Ep 196 Pediatric Meningitis Recognition, Workup and Management
Jul 8, 2024
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This podcast covers recognition, workup, and management of pediatric meningitis including tips on performing LPs, differentiation between meningitis and retropharyngeal abscess, interpreting CSF tests, and administering dexamethasone. Experts discuss challenges in diagnosis, clinical decision tools, and maximizing success in pediatric lumbar punctures. Additionally, the chapter explores antibiotic choices, management strategies, monitoring patients, and preparing for complications in pediatric meningitis cases.
Differentiate pediatric meningitis from retropharyngeal abscess based on physical exam findings.
Understand indications for lumbar puncture in suspected pediatric meningitis patients.
Interpret CSF test results to distinguish between viral and bacterial meningitis.
Consider serology testing for Lyme meningitis diagnosis over CSF studies for more accurate results.
Deep dives
Initial Set-Up and Announcement
The podcast episode commences with Dr. Anton Hellman as the host, highlighting the upcoming EM international cases summit by SHREMI. The summit, scheduled for November 21-23, 2024, promises an interactive and educational experience for participants.
Clinical Presentation and Discussion on Pediatric Meningitis
The episode delves into a case scenario involving a toddler showing signs of illness and shares insights from expert guests Dr. Shannon McPhee and Dr. Jeanette Camot about pediatric meningitis. The discussion focuses on initial management, diagnosis, and considerations based on the child's clinical presentation.
Pathophysiology of Meningitis
Dr. Camot explains the pathophysiological process leading to meningitis, highlighting the stages of pathogen colonization, bloodstream invasion, survival, and eventual invasion of the meninges. Encapsulated bacteria are discussed as contributors to the survival and propagation of bacteria in the cerebrospinal fluid.
When to Suspect Pediatric Meningitis
The podcast addresses the challenge of identifying pediatric meningitis, emphasizing key signs like fever, headache, and neck stiffness. Specific clinical clues, such as petechial rash and neurological symptoms, are highlighted to prompt suspicion for meningitis in infants and older children.
Assessment and Decision-Making Tools for Meningitis Diagnosis
The episode explores clinical decision tools for assessing febrile infants for meningitis risk, emphasizing the importance of differentiating simple and complex febrile seizures. Recommendations on when to perform a lumbar puncture, initiate antibiotics, and consider diagnostic imaging are discussed, offering practical guidance for managing suspected meningitis cases.
Diagnosing Lyme Meningitis
When suspecting Lyme meningitis, serology testing is recommended over CSF studies. While CSF studies can be done, they may lead to variable results due to send-outs for testing. Serologic testing is crucial for Lyme diagnosis, especially in the presence of symptoms like Lyme meningitis.
CSF Analysis for Meningitis
Cell count in CSF analysis varies by age, with any white blood cells in CSF beyond the neonatal stage considered abnormal. Bacterial meningitis can exhibit high cell counts in the thousands, while viral meningitis generally presents lower cell counts. However, initial cell counts are not definitive and empirical antibiotic treatment is crucial, especially in suspected bacterial meningitis cases.
In this episode: recognition, risk stratification, decision tools, indications for lumbar puncture in the febrile pediatric patient, tips and trick on performing LPs in children, and ED management of pediatric meningitis. We answer such questions as: what are the test characteristics of the various clinical features of meningitis across various ages? How does one differentiate between meningitis and retropharyngeal abscess on physical exam? How do the Canadian and American guidelines on work up of well-appearing febrile infants compare when to it comes to indications for lumbar puncture? Which patients with suspected meningitis require imaging prior to lumbar puncture? How do we best interpret the various CSF tests to help distinguish between viral and bacterial meningitis? What are the indications and timing of administering dexamethasone in the pediatric patient with suspected meningitis? and many more....
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