Meningitis – Lumbar PuncturePPT.pptVIP

* Meningitis – Lumbar Puncture Objectives Signs of meningitis – how good are they? Who needs an LP – considering the evidence Interpreting LP results Absolute values Before / After antibiotics Causes of childhood acute bacterial meningitis. In children aged 1 month two pathogens predominate in unvaccinated populations usually accounting for 80% of cases outside the meningitis belt: Strep. Pneumoniae H. influenzae In children 1month the range of pathogens is wider with common ones being: Group B Streptococcus E.coli Klebsiella spp. Outcome of childhood acute bacterial meningitis Death ~30% fatality unless meningococci are a prevalent cause when mortality is a little lower. Outcome of childhood acute bacterial meningitis Death ~ 30% Severe Handicap ~ 25-30% Hemiplegia Blindness Deafness Severe Learning Difficulty Severe behavioural disturbances Severe Epilepsy. Can we do better with hospital care? Steroids? No good evidence that they reduce deaths. Fluid management? Fluid restriction may do more harm than good New antibiotics? Ceftriaxone – there is NO good evidence that such antibiotics reduce deaths (yet) CNS - acute infectious disease Cerebral Malaria Acute Bacterial Meningitis Encephalitis Abscess / TB Any severe illness causing respiratory or circulatory failure Who has bacterial meningitis and who needs an LP? – consider 100 cases of meningitis Clinical signs in a febrile child Able to detect Missed Number over-diagnosed 1 Bulging fontanelle / Stiff neck 40 60 110 2 Signs in 1 or fits aged 6m or fits aged 6yrs 60 40 215 3 Signs in 1 or 2 or partial or focal convulsions 70 30 495 4 Signs in 1 or 2 or 3 or reduced consciousness 80 20 915 So what is a sensible rule for LP? At a minimum, if you want to avoid missing meningitis (and deaths and handicap from it), and avoid wasting antibiotics, at least LP those with history of fever and one of: Bulging fontanelle Stiff neck Fits if age 6 months or 6 yrs Partial or focal fits Reduced consciousness Value of LP fin