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Good Morning!. Thursday July 26 th , 2012. Semantic Qualifiers. Illness Script. Predisposing Conditions Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) Pathophysiological Insult

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Good Morning!

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  1. Good Morning! Thursday July 26th, 2012

  2. Semantic Qualifiers

  3. Illness Script • Predisposing Conditions • Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) • Pathophysiological Insult • What is physically happening in the body, organisms involved, etc. • Clinical Manifestations • Signs and symptoms • Labs and imaging

  4. Kernig sign • Thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful • Brudzinski sign • Involuntary lifting of the legs in meningeal irritation when lifting a patient's head

  5. Aseptic Meningitis • Definition: syndrome of meningeal inflammation in which common bacterial pathogens have not been identified • Caused by a variety of infectious and noninfectious agents • A definitive agent is found in 1 out of 4 patients • Most common: viral • Enteroviruses are most frequent cause in children

  6. Causes of Aseptic Meningitis**

  7. Causes of Aseptic Meningitis**

  8. Predisposing conditions: Enterovirus** • Summer months • Swimming pools • Meningitis caused by enterovirus most common in children < 1 year old; but can be seen at any age • Risk factor for neonatal infection: Mother with enteroviral infection • Intrauterine transmission also possible • Think about in young neonate with signs of sepsis

  9. Pathophysiology: Enterovirus • Enteroviruses (over 66 serotypes) • Echovirus • Coxsackievirus A and B • Poliovirus • Most commonly associated with meningitis outbreaks: • Coxsackieviruses A9, B2, B4 • Echoviruses 6, 9, 11, and 30 • Spread by fecal-oral route** • Vertical transmission (perinatal)**

  10. Clinical Manifestations** • Generally similar to those of bacterial meningitis, but often are less severe • 1-2 days prodromal symptoms • Younger child: fever, hypothermia, lethargy, irritability, poor feeding, vomiting, apnea, seizures, altered mental status • Older child: fever, headache, malaise, myalgia, nausea, vomiting, stiff neck, photophobia

  11. Clinical Manifestations** • Signs of meningeal irritation • Infants: irritability with exam; prefer to be motionless • Older children: Kernig, Brudinski • Absence does not exclude meningitis • Exanthem, pharyngitis, myocarditis, pericardial effusion

  12. Diagnosis: CSF analysis**

  13. Dignosis** • Enterovirus PCR from CSF fluid • More sensitive than viral culture • Enterovirus culture from pharynx or stool can support the diagnosis of enterovirus aseptic meningitis; but results takes longer than PCR

  14. Imaging? ** • CT of the head is necessary before LP in patients with signs or symptoms of increased ICP • Indications for head CT may include • Altered mental status (GCS <12 or drop in GCS of ≥2) • Immune deficiency • Papilledema • Focal neurologic deficit [excluding isolated CN VI or VII palsy] • CSF shunt • Hydrocephalus • CNS trauma • History of neurosurgery or a space-occupying lesions • Signs or symptoms of parameningeal infection or tumor

  15. Management • Supportive Care!! • Fluids, pain control, anti-emetics • Empiric therapy if suspect/cannot rule out bacterial meningitis

  16. Noon Conference! Renal Emergencies, Dr. Straatman

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