15.5.2 Meningitis Flashcards

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1
Q

Pathogenic organisms (common)

A

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

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2
Q

Pathogenic organisms (rare)

A
  • Direct transmission CSF: – E.g. Streptococcus faecalis
  • Immunocompromised: – HIV
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3
Q

Pathogenesis

A
  • know there are different routes
  • common slide
  • rare slide
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4
Q

Pathophysiology

A

leave the white slide with the diagram

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5
Q

Risk factors

A
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6
Q

Clinical exam and history

A

Always suspect meningitis; it can present with alot of different symptoms
It is an medical emergency; start antibiotics immediately
Con with slides

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7
Q

Clinical presentation of meningitis: Neonates

A

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

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8
Q

Clinical presentation of meningitis: older child

A
  • Lethargy
  • Vomiting
  • Bulging fontanel
  • Convulsions
  • Rash
  • Coma
  • Fever
  • Photophobia
  • Headache
  • Neck and backache
  • Signs of meningism
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9
Q

Clinical presentation: meningococcus

A
  • 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)

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10
Q

Routine CSF findings in healthy and childhood meningitis

A
  • neonate normal value
  • changes
  • septic
  • aseptic
  • TB (great mimicer)

Slide with table
Very NB!!

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11
Q

Prevention of meningitis

A
  • Immunization
    ➡️H.influenzae: Hibvaccine
    ➡️Pneumococccus: Polyvalent vaccine
  • Chemoprophylaxis
    ➡️Meningococccus- rifampicin, ciprofloxaxin
    ➡️H. influenzae- rifampicin
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12
Q

Key points to know

A
  • types of organisms
  • give antibiotics
  • rash (antibiotic for everyone)
  • TB meningitis is very NB!
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13
Q

NB TBM epidemiology

A
  • 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
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14
Q

TBM pathogenesis

A
  • 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

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15
Q

Pathology of TBM

A

Dense basal exudate
– CSF obstruction: hydrocephalus
– peri-arteritis: infarction
– peri-neuritis: cranial nerve palsies
– parenchymal: esp brainstem

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16
Q

Clinical presentation: Stages of TBM

A

Stage 1:
- low-grade fever/ apathy and irritability
- Cough (daily for >2 weeks)/vomiting
- NB: weight crossing centiles on RTHB

Stage 2:
- neurological signs: neck stiffness, ⬆️ICP, hemiparesis
- 2a GCS 15
- 2b GCS 11-14 (refined MRC staging)

Stage 3:
- coma/ quadriparesis/ cranial nerve palsies/ possible brainstem dysfunction

17
Q

NB early diagnosis TBM

A

Stage I
➡️100% survival
➡️90% + neurologically normal

Stage 3
➡️30-40% mortality
➡️10% neurologically normal

Early diagnosis tips
- Always think of TBM
➡️esp low socio-economic setting
➡️Persistent symptoms (e.g. vomiting/coughing)
- Ask about TB contact: adults
- Road to Health Booklet
➡️80% poor weight gain months prior to TBM

18
Q

TB in children an puci-bacillary (cannot do only one test to test for TBM)

A