Clinical Sciences Stream (Lecture)

Acute inflammation – Meningitis

Acute inflammation wherever it is gives rise to 5 cardinal changes even in the meninges
Pain – meninges when in pain the child gets a severe headache. Whether or not
the child can express it will depend on child’s age. If it is a very young child who can not
talk he/she will be crying all the time because of the headache.
Swelling – swelling of meninges cause pain
Redness – happens but can’t see
Warmth – happens on the meninges but can’t feel
Loss of function
Bacteria gets in to blood stream (bacteremia)

organisms enter the meninges

resultant manifestations are because of

host response damage caused by microorganisms

 Very very severe because of cytokines and

inflammatory mediators cause endothelial
damage

reaction due to host response and damages cause

cerebral edema

raised intracranial pressure

reduction of blood flow to brain

Most of the time in child with meningitis cannot find;
a. the source of infection
b. the site of infection
If not for the meningitis the child is otherwise perfectly normal.

Direct spread –
Middle ear infections/otitis media (Although meningitis has no predisposing cause
most of the time, if such a cause exist the most common cause in children is otitis media
– so in history taking of a child with meningitis aspect of otitis media has to be eliminated.
Rare in adults.)
Mastoiditis (rare in a child but more common in older children and adults)
Frontal sinusitis
Ruptured cerebral abscess (Not very common but happens especially in a child
with a cyanotic heart lesion)

Head injury –

Base of skull fractures (road traffic accidents or fall from a height, so not common
but can happen. Microorganisms then enter the meninges through the fracture)
Compound fractures

Meningomyelocoele
Sacral sinus
Infected shunts (Meningomyelocoeles are associated with hydrocephalus and treatment
for that includes putting a shunt. Shunts can get infected. A ventricular-peritoneal shunt
is more prone to get infected leading to meningitis)
Organisms causing meningitis
(Need to know because when you are treating a patient with meningitis the treatment
should begin before the results of the culture comes back. So therefore we have to know
the probable organisms)

Probable organism will depend on the age of the child

3 main age groups
Neonate (1st month of life)
Organisms come from the mother
Group B streptococcus – a very common gram +ve organism.
E.coli – always gram negative E. coli are commoner in neonate
Listeria monocytogenes – more common in preterm babies, unless they have
cultured GBS from a vaginal swab from the mother
Streptococcus pneumoniae

1 month to 6 years
Haemophilus influenzae – Used to be the commonest cause for meningitis in
infants. But now very rare because vaccination against H-influenza is now included in
the national immunization schedule.
Streptococcus pneumoniae – Pneumococcus vaccination is only available against at
the private sector.
Neisseria meningitides (meningococcus) – not very common in Sri Lanka

More than 6 years

Streptococcus pneumoniae – more common
Neisseria meningitides

But if the child has underlying immune deficiency they can get meningitis from any of
these organisms.
 Presentation/ Manifestations of meningitis
Adult – Fever, Headache, Vomiting

Child – Presentation depends on age

Neonates - signs and symptoms are non specific

eg :- poor feeding
vomiting
drowsy or extremely irritable
fever/no fever etc.
Convulsions - only occurs on day two which is too late for the
patient. So as a medical officer we should detect or at least suspect meningitis before the
baby gets convulsions.
Bulging fontanelles is a late manifestation

Older children – Headache

Vomiting
Photophobia
Convulsions
Rash - in meningococcus meningitis
Neck stiffness
 Physical signs of meningeal irritation
Brudzinski sign - Severe neck stiffness causes a patient's hips and knees to flex when
the neck is flexed.

Neck stiffness
Kernig sign