15.5.2 Meningitis Flashcards
Pathogenic organisms (common)
Child+adult
- Haemophilus influenzae (haemophilus)
- Streptococcus pneumoniae (pneumococcus)
- Neisseria meningitides (meningococcus)
<3months
- Group B haemolytic streptococcus
- Gram negative organisms: E.coli, Klebsiella etc
immunocompromised on new slide
Pathogenic organisms (rare)
- Direct transmission CSF: – E.g. Streptococcus faecalis
- Immunocompromised: – HIV
Pathogenesis
- know there are different routes
- common slide
- rare slide
Pathophysiology
leave the white slide with the diagram
Risk factors
Clinical exam and history
Always suspect meningitis; it can present with alot of different symptoms
It is an medical emergency; start antibiotics immediately
Con with slides
Clinical presentation of meningitis: Neonates
Signs are non-specific or absent. Therefore lumbar puncture is indicated.
• Irritability
• Restlessness
• Poor feeding
• Vomiting
• Apnoea, Bradycardia
• Temperature instability
• Hypotonia
• Fever
• Bulging fontanelle
• Jaundice
• Diarrhoea
• High pitched cry
Clinical presentation of meningitis: older child
- Lethargy
- Vomiting
- Bulging fontanel
- Convulsions
- Rash
- Coma
- Fever
- Photophobia
- Headache
- Neck and backache
- Signs of meningism
Clinical presentation: meningococcus
- Purpura
- Meningitis:
➡️Often severe brain oedema: LP risky
➡️Mannitol indicated - Shock:
➡️Waterhouse-Friederichsen syndrome
➡️purpura fulminans: limb & digit loss
Give antibiotics immediately!
-> give antibiotics anybody close enough contact for droplet spread (even if vaccinated)
Routine CSF findings in healthy and childhood meningitis
- neonate normal value
- changes
- septic
- aseptic
- TB (great mimicer)
Slide with table
Very NB!!
Prevention of meningitis
- Immunization
➡️H.influenzae: Hibvaccine
➡️Pneumococccus: Polyvalent vaccine - Chemoprophylaxis
➡️Meningococccus- rifampicin, ciprofloxaxin
➡️H. influenzae- rifampicin
Key points to know
- types of organisms
- give antibiotics
- rash (antibiotic for everyone)
- TB meningitis is very NB!
NB TBM epidemiology
- TB incidence South Africa
➡️1000/ 100,000 population - TBM
➡️Most common bacterial meningitis W. Cape
➡️Most common reason for mortality in childhood TB - Acid-fast bacilli
➡️Mycobacterium tuberculosis - Age of presentation
➡️2-4 years
TBM pathogenesis
- Results from primary TB- usually pulmonary
- Rich focus:
➡️granuloma in the brain that breaks through to the subarachnoid space → TBM - Miliary TB
➡️25% of TBM
slide regarding the stats that 20% of TBM will die (especially the last bullet is very important) + slide after
Pathology of TBM
Dense basal exudate
– CSF obstruction: hydrocephalus
– peri-arteritis: infarction
– peri-neuritis: cranial nerve palsies
– parenchymal: esp brainstem