In a small child diagnosed with H.influenza meningitis, what investigation must be done before discharging him from the hospital ?
Clinical description : Bacterial meningitis is characterized by acute onset of fever (usually > 38.5 degC rectal or 38.0 degC axillary), headache and one of the following signs: neck stiffness, altered consciousness or other meningeal signs. Hib, meningococcal meningitis and pneumococcal meningitis cannot be differentiated on clinical grounds alone Laboratory criteria for diagnosis Bacterial meningitis can be confirmed by three methods. (1) Culture method: isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood. (2) Antigen detection methods: identification of a bacterial antigen in normally sterile fluids (i.e. CSF or blood) by such methods as latex agglutination or counterimmunoelectrophoresis (CIE). (3) Gram stain results Case classification Suspected: Any person with sudden onset of fever (> 38.5 degC rectal or 38.0 degC axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal sign Probable: A suspected case with CSF examination showing at least one of the following: - turbid appearance; - leukocytosis (> 100 cells/mm3); - leukocytosis (10-100 cells/ mm3) AND either an elevated protein (> 100 mg/dl) or decreased glucose (< 40) Confirmed: A case that is laboratory-confirmed by growing (i.e. culturing) or identifying (i.e. by Gram stain or antigen detection methods) a bacterial pathogen (Hib, pneumococcus or meningococcus) in the CSF or from the blood in a child with a clinical syndrome consistent with bacterial meningitis. Acute bacterial meningitis (ABM) constitutes 1.5% of all admissions in the pediatric ward with a mean case fatality of 16%. Sensorineural hearing loss (SNHL) is the most common neuropsychological sequel of ABM. It occurs in as many as 30% of patients with pneumococcal meningitis, 10% with meningococcal meningitis and 5-20% with Haemophilus influenzae type &;b&; meningitis.The effect of SNHL on language is well-recognized and therefore early detection is mandatory. However, hearing assessment is difficult in infants and young children. Brainstem evoked response audiometry (BERA) can help to assess hearing in this population. BERA is a helpful tool for screening of SNHL, especially in the young children and infants in whom other conventional methods may not be of much use. There is significantly increased risk of developing SNHL if the CSF has increased cells, paicularly polymorphs and proteins. Reference: GHAI Essential pediatrics, 8th edition
BERA
MBI
CT scan
X-ray skull
Central Nervous system