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A - MSRA Neuro and Stroke [12] > [19] Meningitis > Flashcards

[19] Meningitis Flashcards

1
Q

What is meningitis?

A

Inflammation of the leptomeninges and underlying subarachnoid CSF

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2
Q

What ages are more predisposed to meningitis?

A

Infants, young children and the elderly

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3
Q

What is the underlying cause of most cases of meningitis?

A

An infectious agent that has colonised or established a localised infection elsewhere in the host and spread to the CNS

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4
Q

What sites of infections are commonly associated with meningitis?

A
  • Skin
  • Nasopharynx
  • Respiratory tract
  • GI tract
  • GU tract
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5
Q

How can an infectious organism at a distant site cause meningitis?

A

By circumventing the hosts defense and gaining access to the CNS

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6
Q

How might bacteria gain access to the CNS to cause meningeal disease?

A
  • Invasion of blood stream and haematogenous seeding
  • Retrograde neuronal pathway e.g. olfactory or peripheral nerves
  • Direct contiguous spread
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7
Q

In what conditions might organisms directly spread to cause meningeal disease?

A
  • Sinusitis
  • Otitis media
  • Congenital malformations
  • Trauma
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8
Q

What can often worsen the problem in meningitis?

A

The immune response

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9
Q

How can the immune response worsen meningitis?

A

Creates leaky blood vessels, allowing fluid and WBC to enter meninges and cause swelling

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10
Q

What is the result of swelling in meningitis?

A

Decreased blood flow to the brain

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11
Q

What can cause inflammation of the meninges?

A
  • Viruses
  • Bacteria
  • Other micro-organisms
  • Non-infective causes
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12
Q

What is the more common form of meningitis?

A

Viral

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13
Q

What is the more serious form of meningitis?

A

Bacterial

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14
Q

Due to the severity of bacterial meningitis, what should happen to all patients?

A

Treat as bacterial meningitis until proven otherwise

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15
Q

What viruses can cause meningitis?

A
  • Enterovirus
  • HSV (generally type 2)
  • VZV
  • Mumps
  • HIV
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16
Q

What are the most common bacterial causes of meningitis in neonates?

A
  • GBS
  • Listeria monocytogenes
  • E. coli
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17
Q

What are the most common bacterial causes of meningitis in infants?

A
  • H. Influenzae type B
  • Nisseria meningitides
  • Strep. pneumonia
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18
Q

What group of infants are at risk of H. influenza B meningitis?

A

Those who are unvaccinated

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19
Q

What are the most common bacterial causes of meningitis in adults?

A
  • Strep. pneumoniae
  • H. influenza B
  • N. meningitidis
  • Gram -ve bacilli
  • Staphylococci
  • Streptococci
  • L. monocytogenes
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20
Q

What are the most common bacterial causes of meningitis in the elderly and immunocompromised?

A
  • Klebsiella pneumoniae
  • E. coli
  • Pseudomonas aeruginosa
  • Staph aureus
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21
Q

What are the non-infective causes of meningitis?

A
  • Malignant cells e.g. leukamia and lymphoma
  • Chemicals e.g. intrathecal drugs
  • Drugs e.g. NSAIDs, trimethoprim
  • Sarcoidosis
  • SLE
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22
Q

What are the risk factors for meningitis?

A
  • CSF shunts
  • Dural defects
  • Spinal procedures
  • DM
  • Alcoholism
  • Bacterial endocarditis
  • IV drug use
  • Adrenal insufficiency
  • Malignancy
  • CF
  • Crowding e.g. students
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23
Q

What are the possible presenting features of meningitis?

A
  • Fever
  • Headaches
  • Neck stiffness
  • Photophobia
  • Signs of shock
  • Kernig’s sign
  • Brudzinksi’s sign
  • Paresis and focal neurological defecits
  • Seizures
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24
Q

What are the signs of shock?

A
  • Tachycardia
  • Respiratory distress
  • Poor urine output
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25
Q

What is Kernig’s sign?

A

Pain and resistance on passive knee extension with hips fully flexed

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26
Q

What is Brudzinksi’s sign?

A

Hips flex on bending the head forward

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27
Q

How may viral meningitis be distinguished from bacterial meningitis?

A

Often indistinguishable but can be more mild

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28
Q

In what age groups are the classical symptoms of meningitis often not seen?

A

Infants and the elderly

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29
Q

Are investigations used in meningitis?

A

Yes but should not delay treatment

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30
Q

What investigations may be useful in meningitis?

A
  • LP
  • Renal function testing
  • Coagulation
  • MRI
  • CT
  • CXR
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31
Q

When should an LP be performed in suspected meningitis?

A

Immediately if no signs of raised ICP or focal neurology

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32
Q

What tests should CSF undergo in suspected meningitis?

A
  • Gram stain
  • Ziehl-Neelsen stain
  • Cytology
  • Virology
  • Glucose
  • Protein
  • Culture
  • Rapid antigen screen
33
Q

What can MRI be useful for in meningitis?

A

Detecting and monitoring complications of meningitis

34
Q

What is CT reserved for in meningitis?

A

Specific adverse clinical features

35
Q

When might a CXR be useful in suspected meningitis?

A

To look for lung abscess in suspected TB

36
Q

What are the potential differentials for meningitis?

A
  • Other causes of pyrexia and infection
  • Intracranial abscess
  • Other causes of altered mental state and coma
37
Q

What are some examples of other conditions that can cause altered mental state and coma?

A
  • Encephalitis
  • Subarachnoid haemorrhage
  • Brain tumours
38
Q

What are the three main principals of general meningitis treatment?

A
  • Supportive treatment
  • Treatment of infection (or other underlying cause)
  • Treat complications
39
Q

How is viral meningitis managed?

A

Supportive therapy with analgesia, nutritional support, hydration and oxygenation

40
Q

When can specific management be given in viral meningitis?

A

When the causative organism is known

41
Q

What antiviral can be used in herpetic meningitis?

A

Aciclovir

42
Q

When is aciclovir effective in treating herpetic meningitis?

A

If given early in the course of the infection

43
Q

When should IV aciclovir be given if evidence of herpes simplex encephalitis?

A

Immediately

44
Q

What can be given in CMV meningitis?

A

Ganciclovir

45
Q

Why is close monitoring required for patients on ganciclovir?

A

It has significant renal toxicity

46
Q

What specific management is given in enterovirus meningitis?

A

None - it is usually self limiting

47
Q

What should be done if a patient is suspected to have bacterial meningitis in primary care?

A

Rapid transfer to secondary care (999)

48
Q

What should patients in primary care with suspected meningitis be given before transfer if there is a non-blanching rash?

A

IM or IV benzylpenicllin

49
Q

What makes up secondary care management of bacterial meningitis?

A

Supportive treatment and antibiotic therapy

50
Q

How should immediate antibiotic therapy in bacterial meningitis be determined?

A

Empirical antibiotics

51
Q

Once immediate antibiotic therapy for bacterial meningitis has been started how can changes to the antibiotic of choice be guided?

A

By microbiological diagnosis

52
Q

What is usually the empirical antibiotic of choice in bacterial meningitis?

A

IV ceftriaxone

53
Q

What is the antibiotic of choice for proven meningococcal meningitis?

A

IV ceftriaxone for at least 7 days

54
Q

What is usually the antibiotic of choice for proven pneumococcal meningitis?

A

Vancomycin and 3rd-gen cephalosporin (e.g. ceftriaxone or cefataxime)

55
Q

What is the antibiotic of choice for proven H. influenzae type B meningitis?

A

IV ceftriaxone for 10 days

56
Q

What is the antibiotic of choice for proven GBS meningitis?

A

IV cefotaxime for at least 14 days

57
Q

What is the antibiotic of choice for proven Listeriosis meningitis?

A

IV amoxicillin or ampicillin for 21 days + gentamicin for at least first 7 days

58
Q

If a case of bacterial meningitis is confirmed in secondary care what must be done by primary care?

A

Involvement in identifying contacts who are at risk

59
Q

What should be given to contacts who are at risk of bacterial meningitis?

A

Prophylactic antibiotics

60
Q

Should antibiotics be given to contacts who are not at risk of bacterial meningitis?

A

No, reassure only

61
Q

When should prophylaxis be considered (i.e when is a contact at risk) in contacts of a patient with bacterial meningitis?

A

In people who had prolonged close contact with the case in a house-hold type setting during 7 days before onset of illness

62
Q

In what time frame should prophylactic antibiotics be given for bacterial meningitis?

A

ASAP and within 24 hours of diagnosis of the index case

63
Q

Why is bacterial meningitis important from a public health perspective?

A

It is a notifiable disease in England and Wales

64
Q

What vaccinations are available to protect against causes of meningitis?

A
  • Meningitis B
  • 6-in-1 vaccines
  • Pneumococcal vaccine
  • Hib/MenC vaccine
  • MMR vaccine
  • Men ACWY
65
Q

What does the Men B vaccine protect against?

A

Meningococcal group B

66
Q

When is the Men B vaccine and its boosters given?

A
  • 8 weeks
  • 16 weeks
  • 1 year
67
Q

What does the 6-in-1 vaccine contain protection against?

A

Haemophilus influenzae type B

68
Q

When is the 6-in-1 vaccine given?

A
  • 8 weeks
  • 12 weeks
  • 16 weeks
69
Q

When is the pneumococcal vaccine given?

A
  • 8 weeks
  • 16 weeks
  • 1 year
70
Q

What does the Hib/MenC vaccine protect against

A

Haemophilus influenzae type B and Menigococcal group C

71
Q

When is the Hib/MenC vaccine given?

A

1 year

72
Q

What does the MMR vaccine protect against?

A

Measles, mumps and rubella

73
Q

Why is the MMR vaccine relevant in preventing meningitis?

A

It is sometimes a complication of measles, mumps or rubella

74
Q

When is the MMR vaccine given?

A
  • 1 year

- 3 years and 4 months

75
Q

What does Men ACWY protect against?

A

Meningococcal groups ACWY

76
Q

When is the Men ACWY vaccine given?

A

To teenagers and first time university students

77
Q

What are the early complications of meningitis?

A
  • Septic shock
  • Septic arthritis
  • Pericardial effusion
  • Haemolytic anaemia
  • Subdural effusion
  • SIADH
  • Seizures
78
Q

What can result from septic shock caused by meningitis?

A
  • DIC
  • Coma
  • Cerebral oedema
  • Raised ICP
79
Q

What are the delayed complications of meningitis?

A
  • Hearing impairment
  • Cranial nerve dysfunction
  • Multiple seizures
  • Focal paralysis
  • Subdural effusions
  • Hydrocephalus
  • Intellectual deficits
  • Ataxia
  • Blindness

A - MSRA Neuro and Stroke [12] (33 decks)

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