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Lucy Knox - Year 2 > 221 - Meningitis > Flashcards

221 - Meningitis Flashcards

1
Q

What is meningitis?

A

Inflammatory disease of leptomeninges - the tissues surrounding the brain and spinal cord (arachnoid mater, CSF)

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2
Q

What is the mortality of meningitis?

A

100% if untreated (bacterial)
Bacterial - 10%
Viral - fewer complications

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3
Q

If there is a CNS infection of the parenchyma, what is it called?

A

Encephalitis

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4
Q

List some risk factors for meningitis

A 
Under 5 or over 60
Diabetes
Renal/adrenal insufficiency
Cystic fibrosis, sickle cell
immunosuppression, HIV
Crowding
Splenectomy
Alcoholism
Dural defect
IV drug abuse
Malignancy
Bacterial endocarditis
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5
Q

What are the 2 patterns of the course meningitis runs

A

Progressive - ober a few days, deteriorate more steadily

Acute/Fulminant - Rapid decline over hours, signs of sepsis

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6
Q

Which causative agents are most common if <3 months

A 
Group B Strep (40%)
G –ve bacilli (14%)
S. pneum (14%)
N. mening (12%)
E. coli (neonates)
Listeria monocytogenes (neonates)
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7
Q

Which causative agents are most common if 3 months to 3 years?

A

S pneum (45%)
N mening (34%)
Group β strep (11%)
G –ve bacilli (9%)

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8
Q

Which causative agents are most common if 3 - 10 years old?

A 
S pneum (47%)
N mening (32%)
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9
Q

Which causative agents are most common if 10-19 years old?

A

N mening (55%)

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10
Q

What key things should be considered in a history of ? meningitis?

A

Lethargy? Confusion?

Birth history - hydrocephalus?
PMH - immunocompromised? risk factors?
DH - Recent antibiotics? Full course?
Immunisations
FH - anyone else?
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11
Q

How much fluid should you give a child in shock/sepsis?

A

20mls/kg - 1/4 circulating vol

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12
Q

What are the key signs of meningism?

A

Neck stiffness
Photophobia
Headache

+ Vomiting
+ fever

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13
Q

What added signs may you see in a baby with ? meningitis?

A

Bulging fontanel

High pitched screaming cry

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14
Q

What two signs can be elicited to show meningism?

A

Kernigs sign - lie down with hip flexed at 90 degrees, flex knee - pain?
Brudzinski’s sign - lie down, lift neck, knees bend up too

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15
Q

What investigations would you do in ? meningitis?

A
  • FBC - WCC can be high or low, Neutropoenia - bad sign
  • Culture
  • Capillary blood gas (less painful)
  • CRP (increased in bacterial)
  • U&Es
  • BM (low sugar can cause confusion)
  • Lumbar puncture
  • Full neuro exam
  • meningococcal PCR (more sensitive)
  • Throat swab (old fashioned)
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16
Q

What should normal CSF look like from a lumbar puncture?

A

Gin clear

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17
Q

What would make you hold off doing a lumbar puncture?

A

Reduced GCS - confusion sign of raised ICP
Papilloedema
High Bp

  • If high ICP and you do a lumbar puncture - causes you to cone - fatal
18
Q

If a child with ? meningitis comes into your GP, what do you do?

A

Call 999
Give IM pennicillin
Give supportive care - paracetamol
Communicate - warn A+E peads

19
Q

What signs of shock can you look for in a child ?

A

Slow cap refil
Low Bp (children keep this high until very late)
High HR
Urine output - should be 1ml/kg/hour

20
Q

What is the aim of meddication in meningitis?

A

Erradicate infection
Reduce morbidity
Prevent complications

21
Q

What medication would you give to:

- Neonate with meningitis?

A

Ampicillin + an aminoglycoside or Cephalosporin

22
Q

What medication would you give to:

- <3 month old with meningitis?

A

Ampicillin + Cephalosporin (Ceftriaxone/Cefotaxime)

23
Q

What medication would you give to:

- 3 years + with meningitis?

A

Cephalosporin (ceftriaxone/cefotaxime)

24
Q

What is the thinking re: giving or not giving steroids with antibiotics in meningitis?

A

Reduce inflammation but uncertain

If given with 1st antibiotics - ? reduced hearing loss/long term neuro effect

25
When is a rash seen in meningitis?
When it develops into mengiococcal Septicaemia
26
What does an aseptic meningitis mean?
The CSF is sterile - usually viral
27
What types of bacteria are likely causes of meningitis int he elderly?
S. pneumonia | Listeria monocytogenes
28
What is the usual source of meningitis infection?
Via the blood stream | can be due to local extension, direct implantation + via the peripheral NS eg. rabies
29
What are the key CSF findings in bacterial meningitis?
``` Cloudy High polymorphs High neutrophils High protein Low glucose Gram stain +ve ```
30
What are the complications of meningitis (esp. bacterial)
``` Severe sepsis + death Cerebral oedema Cerebra thrombophlebitis Permenant neuro complications - eg. hearing impairment Abcess Subdural empyema Obstructive hydrocephalus ```
31
What are likely viral causative agents of meningitis?
enteroviruses (85%): Coxsachie, Echo, polio-virus - most in summer Mumps, measles Herpes virus (HPV + varicella) HIV
32
What are the key CSF findings in viral meningitis?
CSF - Clear Slightly high protein Normal glucose High lymphocytes
33
What are the possible routes of entry of a CNS infection?
Direct implantation - trauma, iatrogenic, congenital lack of Blood-brain-barrier) Local extension of established infection - sinuses, teeth, ear infection Peripheral NS - Rabies, herpes, shingles.. Rare Blood - via capillaries in the parenchyma or at choroid plexus - must cross BMEC - Brain microvascular endothelial cells
34
Where is it easier for an infection to cross the BMEC?
At the choroid plexus - capillaries have fenestrations - increased permiablility - weaker tight junctions + weaker electrical resistance - increased transcellular flux - easier for infection to cross into brain
35
What cell type surrounds the endothelium of capillaries in the brain parenchyma BMEC? What makes it harder for infection to cross?
- Astrocyte cells - foot wraps around it - Endothelum has strong tight junctions - Less paracellular flux - Slow rate of fluid phase endocytosis - less transcellular flux
36
Overall what is the most common bacterial cause of meningitis?
Neisseria meningitidis
37
What type of bacteria does the Men C and Men B vaccine act against?
Neisseria Meningitidis
38
What does the PCV13 and PPV23 vaccine act against in meningitis?
Strains of Streptococcus Pneumoniae
39
What does the Hib vaccine vaccinate against?
Haemophilis Influenzae B
40
How much protection does BCG vaccine give against meningitis?
75% protection
41
What causes fungal meningitis? What are the symptoms?
Cryptococcus neoformans Gradual onset In pts with impaired cellular immunity India ink stain +ve
42
What is the most common cause of encaphalitis?
HSV - Herpes simplex virus 70% mortality if untreated Extensive asymmetric necrosis of temporal lobes

Lucy Knox - Year 2 (17 decks)

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