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Meningitis, Other CNS Infections and Sepsis

Mediators of Meningeal Inflammation

· Tumor necrosis factor alpha · Prostaglandins

· Interleukin - 1 · Interleukin gamma

· Interleukin - 6 · Platelet-activating factor

· Interleukin -8 · Nitric Oxide

· Interleukin - 10 · White blood cell products

· Macrophage inflammatory proteins 1 & 2

  SIRS and Sepsis: a Continuum

· SIRS-- Presence of two or more of the following: altered temperature, tachypnea, tachycardia and abnormal WBC

· SEPSIS --SIRS with proven/suspected microbial etiology

Sepsis Meningitis

· SEVERE SEPSIS --Sepsis with signs of organ dysfunction

· SEPTIC SHOCK-- SEPSIS with hypotension and multiple organ dysfunction (may become refractory)

Bacteriology and Outcome of Pediatric Sepsis

Outcome of Pediatric Sepsis

Complications of Severe Meningococcemia

DIC 68%

ARDS 34%

Renal failure 9% meningitis

Pancreatitis 7%

Myocarditis 7%

Adrenal hemorrhage 5%

Myocardial infarction 2%

Initial Empiric Therapy for Sepsis

Community-acquired

Newborns Amp + aminoglycoside or Cefotaxime

Infants Ceftriaxone, Cefotaxime

Children Ceftriaxone, Cefotaxime

Hospital-acquired

Anti-staph + aminoglycoside, or cephalosporin

Immunocompromised

Many possibilities: Anti-staphylococcal penicillin + Aminoglycoside or cephalosporin; cephalosporin + Aminoglycside; cephalosporin alone; meropenem alone. Anaerobe coverage for