Pediatric emergency medicine trisk 4017 4017

Current Evidence. The most common bacterial and viral pathogens are
listed according to age in Table 122.2 . The relative rates of meningitis,
especially bacterial meningitis, remain highest in the neonatal age group.
Clinical Recognition. Most patients present with fever, evidence of
meningeal irritation, and increased ICP from diffuse cerebral edema or
hydrocephalus with CSF obstruction at the basilar cisterns. However,
clinical manifestations may be nonspecific.
Diagnostic testing. Infection of the subarachnoid space can be diagnosed
by sampling the CSF through a lumbar puncture. A CT scan or quick brain
MRI should be performed prior to lumbar puncture to rule out
hydrocephalus. Lumbar puncture in the setting of untreated hydrocephalus
may precipitate life-threatening herniation.
Management. Suspected bacterial meningitis is a medical emergency and
administration of appropriate antibiotic therapy should not be deferred if
lumbar puncture cannot be performed. Placement of an ICP monitor is
controversial even in the presence of a poor neurologic examination or
cerebral edema. Monitoring ICP has not been shown to improve outcomes
in these patients. Maintenance of cerebral perfusion, by avoiding
hypotension, not the direct treatment of elevated ICP, improves outcomes.
The most important prognostic factor for patients with meningitis is prompt
and appropriate antimicrobial treatment.