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S. pneumoniae
H. influenzae
N. meningitis
0 1 12 5 10 20 40 60 or >
MONTHS YEARS
AGE
irritability arching back
fever cries when picked
sleeping more up or being held
than usual inconsolable crying
poor feeding bulging fontanelle
high-pitched cry (soft spot on an
infant's head)
noticeably
different
temperament
neck and/or back refusing to eat
pain decreased level of
headache consciousness
sleepiness seizures
confusion photophobia
irritability (sensitivity to
fever light)
nausea and
vomiting
neck stiffness
Do not rely on these signs due to low
efficacy in pediatrics
Kernig's Sign and Brudzinski's Sign
1. Test Sensitivity: 5%
2. Test Specificity: 95%
Nuchal and spinal rigidity
1. Test Sensitivity: 30%
2. Test Specificity: 68%
So a high degree of clinical suspicion is
required
White blood cell (WBC) counts over 1000/mm3
usually are caused by bacterial infections.
Gram stain may aid in diagnosis, but the
diagnosis may be missed in up to 30% of cases
of culture-proven disease.
The protein concentration usually is elevated
in bacterial meningitis
Normal CSF glucose should be greater than
two-thirds that of the serum glucose. Levels
less than 50% of serum are suggestive of
bacterial meningitis.
The WBC count in viral meningitis is
usually below 500/mm3, with greater
than 50% lymphocytes.
The protein may be elevated.
The glucose level may be normal or low.
Gram stain results are negative.
- Hearing loss is the most encountered
sequelae; it occurs
* in 30% cases of S. pneumoniae
meningitis,
* in 20% of H. influenzae meningitis,
* in 10% of N. meningitidis meningitis.
- Mental retardation, seizures, delay in
language acquisition, visual impairment,
behavioural problems and hydrocephalus.
Other serious
complications can
include:
1. Brain damage
1. Epilepsy
2. Changes in eye
sight
Encephalitisis a similar disease of
the central nervous system. This
disease is an inflammation of brain
parenchyma. Often, a viral agent is
responsible. Viral entry occurs
through hematogenous or neuronal
routes.
HSV type 1 and 2 (almost
exclusively in neonates), VZV,
EBV, measles virus (PIE and SSPE),
mumps, and rubella are spread
through person-to-person contact.
Mycoplasma species
Rickettsia
Toxoplasmosis
Severe headache
Sudden fever
Drowsiness
Vomiting
Confusion
Seizures
CSFanalysis shows pleocytosis
(predominantly mononuclear cells)
and high levels of protein. A small
percentage (3-5%) of samples have
normal CSF. Identification of viral
antigen or nucleic acid may provide
some diagnostic help.
Bacterial meningitis can be treated with a number
of effective antibiotics. It is important, however,
that treatment be started early in the course of the
disease. Appropriate antibiotic treatment of most
common types of bacterial meningitis should
reduce the risk of dying from meningitis to below
15%,
15% although the risk is higher among the elderly.
SUPORTIF
PERAWATAN
Radang selaput otak yang
disebabkan oleh Mycobacterium
tuberculosis.
Usia 3 bulan sampai 5 tahun
Mortalitas : 10-20 %
Anamnesis : demam kronis atau akut, penurunan BB, kejang,
imunisasi BCG, kontak dengan pasien dewasa.
PD :
Stadium I :
gejala gastrointestinal, tanpa kelainan neurologi.
apatis, iritabel,nyeri kepala intermiten.
Stadium II :
mengantuk,disorientasi
Rangsang meningeal,refleks tendon meningkat,
abdomen hilang, klonus patela dan pergelangan kaki.
N. kranialis VII, IV,VI,III terlibat.
Stadium III :
Koma Pernafasan ireguler
Pupil terfiksasi Peningkatan suhu
Spasme kronik tubuh
Hidrosefalus
CBC
LP : - CSF jernih atau xantokrom
- sel meningkat 500 sel/mm³ dom limfosit
- Glukosa : menurun
PCR
ELISA
Latex Particle Agglutination
CT Scan atau MRI : lesi parenkim dasar otak,
infark, tuberkuloma
Ro foto : TB paru.
INH 5-10 mg/kgBB/hari max 300mg/hr
Rif 10-20 mg/kgBB/hari max 600 mg/hr
PZA 20-40 mg/kgBB/hari max 2000
mg/hr
Etambutol 15-25 mg/kgBB/hari max
2500mg/hr
Prednison 1-2 mg/kgBB/hari, selama 2-
3 mgg, dilanjutkan dg tapp-off.