1(E): Meningitis Flashcards
What is meningitis
Inflammation meninges
When is meningitis incidence at it’s highest
Infants and children
Why is epidemiology of meningitis reduced
Introduction haemophillus Influenza and Men B into immunisation schedule
During first three-months of life, what causes meningitis
Group B Strep
E.Coli
Listeria
During three-six months, what is most common organisms
- N Meningitides
- S Pneumonia
- H Influenza
During 6 months - 60 years what can cause meningitis
N Meningitides
S Pneumonia
Over 60-years what are common causes of meningitis
S Pneumonia
N Meningitides
Listeria
If diabetic, what is a common cause of meningitis
S. Pneumonia
If penetrating skull injury, what can cause meningitis
S. Aureus
What can cause meningitis in hyposplenism (eg. sickle cell)
S. Pneumonia
If immunosuppressed what may cause meningitis
Cryptococcus
What are four RF for meningitis
- Maternal group B strep
- Sinusitis
- OM
- Immunocompromised
In a child or adult, what are common initial symptoms of meningitis
- Cold peripheries
- Myalgia
- Fever
- Headache
What are late features of meningitis
Meningism:
- Headache
- Photophobia
- Nausea, Vomiting
- Kernig
- Brudzinski’s sign
- Drop in GCS
- Non-blanching petechial rash
What is not present in meningitis in neonates
Meningism
What are features of meningitis in neonates
- Lethargy, Hypotonia
- High-Pitch crying
- Vomiting
- Poor Feeding
- Bulging fontanelle
- Seizures
In primary care, if someone has non-blanching rash what should they be given
IM Benzylpenicillin
How should a patient in meningitis be approached
A-E
- Resuscitation
- IV access
- Glucose if required
If meningococcal septicaemia how should the patient be managed
Initiate sepsis 6
Blood culture Urine output Fluid Antibiotics Lactate, FBC, ABG Oxygen
If meningitis without shock, what should be done
Blood cultures
Assess ICP
If signs of raised ICP, what should be done
Contact ITU
- Nurse at 30’
- Antibiotics
- Dexamethasone
If patient does not have raised ICP what should be done
Contact senior
- LP in 1h
- Antibiotics
- Dexamethasone
What is a way to remember CI of LP
PIICCS
What are CI of LP
Purpura Infection at LP site ICP raised Coagulation: platelets <100 Convulsions Shock
What are symptoms of raised ICP
- Reduce GCS (by 3, or less than 9)
- Bulging Fontanelle
- Focal Neurological Sign
- Bradycardia
What platelet count should individuals not have LP
<100
If patient has meningococcal septicaemia what is ordered
do NOT perform LP
- Order PCR and BC
Explain the following in bacterial LP
a. Appearance
b. Glucose
c. Protein
d. WCC
a. Cloudy
b. Low
c. High
d. High polymorph count
Explain the following in TB LP
a. Appearance
b. Glucose
c. Protein
d. WCC
a. Fibrin web
b. Low
c. High
d. High lymphocytes
Explain following in viral LP
a. Appearance
b. Glucose
c. Protein
d. WCC
a. Clear
b. Normal (More than half of serum)
c. Normal
d. High lymphocytes
What is used to test CSF for TB and why
PCR , as ziehl-neelsen is only positive in 20%
What antibiotics are given for meningitis
IV Ceftriaxone
If suspecting viral meningitis, what is given
Acyclovir
When is amoxicillin given and why
Infants, Immunocompromised, Elderly
When is dexamethasone NOT given
To infants under 3-months
What should all household contacts of those with meningitis be given
Ciprofloxacin, Meningococcal Vaccine
What is used to prevent meningitis
Men B: 3,4 and 12 months
Pneumococcal vaccine given to those with asplenism
What is most common complication of meningitis
SNHL
What are 3 neurological complications of meningitis
SNHL
Epilepsy
Cognitive Impairment
Hemiparesis
What are 2 infective complications of meningitis
Sepsis
Cerebral abscess
What are pressure consequences of meningitis
Herniation
What is a metabolic complication of meningitis
Waterhouse Freiderichson Syndrome
When is waterhouse-freiderichson syndrome more common
Children
Asplenism
What is water friederichson syndrome
Haemorrhagic necrosis of the adrenal glands due to endotoxin release. Presents with non-blanching rash petechial rash and myalgia
