MENINGITIS

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Inflammation of the covering of the brain and can also involve the brain parenchyma (encephalitis/meningoencephalitis) mostly caused by infection ( bacteria,viruses, fungal)

Causes:

Bacteria eg: S .pneumonia, H. influenza, meningococcus, tuberculosis

Viruses eg: Enteroviruses, Herpes simplex

Fungus eg: Cryptococcus, Candida albicans

Signs and symptoms:

Suspect meningitis if signs of serious bacterial infection and particularly if any one of the following is present:

The infant is:

• Drowsy, lethargic or unconscious
• Convulsing
• Has a bulging and tense anterior fontanelle
• Irritable
• Has a high-pitched cry (in-consolable).

Investigations:

• Lumbar puncture for CSF analysis after ruling out contraindications
• Biochemistry (blood sugar)
• Electrolyte panel
• Chest X-ray
• Gene Xpert

Note

It is important to attempt lumbar puncture once the infant has been stabilized, ideally within 2 hr of initiating antibiotic treatment, because it serves to confirm the diagnosis. Please note that you can’t withhold treatment when all the signs and symptoms are observed and also be mindful of contraindications in Lumbar puncture such as raised ICP, thrombocytopenia and when patient is cardiopulmonary unstable.

Pharmacological treatment

First-line antibiotics for 3 weeks

Ampicillin

Age	Dose	Frequency of administration
First week of life	50mg/kg	Every 12 hours
Weeks 2-4 of life	50mg/kg	Every 8 hours

PLUS

Gentamicin

Birthweight	Age	Dose	Frequency of administration
Low birth weight	First week of life	3mg/kg	Once a day
Normal birthweight	First week of life	5mg/kg	Once a day
	Weeks 2-4 of life	7.5mg/kg	Once a day

Alternatively

Ceftriaxone IM/IV for 3 weeks

Age	Dose	Frequency of administration
First week of life	50mg/kg	Every 12 hours
Weeks 2-4 of life	75mg/kg	Every 12 hours

PLUS

Gentamicin (as above)

• If there are signs of hypoxaemia, give oxygen
• If the infant is drowsy or unconscious, ensure that hypoglycaemia is not present; if infant is hypoglycaemic, give 2 ml/kg 10% glucose IV.
• Treat convulsions (after ensuring they are not due to hypoglycaemia or hypoxaemia) with phenobarbital
• Make regular checks for hypoglycaemia