E. CSF analysis – Explanation
The fever, headache, vomiting and drowsiness are nonspecific but given there is absent
history of symptoms of a urinary tract infection or respiratory infection, we should
consider CNS involvement. The key phrase here is also photophobia which makes
meningitis the top of your list of which a lumbar puncture is the method of choice for
diagnosis.
MENINGITIS IN CHILDREN
Children with meningitis present with mostly nonspecific symptoms or signs.
Treatment for meningitis should be started before doing any investigations due to the
seriousness of the disease.
The issue with the exam questions is it is often difficult to identify septicaemia and
meningitis whereas in real life you could easily perform both blood cultures and a
lumbar puncture which would point you towards a diagnosis. The following are some
ways to help differentiate septicaemia and meningitis in children in the exam.
| Clinical features | Diagnosis |
| Fever and vomiting | Septicaemia, Meningitis |
| Non-blanching rash | Septicaemia, Meningitis |
| Drowsy and confused | Septicaemia, Meningitis |
| Arthralgia and muscle aches | Septicaemias |
| Cold periphery | Septicaemia |
| Pale or mottled skin | Septicaemia |
| Shortness of breath | Septicaemia |
| Severe headache | Meningitis |
| Stiff neck | Meningitis |
| Photophobia | Meningitis |
For exam purposes, a good trick which works most of the time is if the patient has got a
rash, then perform blood culture as the diagnosis is most likely meningococcal
septicaemia. The causative organism is Neisseria meningitides.
If there is no rash then a lumbar puncture (LP) would be the answer, but this can only
be done if there are no signs of raised intracranial pressure (ICP).
Lumbar puncture contraindications to look out for during the exam:
- Glasgow Coma Scale less than 9 or a drop of 3 points or more
- Papilloedema
- Unequal, dilated or poorly responsive pupils
- Bulging tense fontanelle
