Suspicion Of Meningitis Research Articles

Adjunctive corticosteroids in adults with bacterial meningitis

Bacterial meningitis is a complex disorder in which neurologic injury is caused, in part, by the causative organism and, in part, by the host's own inflammatory response. In studies of experimental bacterial meningitis, adjuvant treatment with corticosteroids, specifically dexamethasone, has beneficial effects. On the basis of these experimental studies, several clinical trials were undertaken to determine the effects of adjunctive corticosteroids in patients with bacterial meningitis. On the basis of overall benefit without detrimental effects by subgroup analysis, dexamethasone therapy should be initiated before or with the first dose of antibiotic and should be continued in most patients with community-acquired acute bacterial meningitis. For patients with a low suspicion of meningitis but an urgent need for antibiotics before cerebrospinal fluid can be obtained, we recommend initiation of treatment with dexamethasone, with discontinuation of dexamethasone therapy as soon as the diagnosis has been excluded.

Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries

There is a paucity of data on the referral of children with meningitis in developing countries, and on the relationship of presentation and outcome to previous care. Referral and previous care were investigated in 281 post-neonatal children treated in two tertiary centres. Data were obtained through the review of referral notes from orthodox health facilities, interview of parents/guardians and review of admission notes. Forty-four (16%) children were facility-referred and 81 (29%) self-referred from orthodox facilities while 156 (55%) were self-referred without previous care in these facilities. The facility-referrals ( n=44) included 19 (43%) with meningitis on treatment, 13 (30%) with suspected meningitis and 12 (27%) with unsuspected meningitis. Twenty-two (50%) were referred because of deterioration, partial response or non-response to treatment, 5 (11%) on request by the parents, 9 (21%) on the suspicion of meningitis or other neurological disorder and 7 (16%) for mixed reasons. No reason was given in 1 case of meningitis on treatment. Among the 19 children referred with meningitis on treatment, only 1 was referred within 24 h of diagnosis, a confirmatory lumbar puncture was done only in 7, and only 10 of 18 (no data in 1 case) were on reasonably appropriate antibiotic regimens. Previous care in orthodox facilities was significantly associated with delayed presentation (>3 days of illness, p<0.001), partial treatment ( p<0.001), lack of typical signs ( p<0.05), severe illness ( p<0.01), and adverse outcome (death or recovery with neurological sequelae, p<0.05). Limited recognition of the possibility of meningitis in acutely ill children and an inadequate referral practice may account for these effects. A clear delineation of referral needs might reduce the magnitude of these problems.

Extrapyramidal Reactions Caused by Metoclopramide in Children

Extrapyramidal Reactions Caused by Metoclopramide in Children

Jolt Accentuation of Headache: The Most Sensitive Sign of CSF Pleocytosis

We prospectively examined the clinical signs of 54 febrile patients associated with recent-onset headache. They underwent lumbar puncture (LP) on suspicion of meningitis. The relation of each sign to cerebrospinal fluid (CSF) pleocytosis was estimated. Among 34 patients with pleocytosis, 33 had jolt accentuation (sensitivity: 97.1%), while only 5 of them had neck stiffness or Kernig's sign. Among 20 patients without pleocytosis, 12 had no jolt accentuation (specificity: 60%). We found jolt accentuation to be the most sensitive sign of CSF pleocytosis. If jolt accentuation is noted in a febrile patient associated with recent onset headache, the CSF should be examined even in the absence of neck stiffness or Kernig's sign.

Lumbar puncture and the diagnosis of meningitis.

Because the symptomatology of meningitis in infancy frequently is nonspecific, interns and residents staffing a busy pediatric hospital emergency room are encouraged to perform lumbar punctures at the slightest suspicion of meningitis. The effects of this policy were investigated with regard to the number of lumbar punctures done, number of meningitis cases diagnosed, number of meningitis cases missed, and whether the degree of pyrexia and peripheral leukocytosis were helpful diagnostic clues. The results indicate that particularly when inexperienced interns and residents are evaluating young infants in whom the possibility of meningitis is raised, the only definitive diagnostic procedure is lumbar puncture. Hyperpyrexia and/or elevated peripheral white blood cell counts for not helpful in establishing the diagnosis of meningitis. Black infants of low socioeconomic status are a high-risk group for meningitis.

To Tap or Not to Tap…

A survey of the signs and symptoms of 709 children subjected to lumbar puncture on the suspicion of meningitis did not permit construction of a pattern which could identify the existence of meningitis in a suspected case. The predictive value for the symptoms of lethargy, headache, and convulsion associated with fever became meaningful only when the symptoms were associated with one or more signs of meningeal irritation.