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- Anathi (1 yr. old)
- Lives with mother and 8 other family members
- 2 bedroom-brick house
- mother is recently divorced
- father is an alcoholic

[First visit]
- Presenting complaint: loss of appetite, vomiting, being very irritable
- Has not been vaccinated (mother does not recall)

[Second visit]
- not speaking ("mamma")

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Dr. observation
- pyrexial (40 °C )
- drowsy
- neck stiffness
- bulging anterior fontanelle

Investigation results
- CT scan; no brain hierniation
- chest X-ray; no abnormalities
- lumbar puncture;  microscopy, biochemical tests and routine culture (Haemophilus influenzae type B)

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- Anathi was given  Ceftriaxone (prior to admission + IV in hospital)
- communication parent training (signing + lip reading)

- notifiation of disease (Category 2)
- on 2nd visit; referred to audiologist
- prophylaxis (family)

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- lumbar puncture;  microscopy, biochemical tests and routine culture (Haemophilus influenzae type B)
- clinically worsening
-  sensorineural hearing loss

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Knowledge gaps
- effect of meningitis in children (sensory, visual)
- meningitis
- Public health of Catergory 2 notifiable disease
Prior knowledge
- S. agalactiae, Listeria mono., CMV
- main telling sign of meningitis; stiffness fo neck
- sub-arachnoid haemorrhage can present with meningitis-like symptoms (proximity of structures in the brain, cause effect on meninges)

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- meningitis
- treatment of meningitis
- prevention of meningitis
- presentations
- complications
- prognosis

- investigations for meningitis (microscopy, biochemical tests and routine culture)

- sign language and lip reading
- child language development
- dynamics of family; child with hearing loss, language development barrier

- Public health of meningitis (on population scale)