1: Infections - Meningitis Flashcards
What is the main cause of meningitis in children
Viral
What proportion of meningitis in children is viral
2/3 cases
What is the most-common cause of bacterial meningitis in children 0-3 months
Group B Streptococcus
What are 3 organisms that cause meningitis in children 0-3 months
- Group B Streptococcus
- S. Pneumonia
- N. Meningitides
What is most common cause of meningitis in children 3-6 years
N. Meningitides
What are 3 organisms that cause meningitis in children 3-6 years
- N. Meningitides
- S. Pneumonia
- H.Influenza
What is the main cause of bacterial meningitis in 6-60 year-olds
N. Meningitides
What are two causes of bacterial meningitis in 6-60 year-olds
N. Meningitides
S. Pneumonia
When is Listeria Monocytogenes are more common cause of meningitis
- 0-3 months
- > 60 years
- Immunocompromised
What can cause meningitis in immunocompromised patients
Cryptococcus Neoformans
What are 5 risk factors for Meningitis
- Sinusitis
- Otitis media
- Immunocompromised
- Maternal Group B Infection
- Crowded Living Conditions
Explain order of septic signs to meningitis signs
Septic signs typically precede meningitis signs
What are the septic signs of meningococcal septicaemia
- Fever
- Abnormal skin colour
- Rash
- Shock: tachycardia, low RR, low BP
When does a non-blanching petechial rash occur
If caused by N. meningitides
What are 5 meningeal signs of meningitis
- Photophobia
- Neck stiffness
- Kernig’s
- Brundinzki’s sign
- Opisthotonus
When is neck stiffness absent
Under 18-months
What is Kernig’s sign
Resistance to knee extension, when hips are flexed
What is Brudzinski’s sign
When neck is bent, hips will flex
What is opisthotonus
Spasm muscles - causing backward arching of head, neck and spine
What is problem with meningitis in children
Often quite non-specific symptoms
When should meningitis be suspected in infants
Any unwell infant with fever
What are 5 early symptoms of meningitis in infants
Lethargy Vomiting Irritable Poor appetite Dyspneoa
What are 3 late-symptoms of meningitis in infants
Bulging fontanelle
Seizures
High-pitch cry
What are symptoms of meningitis in young children
Fever
Poor Feeding
Lethargy
How do older children with meningitis present
Triad:
- Headache
- Neck Stiffness
- Photophobia
If in the community and suspect meningitis, what should be given
IM (of IV) Benzylpenicillin
If in hospital, what 4 investigations are ordered for neonates (under 1 -month) with meningitis
- FBC
- CRP
- Blood Culture
- LP - send for culture
What is given to manage neonates under 1-month
Cefotaxime and Amoxicillin
Why is amoxicillin given
To cover for listeria - which is more common in younger patients
When is vancomycin added
If known MRSA
If from an area of known pneumococcal cephalosporin resistance
In an infant or child over 1-month with suspected meningitis, what 4 investigations are ordered
- FBC
- CRP
- LP
- Blood Culture
What is first-line management for meningitis in children over 1-month
Ceftiraxone and IV Vancomycin
When is IV Vancomycin indicated
MRSA positive patients or from an area with known pneumococcal-cephalosporin resistance
What 3 medications are given for meningitis in children over 1-months
Ceftriaxone
Amoxicillin
Dexamethasone
What are the indications for dexamethasone
Child over 3-months with:
- Cloudy CSF
- Gram stain positive
- WCC >100
- Protein >1
What age must a child be for dexamethasone to be given
> 3-months
List 6 contraindications for LP
- Raised ICP
- Low HR, Raised BP
- Papilloedema
- Significant bulge in fontanelle - Meningococcal septicaemia (Petechial rash)
- DIC
- Focal Neurological Signs
- Shock
- Infection at LP Site
How can DIC and meningococcal septicaemia be excluded
Absence petechial rash
What are the features of bacterial infection on LP
- Cloudy Fluid
- Low Glucose (Less than half of plasma)
- High Protein
- Polymorphs
What are the features of viral infections on LP
- Clear Fluid
- Normal Glucose
- Normal Protein
- High Lymphocytes
What are features of TB on LP
- Fibrin Web
- Low Glucose
- High Protein
- High Lymphocytes
What is used to test for TB in CSF and why
- PCR is preferred as Ziehl Neelsen Stain is only 20% accurate
Is meningitis a notifiable disease
Yes
What should all household contacts of someone with meningitis be given
Ciprofloxacin for all household contacts
What should be offered 4W following meningitis in children and why
Audiology assessment - as SNHL is the greatest complication of meningitis
If SNHL what is offered
Cochlear Implant
What endocrinological complication can occur post-meningitis
Waterhourse - Freiderichson
What is waterhourse - friederichson syndrome
Coagulopathy triggered by meningitis results in ischaemic necrosis of adrenal glands
What are 3 neurological complications of meningitis
Seizures
SNHL
Paralysis
What are 2 infective complications of meningitis
Sepsis
Brain abscess
What can meningitis lead to
Raised ICP - brain herniation
What do NICE state on using CT to check for raised ICP before lumbar puncture
Do not use CT to check for raised ICP prior to LP. ICP is a clinical diagnosis
When may a CT performed in children
- Fluctuating consciousness: GCS less than 9 or change of more than 3
What is bacteraemia
Bacteria in the blood
What is septicaemia and what does it lead to
Bacteria proliferating in the blood that release toxins which bind and causes vasodilation resulting in shock
What is meningococcal septicaemia
Proliferation meningococcal bacteria in the blood stream, without meningitis
What causes meningococcal septicaemia
N. meningitides
Describe clinical presentation of meningococcal septicaemia
Non-Specific:
- Malaise
- Fever
- Signs shock: poor urine output
Haematological:
- DIC
CNS:
- Meningitis (20-30%)
When should someone be suspected of having meningococcal septicaemia
Unwell child with petechial or purpuric rash
What is glass test used for
Determine if rash is non-blanching
How is suspected meningococcal septicaemia managed
Community: IM benzylpenicillin
Hospital: IV Ceftriaxone
If in shock - manage with fluid resuscitation
If individual with meningococcal septicaemia is in shock what may be required
Inotropes
Name two inotropes
Dopamine
Dobutamine
What is given as prophylaxis for contacts of patients with meningococcal septicaemia
Ceftriaxone
How does meningococcal septicaemia lead to DIC
Proliferation of bacteria in the blood stream causes release of endotoxins - these trigger systemic DIC
What is DIC
Systemic activation of coagulation cascade leading to formation or micro thrombi. Micro thrombi formation results in use of clotting factors causing bleeding
What are 3 causes of DIC
Sepsis
Trauma
Malignancy
How can presentation of DIC be divided
Clotting Symptoms
Bleeding Symptoms
What are bleeding manifestations of DIC
- Ecchymosis
- Petechiae
- Purpura
- Haematuria
- Haemtemesis
What are clotting symptoms of DIC
Oliguria: kidneys Jaundice: liver ARDS: lungs Pupura fulminans: skin Waterhouse-Friederichson
What is purpura fulminans
DIC with skin necrosis
How will DIC present on coagulation studies
Prolonged APTT, PT and Bleeding time
How do d-dimers present in DIC
Raised
