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Pathogen
vNeisseria meningitidis
§ incidence has ↓ with routine immunization
Ø 11-18 y/o with quadrivalent meningococcal glycoconjugate vaccine
§ petechial or purpuric skin lesion
§ can progress to death w/in hours of symptom onset
§ through nasopharyngeal colonization
§ can be asymptomatic (carrier state) or invasive meningococcal disease
ETIOLOGY
v Gram-negative Bacilli
v Streptococcus agalactiae
q responsible for meningitis predominantly in neonates
vListeria monocytogenes
q increasingly important cause of meningitis in neonates (<1 month of age), pregnant women,
individuals >60 years, and immunocompromised individuals of all ages
qKernig's sign
elicited with the patient in the supine position Thigh is flexed on the abdomen attempt to passively extend the knee elicit pain when
meningeal irritation is present
CLINICAL PRESENTATION
qBrudzinski’s sign
Elicited with the patient in the supine position and is positive when passive flexion of the neck results in
spontaneous flexion of the hips and knees
CLINICAL PRESENTATION
q Seizures
§ part of the initial presentation of bacterial meningitis or during the course of the
illness in 20–40% of patients
qRaised ICP
§ expected complication and the major cause of obtundation and coma in this
disease.
§ the patient lies on his or her side with the vertebral column flexed.
Ø Flexion of the vertebral column increases the distance between the spinous processes of
the vertebrae, which allows easy access to the subarachnoid space.
§ A line drawn across the highest points of the iliac crests, called the supracristal line, passes through the
spinous process of the fourth lumbar vertebra and is used as a landmark for administering a spinal tap
DIAGNOSIS
DIAGNOSIS
CSF EXAMINATION