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Bacterial Meningitis: Signs/Symptoms in Newborns & Younger Children

by John Fisher, MD
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    00:02 So, let's look at the clinical features of bacterial meningitis.

    00:08 Newborns are a challenge for physicians because they do not have the classic findings that are talked about in meningitis.

    00:18 For example, newborns don't have generally a stiff neck.

    00:25 They may have fever, but they may have no fever or they may have a low temperature, so they have temperature instability.

    00:37 Newborns with meningitis are generally listless.

    00:41 They are not responsive to their surrounding.

    00:45 They may have an unusual kind of high-pitched cry, which suggests a process going on in the brain.

    00:53 They, as expected, would be fretful, they’re lethargic, they may not feed well, they may not feed at all, and the mothers may notice that they have a very weak suck.

    01:07 So, they're generally irritable.

    01:09 And, of course, all newborns are jaundiced, but newborns with meningitis may have unusually severe jaundice.

    01:18 They may vomit, they may have diarrhea and respiratory distress.

    01:23 So, a pediatrician evaluating a newborn has to worry about meningitis in a baby with these kind of findings, any of them.

    01:32 And there's an indication to do a spinal tap and examine the cerebrospinal fluid if there's any suggestion of meningitis.

    01:46 Children from age one to four are a little easier to evaluate.

    01:52 More than 90% of them are going to have fever.

    01:55 Eighty-plus percent will be vomiting.

    01:59 And stiff neck starts to present itself after about the year of one.

    02:07 So, those are the main findings in children one to four.

    02:13 Older children and adults are easier to diagnose.

    02:17 Virtually 100% will have fever.

    02:21 Most of them have headache.

    02:24 Almost all of them will have meningismus, which is the syndrome of having a stiff neck.

    02:31 And this is an important point.

    02:35 Patients with viral meningitis, they may complain of headache, they may have fever, they may even have a stiff neck, but they're not out of it.

    02:45 Most patients with bacterial meningitis on the other hand have cerebral dysfunction.

    02:50 When they are brought to a physician, and they are usually brought to the physician, they have confusion, their head doesn't work.

    03:02 And the classic findings are the findings of Kernig’s and Brudzinski sign.

    03:07 Now, Kernig's sign, it's often hard to remember.

    03:12 It was for me when I was a student.

    03:15 But the way I remember it now is K for kerning, K for doing something with the knee.

    03:24 So, the patient is supine and you take the patient's leg and flex the leg like that and then extend the knee.

    03:34 Now, in a patient who’s awake, extending the knee puts traction on the meninges and that causes pain going up and down the spine.

    03:45 That would be a positive Kernig's sign.

    03:48 Now, in a comatose patient, they can't tell you whether they have pain, but doing this maneuver and feeling resistance when you try to extend the knee is a positive Kernig's sign in a comatose patient.

    04:04 Brudzinski's sign is where you have the patient lying supine and you flex the patient's neck.

    04:15 And if the patient's hips involuntarily flex, they have a positive Brudzinski sign.

    04:25 Cranial nerve palsies are not as frequent.

    04:29 They occur in a minority of patients with bacterial meningitis, but they are an ominous sign because it usually means that there is involvement of the brainstem.

    04:45 In every patient with meningitis, they need to be searched carefully, their extremities, legs, arms for a petechial rash because a petechial rash occurs primarily in meningococcal meningitis, the meningitis due to Neisseria meningitidis.

    05:04 But it can occur also in other forms of meningitis, particularly pneumococcal meningitis in the presence of a splenectomy.

    05:16 Seizures are, obviously, a bad sign and indicate that the meningitis is pretty far advanced as is hemiparesis.


    About the Lecture

    The lecture Bacterial Meningitis: Signs/Symptoms in Newborns & Younger Children by John Fisher, MD is from the course CNS Infection—Infectious Diseases. It contains the following chapters:

    • Signs/Symptoms – Newborns and Younger Children
    • Sign/Symptoms – Older Children and Adults

    Included Quiz Questions

    1. Gram-positive diplococci
    2. Gram-positive bacilli
    3. No organisms seen
    4. Gram-negative intracellular and extracellular diplococci
    5. Pleomorphic Gram-negative coccobacilli
    1. Brudzinski’s sign
    2. Kernig's sign
    3. Hamman's sign
    4. Murphy's sign
    5. Homan's sign
    1. Start intravenous ceftriaxone + vancomycin + dexamethasone
    2. Perform a lumbar puncture
    3. Obtain a CT scan of head
    4. Start intravenous amoxicillin/clavulanate
    5. Obtain sputum Gram’s stain
    1. Lumbar puncture
    2. Brain MRI
    3. Arterial blood gases
    4. Chest x-ray
    5. Pulse oximetry
    1. Altered mental status
    2. Fever
    3. Headache
    4. Meningismus
    5. Nausea/vomiting
    1. Nuchal rigidity
    2. High pitched cry
    3. Decreased feeding
    4. Jaundice
    5. Respiratory distress

    Author of lecture Bacterial Meningitis: Signs/Symptoms in Newborns & Younger Children

     John Fisher, MD

    John Fisher, MD


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