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terial meningitis
Children under 1 year
T he classic signs o f m eningitis are usually absent.
– T h e ch ild is irritable, ap p ears sick w ith fever o r h y p o th erm ia, p o o r feed ing o r
vo m iting.
– O th er features includ e: seiz ures, ap no ea, altered co nscio usness, bulging fo ntanelle
(when no t cry ing); o ccasio nally , neck stiffness and p urp uric rash.
Laboratory
– L um bar p uncture (L P ):
• M acro sco p ic exam inatio n o f th e cerebro sp inal fluid ( C S F ) : antibio tic th erap y
sho uld be initiated im m ed iately if the L P y ield s a turbid C S F .
• M icro sco p ic exam inatio n: G ram stain (but a negative exam inatio n d o es no t exclud e
the d iagno sis) and white blo o d cell co unt (W B C ).
• I n an ep id em ic co ntext, o nce the m eningo co ccal aetio lo gy h as been co nfirm ed ,
there is no need fo r ro utine L P fo r new cases.
Pressure Aspect WBC Protein Other tests
C lear
3
(leuco cy tes/ m m )
Normal CSF <5 P and y – –
Bacterial
meningitis < 4 0 m g/ d l
Viral ++++ C lo ud y , 1 0 0 -2 0 0 0 0 P and y + G ram
meningitis stain +
turbid m ainly neutro p hiles 1 0 0 -5 0 0 m g/ d l
In neo nates:
> 20
In
im m uno co m p ro m ised
the W B C m ay be
< 100
No rm al C lear 1 0 -7 0 0 P and y – –
to +
m ainly ly m p ho cy tes
TB +++ C lear o r < 500 P and y + A FB
meningitis m ainly
y ello wish ly m p ho cy tes
Cryptococcal
meningitis ++++ C lear < 800 P and y – Ind ia
m ainly
ly m p ho cy tes ink
– R ap id test fo r d etectio n o f bacterial antigens.
Note: in an end em ic area, it is essential to test fo r severe m alaria ( rap id test o r
thin/ thick film s).
166
Children under 1 year
T he classic signs o f m eningitis are usually absent.
– T h e ch ild is irritable, ap p ears sick w ith fever o r h y p o th erm ia, p o o r feed ing o r
vo m iting.
– O th er features includ e: seiz ures, ap no ea, altered co nscio usness, bulging fo ntanelle
(when no t cry ing); o ccasio nally , neck stiffness and p urp uric rash.
Laboratory
– L um bar p uncture (L P ):
• M acro sco p ic exam inatio n o f th e cerebro sp inal fluid ( C S F ) : antibio tic th erap y
sho uld be initiated im m ed iately if the L P y ield s a turbid C S F .
• M icro sco p ic exam inatio n: G ram stain (but a negative exam inatio n d o es no t exclud e
the d iagno sis) and white blo o d cell co unt (W B C ).
• I n an ep id em ic co ntext, o nce the m eningo co ccal aetio lo gy h as been co nfirm ed ,
there is no need fo r ro utine L P fo r new cases.
Pressure Aspect WBC Protein Other tests
C lear
3
(leuco cy tes/ m m )
Normal CSF <5 P and y – –
Bacterial
meningitis < 4 0 m g/ d l
Viral ++++ C lo ud y , 1 0 0 -2 0 0 0 0 P and y + G ram
meningitis stain +
turbid m ainly neutro p hiles 1 0 0 -5 0 0 m g/ d l
In neo nates:
> 20
In
im m uno co m p ro m ised
the W B C m ay be
< 100
No rm al C lear 1 0 -7 0 0 P and y – –
to +
m ainly ly m p ho cy tes
TB +++ C lear o r < 500 P and y + A FB
meningitis m ainly
y ello wish ly m p ho cy tes
Cryptococcal
meningitis ++++ C lear < 800 P and y – Ind ia
m ainly
ly m p ho cy tes ink
– R ap id test fo r d etectio n o f bacterial antigens.
Note: in an end em ic area, it is essential to test fo r severe m alaria ( rap id test o r
thin/ thick film s).
166
