientales de prevencion de casos nuevos. Salvo indicacion especifica de las autoridades sanitarias, la escuela no debe cerrarse ya no solamente es innecesario si no que ademas se pierde el control sobre los posibles nuevos casos y por consiguiente la posibilidad, cuando esta indicado, de administrar en forma preventiva el adecuado tratamiento preventivo de los contactos. En jardines de infantes y guarderias, es importante evitar compartir vasos, utensilios, caramelos, toallas, chupetines, chupetes, etc. Deben hacerse reuniones informativas a cargo de profesionales idoneos para aclarar las dudas de los padres.
Para el paciente: Confirmar el diagnostico mediante estudios especificos que ademas identifican el tipo de germen. Se debe internar y aislar al paciente, por lo menos durante las primeras 24 horas de comenzado el tratamiento antibiotico. Las meningitis producidas por virus y bacterias pueden ocurrir en cualquier momento del ano, pero existe un incremento estacional de casos al final del invierno y durante la primavera.
Las meningitis bacterianas, pueden ser causadas por diversos tipos diferentes de bacterias, las que producen el mayor numero de casos son el Haemophilus influenzae tipo b, el meningococo, y el neumococo, existiendo ademas varios subtipos de estos dos ultimos. El meningococo aunque proporcionalmente es mas frecuente en menores de 5 anos, puede causar meningitis a cualquier edad.
Tanto el meningococo y el neumococo estan presentes en la garganta de personas sanas, especialmente desde el otono hasta fines de la primavera. El haemophilus tipo b solo puede ser encontrado en la garganta entre el 2 al 5% de la poblacion.
En el nino pequeno deben ser tambien signos de alarma: el rechazo del alimento, el llanto continuo (expresion de dolor) y la fiebre o temperatura axilar menor de 36?.

La meningitis no es producida por un unico germen, por lo tanto no hay una unica vacuna para prevenirla. Vacuna BCG: Que se aplica al recien nacido, es util para la prevencion de la meningoencefalitis tuberculosa u otras formas clinicas graves. Vacunas antimeningococcicas: (no incluidas en el esquema oficial) Existen distintos tipos de vacunas antimeningococcicas. El efecto de las vacunas no es inmediato ya que en general requieren entre dos o tres semanas para generar anticuerpos.
Tal como lo dice la nota, la meningitis es una enfermedad que puede ser producida por diferentes tipos de agentes infecciosos (virus, bacterias, bacilos,hongos, etc) por lo que dependiendo de esto sera el periodo de incubacion. Los sintomas con que se presenta con mas frecuencia en los ninos de edad escolar (tanto la meningitis viral como la bacteriana) son: dolor de cabeza intenso, fiebre alta, vomitos, que suele acompanarse de intolerancia a la luz, somnolencia acentuada o irritabilidad y convulsiones. Mi hijo tuvo meningitis causada por un virus cuando tenia apenas una semana de nacido, ahora tiene 5 anos y esta en perfecto estado de salud. Estuvo en ese tiempo un mes en terapia intensiva pero gracias a Dios no tuvo convulsiones, ya que fue medicado a tiempo. Pese a ello los medicos nos dijeron a mi esposo y a mi, que durante el transcurso de su vida debiamos cuidar que no presente cuadros de fiebre muy alta, debido a la sensibilidad dejada por la enfermedad. Quisiera saber cuanto hay de cierto en esto y porque debemos cuidar este aspecto, si fuera verdad.
Por la informacion referida la evolucion ha sido favorable y no amerita ningun cuidado especial, maxime si en aquel momento de la meningitis y desde ese entonces hasta la fecha no tuvo episodio convulsivo alguno.
El tenia casi dos anos,el medico confundio los sintomas con una amigdalitis, ?Falto un buen diagnostico? Alex presentaba todos estos sintomas, pero el medico no le envio a hacer ningun examen ,?Habria bastado para ponerlo en tratamiento?
La meningitis es una enfermedad infecciosa que en ocasiones tiene un desenlace muy rapido y cuya evolucion no siempre es predecible.
Cuanto antes se llegue a un diagnostico y se logre iniciar el tratamiento adecuado mejores seran las posibilidades de evitar complicaciones graves o la muerte.
Ante la sospecha, la puncion lumbar y el estudio por laboratorio del liquido cefalorraquideo, permite en la mayoria de los casos determinar el tipo de meningitis, tipificarla y en base a ello instaurar el tratamiento mas apropiado. En la actualidad existen efectivos antibioticos para tratarla, como asi tambien vacunas para prevenir las formas mas comunes de meningitis que pueden afectar a bebes y ninos.
A mi prima los estudios de laboratorio le dieron positivo al meningococo b estando enbarazada.
Mi pregunta es: que posibilidades tiene la beba de que pueda desarrollar menigitis y porque la mama durante el embarazo estuvo asintomatica y no desarrollo le enfermedad?
La meningitis es una enfermedad que puede ser producida por diversa variedad de agentes infecciosos. Si bien el haberla padecido puede generar inmunidad duradera, esto no no evita que pueda repetirse si fuera causada por otro tipo de germen.
La meningitis es una enfermedad grave, que desde que comienzan los primeros sintomas evoluciona en pocas horas, requiere internacion y tratamiento por via endovenosa.
Desearia saber que medidas se deben tomar en una escuela donde se detecta un caso de meningitis. Frente a un caso de meningitis no es necesario suspender las clases ni realizar una desinfeccion especial. Que los companeros del nino enfermo reciban o no medicacion depende del tipo de germen causante. Hola, quiero saber si existe riesgo de contagio, pues de compartir un aula de una facultad donde la profesora tuvo y se murio de meningitis, la facultad es muy cerrada en si, hay pasillos largos para llegar a las aulas y tiene varios pisos. El riesgo de contagio debe considerarse para aquellas personas que han tenido un contacto muy directo y personal con el enfermo. Hola, quisiera saber si en un natatorio hay mas posibilidad de contagio, estoy por mandar a mi hija de 20 meses, estoy con miedo. El riesgo es similar al de cualquier otro ambiente cerrado donde comparta su actividad con otros ninos.
Las normas de higiene y de seguridad del lugar son fundamentales para prevenir este y otros riesgos. Hola, tengo a mi sobrino internado por meningitis lo operaron de los pulmones y yo tengo un bebe de 2 anos.
Las medidas de prevencion que deben tomarse depende del tipo germen que produjo la meningitis.
El riesgo de contagio de meningitis a meningococo se plantea para los casos de contacto directo con el paciente afectado como los convivientes o companeros de clase.
The size of these epidemics can be enormous and place an immediate and great burden on the health systems of meningitis belt countries. Since the 1940s, epidemic cycles have been detected every 8 to 12 years, but two troubling phenomena have been observed since the early 1980s: the intervals between epidemics have become shorter and more irregular, and the meningitis belt seems to be extending further south, touching regions that had been spared until now, such as Angola, Burundi, the Democratic Republic of the Congo, Rwanda (Great Lakes region), and Zambia.
Although the pattern of these epidemic cycles is not entirely understood, several risk factors have been associated with the development of epidemics in the meningitis belt. Demographic conditions: travel and large population displacements due to pilgrimages and traditional markets at regional level.
Group A meningococci have been the main cause of meningitis epidemics in Africa and account for about 80 to 85 percent of all cases. The most recent large-scale meningitis epidemic in the African meningitis belt occurred in 2009, when more than 80,000 cases were reported. 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. Each statement sets a standard of care with the aim of assessing local practice and expressing results as a proportion receiving care to the suggested standard. NICE recognises that not all children with a temperature and in a bad mood have invasive meningococcal disease, and conversely not all children who are diagnosed with invasive meningococcal disease present with fever, vomiting and a purpuric rash. Children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia have their temperature, respiratory rate, pulse, blood pressure, urine output, oxygen saturation and neurological condition monitored at least hourly until stable. Having done an audit of triage observations for children presenting with temperature (as in the NICE Feverish Illness guideline), I can tell you that this is something we do badly. Children and young people presenting with a petechial rash receive antibiotics in accordance with NICE guidance.
If you were concerned enough to start antibiotics, stand by your decision and get the child admitted.
Children and young people with suspected bacterial meningitis or meningococcal septicaemia receive intravenous or intraosseous antibiotics within an hour of arrival at hospital.
Helpfully, the Royal College of Pathologists has endorsed the standards, so it should be easier to get bloods processed. Notably, you need to have normal coagulation; so in children with a petechial or purpuric rash, LP shouldn’t be carried out until platelet and coag results are available and confirmed normal.
Children and young people with suspected bacterial meningitis or meningococcal septicaemia have whole blood meningococcal polymerase chain reaction (PCR) testing. Children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia, who have signs of shock or raised intracranial pressure, are assessed by a consultant paediatrician. Children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia being transferred within or between hospitals are escorted by a healthcare professional trained in advanced paediatric life support. Children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia requiring transfer to a paediatric intensive care unit or high dependency unit in another hospital are transferred by a specialist paediatric retrieval team.
This is either available to you or it isn’t – so I’m going to take the opportunity to big-up the fabulous NEWTS team. I think this is particularly so when the petechiae are in an SVC distribution ( and I’m sure we all know that it svc distribution alone doesnt exclude meningococcaemia). At RMCH they take 48h to give a result, but they don’t usually get processed immediately if out of hours. As you know we have a PED short stay unit so we have the option to keep kids for up to 24 hours under the care of the ED.
An experienced clinician in (paediatric) emergency medicine will have a different set of alarm bells than someone less experienced.
NO SE AUTOMEDIQUE CON ANTIBIOTICOS porque un tratamiento inadecuado puede retrasar el diagnostico temprano y conducir a posibles secuelas neurologicas. Se indica la administracion profilactica de antibioticos, a los convivientes y contactos intimos Se entiende por contacto a los que mantuvieron un trato directo intimo o cercano en tiempo y proximidad (de 3 a 4 horas o mas compartiendo el mismo ambiente). Si el brote es en una escuela o comunidad pequena, la prevencion con antibioticos sera simultanea y a todos los miembros del grupo contacto. Previene cuadros de menigoencefalitis que pueden presentarse en el curso de estas enfermedades. Me gustaria saber cuanto tiempo de incubacion o cuanto tarda para dar los primeros sintomas.
Despues que la beba nacio la dejaron internada 10 dias en tratamiento con antibioticos y los resultados de la bebe salieron bien.
Pero es muy importante poder identificar el germen causante para definir la medidas de prevencion que deben tomarse. Tiene todas las vacunas incluidas las de fuera del calendario, a la espera de una respuesta, mis saludos. Lo importante en este caso es que tenga completo el esquema de vacunacion, incluidas las optativas para prevencion de meningitis.
The disease is most prevalent in the sub-Saharan meningitis belt, an area that stretches from Senegal and the Gambia in the West to Ethiopia in the East and has an at-risk population of about 430 million.
In 1996a€“1997, the largest epidemic wave ever recorded in history swept across Africa, causing over 250,000 cases and 25,000 deaths.
At this point, it is not possible to tell with certainty if these changes are real or if they result from enhanced disease surveillance in the region. In 2002 there was an exceptional major outbreak of group W135 meningococcal meningitis in Burkina Faso. The number of meningitis cases reported during the 2009 epidemic season was the largest since 1996, and laboratory testing showed that most cases were due to group A meningococci. 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.
They may not look particularly unwell to begin with; in fact, back in late 2011 I saw an alarming case where a child with a temp had been admitted to the observation ward, had some vomiting and diarrhoea, normal WCC and CRP of 4. IO access is brilliant, the EZIO (the “baby drill”, as I like to call it) makes it ridiculously easy, and you honestly do look even cooler drilling into a baby’s leg than you do getting the cannula no-one else could manage. Although in reality if you call the lab, ask nicely and explain why you need the results, it will probably work better than taking the “because NICE says so” route.
My top tip; take a blood culture and PCR sample at the same time as your FBC and CRP, and put them to one side (labelled, of course). I am certain that (unpleasant exam willing) when I am a consultant, this is definitely the sort of patient I want to know about.
Having spent the last three months working (and training) alongside these guys, I can see why this standard exists; not only are they highly skilled in looking after sick kids, they also set up infusions etc. And if not, does the NICE flow chart actually give us a pretty reasonable (if not validated) clinical decision rule? A shoot first ask questions later policy in respect of SBI in children is clearly safe but when I will shoot will be different from the juniors I work with. Puede ser producida por virus, por bacterias y en menor proporcion por otros agentes infecciosos como hongos o parasitos. Esto puede acompanarse de irritabilidad o somnolencia acentuada e intolerancia a la luz y convulsiones.
Epidemics occur in the dry season (December to June), and an epidemic wave can last two to three years, dying out during the intervening rainy seasons. The true disease burden is likely to be higher than statistics suggest because routine reporting systems break down during epidemics. Since then, enhanced surveillance activities show a dramatic fall in cases of W135 disease, isolated clusters of group X and group C cases, and a major return of epidemic disease due to group A throughout the belt.
At the time her purpura appeared (approx 11h after her attendance at PED), her EWS had been “green” for more than four hours and it was Mum’s assertion that she “just wasn’t right” combined with a blood glucose of 2.9 that had made me hang on to her a little longer.
Because EDs are busy, and ED nurses (despite being the best nursing staff in the hospital – I genuinely believe this!) are busy and often stretched beyond the capacity of mere humans.
And this comes from someone who lists IV cannulation as one of her two skills (the other is ABGs – thanks for asking). No-one likes stabbing a child repeatedly, so if your results or a change in clinical condition necessitates antibiotics, you can send the culture and PCR; if not, and you are discharging the child, you can discard them.
It’s a perfect time to get out there and audit; identify the weaknesses and take steps to fortify them. If ALL children who were perceived at any risk had admission and antibiotics (even if only for short duration and one dose) then systems would struggle.
El contagio de la meningitis es directo de persona a persona por medio del aire respirado y se requiere un contacto muy directo. In addition, many people die before reaching a health center and thus remain unrecorded in official statistics.
She grew Neisseria meningiditis from the blood culture taken at the same time as her baseline bloods. It makes sense, of course – we know that these children can deteriorate quickly, so we need to keep a close eye on them. Well, they are anaesthetists who are current APLS providers (or equivalent) – or other clinicians experienced in paediatric airway management (which presumably means the same APLS standard).
Another exercise in communication then; asking the super-stretched nurses to perform hourly observations without annoying them too much – or maybe doing them yourself??
There’s a little reminder to let your local PICU’s consultant oncall know if you are intubating; the child is going to end up there and we do like to know about these things in advance (as sometimes we need to discharge other patients).

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