Pediatric emergency medicine trisk 2265 2265
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TABLE 94.3
ETIOLOGIES OF ACUTE BACTERIAL MENINGITIS CHILDREN
OUTSIDE THE NEONATAL PERIOD
Goals of Treatment
The goal of treatment is the rapid recognition and treatment of bacterial meningitis to decrease a child’s risk of
neurologic sequelae. The clinical team should consider neuroimaging prior to LP in the immunocompromised
child or the child with focal neurologic deficits. Clinical outcomes include time to appropriate parenteral
antibiotics, CSF sterility at 24 to 48 hours, and neurologic outcome.
Clinical Considerations
Clinical recognition: The most common signs and symptoms of bacterial meningitis are listed in Table 94.4 .
Before 2 months of age, the history is usually that of irritability, an altered sleep pattern, vomiting, and decreased
oral intake. In particular, paradoxical irritability points to the diagnosis of meningitis. Irritability in the infant
without inflammation of the meninges is generally alleviated by maternal fondling; however, in the child with
meningitis, any handling, even directed toward soothing the infant, may increase irritability by its effect on the
inflamed meninges. The amount of time spent sleeping may either increase because of obtundation or decrease
from irritability. Bulging of the fontanelle, an almost certain sign of meningitis in the febrile, ill-appearing infant,
is a late finding. Vomiting is a sensitive but nonspecific feature of infantile meningitis.
As the child ages past 2 months, the symptoms gradually become more specific for involvement of the central
nervous system (CNS). A change in the level of activity is almost always noticeable. However, it is only in the
child older than 2 years that meningitis manifests reliably with complaints of headache, neck stiffness, and
photophobia.
