Meningitis (peds)

Background

• Meningismus is difficult to discern if <6mo, (esp if <2mo)
• <3months old
  • 1% incidence of bacterial meningitis
  • E. coli, Group B strep, listeria
• >3months old
  • S. pneumo, meningococcus, staph

Diagnosis

Bacterial Meningitis Score for >2mo and well-appearing

• Risk Factor
  • Peripheral blood ANC >10K
  • Seizure
  • CSF
    • CSF ANC >1000
    • CSF protein >80
    • CSF Gram stain (if + 61% Sn, 99% Sp)

• Any risk factor = high risk for bacterial meningitis
• Very low risk if infant lacks all risk factors

Work-Up

1. CBC
2. CSF

Pediatric Bacterial Meningitis Score

Bacterial Meningitis Score	'
Criteria	Point Score
Positive CSF Gram Stain	2
CSF protein > 80mg/dL	1
Blood Absolute neutrophil count > 10,000 cells/mm3	1
Incidence of seizures with illness	1
CSF neutrophil count ≥ 1000 cells/mm3	1

• 0 points: Aseptic meningitis likely
• 1 point: Aseptic meningitis less likely
• ≥2 points: Bacterial Meningitis more likely

Treatment

• Neonates - IV ampicillin + gentamicin
  • If suspecting S. pneumoniae, add vancomycin
  • Empiric therapy for late-onset includes anti-staph agent plus ceftazidime, amikacin, or meropenem
  • Ceftriaxone may cause bilirubin encephalopathy in neonates
• Infants and children - Vancomycin 60 mg/kg/d q6h plus Ceftriaxone 100 mg/kg/d q12h
• Length of Tx depends on organisms isolated

Disposition

• Admit despite negative meningitis score if:
  • Age <2mo w/ any degree of pleocytosis
  • Appear ill
  • Infants w/ aseptic meningitis
• If likely viral meningitis still give ceftriaxone x 1, f/u in 24hr

See Also

• Meningitis

Source

Tintinalli Lexicomp eMedicine - Pediatric Bacterial Meningitis