Meningitis in Children

~ Overview
mtsdarmawan
dept anak fk uii

Meningitis
Penyakit berat pada anak
Meningitis virus : lebih ringan
Meningitis bakterial (sebagian besar) :
Sembuh : cacat
Kematian.

Meningitis
Mengancam jiwa
Dapat memburuk progresif :
Kerusakan otak permanen ,
neurologic problems s/d kematian.

Dokter : diagnosis & terapi dini utk

cegah sequele ~ gejala sisa

Meningitis
Direct bacterial infection or a
viral infection.
Rare conditions:
cancer, drug reaction, or
disease of the immune system.

Meningitis
Normally : fever, lethargy, and a mental
status (teler), but
Often hard to detect in young children: not
specific (< 6-12 bulan).
Proses sering meluas : encephalitis
meningoencefalitis (ME)

Incidence
Highest : 0-2 years.
Greatest risk : 3-8
months.
Risiko :
immunocompromise,
misal Down
syndrome

Causes
Complication infection in the bloodstream.
Blood-brain barrier :
Normally protects the brain
Sometimes, infections directly decrease
the protective ability

Blood Brain Barrier ~ Sawar Darah Otak

Blood brain barrier

Causes
Once the BBB becomes leaky, organisms
invade the fluid surrounding the brain.
BERKEMBANG BIAK AMAT CEPAT
Reaksi : lekosit .
Lekositosis : bisa me inflammation.
edema serebri vaskularisasi .

Causes
Direct spread nearby severe infection, otitis
media or sinusitis
Direct trauma to the head or after head surgery.
Bacterial meningitis : many different types.
Umur tertentu : predisposi bakteri tertentu
Setelah lahir :
B Streptococcus,
Escherichia coli, and
Listeria

Causes
Age 1 month :
Streptococcus pneumoniae,
Haemophilus influenzae type B (Hib), and
Neisseria meningitidis
use Hib vaccine as a routine
immunization

Causes
Viral meningitis is much
less serious
Its symptoms ~
common flu.
The frequency of viral
meningitis in summer
: enteroviruses.

Meningitis bakterial

Symptoms
Tersering : develops 1-4 days.
Severe cases : child who looks healthy
can rapidly become seriously ill within 1
day, death is possible.
In children, the signs & symptoms depend
on : child's age & not always obvious
because the child cannot communicate
symptoms.
Perhatian sangat ekstra

Classic symptoms < 3 months :

Trias : demam, kejang, pe kesadaran.

Tak mau minum,muntah
Rewel, gelisah
Bulging fontanelle ~ uub menonjol
Kejang

Classic symptoms < 3 months :

Classic symptoms > 1 year :

Mual & muntah

Nyeri kepala, fotofobia
Demam
Perub kesadaran, cuek, somnolen
Lethargy, kejang
Kaku kuduk or nyeri kepala

Classic symptoms > 1 year :

Classic symptoms > 1 year :

Munculnya reflekspatologis,
hiper~refleksia
Tanda meningeal
Hati-hati anak dengan prologed fever ~
demam > 2 minggu. Kadang tiba-tiba
menjadi ME

Classic symptoms > 1 year :

Brudzinski sign (+), Kernig sign(+)

Babinski sign

Clonus & Refleks Patologis

Spastisitas

Spastisitas

Exams & Tests

Di UGD, cek : vital sign : suhu, TD, RR, N,
analisis gas darah.
Quickly check ABC.
Cari fokal infeksi,
Utk menilai perub status mental
Utk memastikan meningitis / bukan.

Fokal infeksi

ISPA
OMA, sinusitis
Diare
Percontinuitatum (trauma kepala)

Exams and Tests

Lumbal punctie (LP),
analisis di lab.
CSF (cerebro~spinal
fluid LCS)

CSF ~ LCS bakteial

Tes Nonne Pandy (+) ~ protein banyak
Keruh
Kadar glukosa : utk metabolisme yg

Exams & Tests

Infus: utk mencegah dehidrasi &
maintenanse tekanan darah.
Cek urin : cari fokal infeksi urinary tract
Ro : cari fokal infeksi di paru ~ meningitis
TB

Indikasi Head CT :

Trauma
TIK meningkat
Neurologic problem
Lack of fever
Brain abscess
Tumor

Treatment
Viral : self-Care at Home
Meningitis dapat menjadi cepat progresif&
mengancan jiwa
Perlu immediate medical care ~ IMC

Treatment
- Transport ke RS:
Acetaminophen .
Jaga anak agar nyaman & cegah tersedak
atau aspirasi muntahan.
Perhatikan perburukan setiap waktu

Treatment
Sometimes, children are sent home from
the emergency room if the doctor is
confident that the child has viral meningitis.

Treatment
Frequently, a child with viral meningitis
can be treated successfully at home :
acetaminophen & drinking fluids.
Follow-up is still important.
Re~evaluated 1-2 hari utk pastikan perbaikan.
Perhatikan perburukan atau symptoms
Bila perlu kirim kembali ke RS

Medical Treatment
Because potentially life-threatening
therapy often begins before the test
results are back.

Medical Treatment
Respiratory distress : intubation ~ ET
Monitor jantung : frekuensi & ritme
Infus.

Medical Treatment
Kateter : memastikan out put & kecukupan
cairan ~ balance cairan.

Medical Treatment
Viral meningitis & improving : sent home
for supportive therapy :
Fluids
Acetaminophen or ibuprofen

If sent home : check within 24 hours to

make certain condition has improved.

Medications

Antibiotics : early as quickly as possible.

Type of antibiotic depends age & allergies.
Antibiotics : not helpful for viral meningitis.
Steroids : minimize inflammation.
Dexametason 30 sebelum antibiotika utk
membuka awardarah otak.
Aggressive medications : depending on
the severity : albumin. Immunoglobulin.

Antibiotika
Sesuai kultur : lama ~ 5 hari
Broad spectrum :
Ampisilin & kloramfenikol
Cefotaxim & kloramfenikol
Ceftriaxone
Cefepime

Prevention
Antibiotics : to all intimate contacts with
meningococcal meningitis: very specific
type of bacterial meningitis.
Include family members, friends, health
care workers, and even daycare or
nursery contacts.

Prevention
Adults can contract & become carriers.
Preventive antibiotics : not needed

Komplikasi

Komplikasi & Sequele

Hidrosefalus
Cerebral palsy (CP)
Epilepsi
Retardasi mental
Paralysis
Buta ~ tuli ~ ggn bicara

Hidrosefalus ~ terapi

Cerebral palsy

Prognosis
Depends cause & infection severity.
Initial treatment : unable to tell prognosis .

Prognosis
Bla selamat, penderita
bacterial meningitis berat :
sequele, cacat seumur hidup :

visual troubles,
hearing difficulty,
Seizures (CP),
Paralysis, and
mental function.

Outlook
Bacterial meningitis sangat ringan treated
early : completely recover a few weeks
Most viral meningitis get better within 2
weeks.

Terima Kasih