6.1 Bacterial Meningitis Flashcards
How does organism get to meninges?
Nasopharyngeal
Bloodstream
CNS
When do you get meningitis?
Once level of bacteraemia crosses a certain threshold
What causes colonised bugs in nasopharyx to go into blood stream?
Recent URTI
Smoking
Crowding
What promotes proliferation of bacteria in blood stream?
Capsular polysaccharide
Hides from the immune system
Why does bacterial meningitis kill you?
Endothelial cell damage: thrombosis, cerebral oedema.
Breakdown of BBB = increase ICP = decreased cerebral blood flow
What organisms in neonate cause meningitis?
Group B strep
Ecoli
Strep faecalis
Listeria
What organisms cause meningitis in older child?
HiB
Strep pneumonia
Neisseria meningitidis
Mening serotypes?
A-Africa B- Australia but hard to make vaccine cause polysaccharide looked like brain saccharaide C-most deadly and virulent in aus W-135 - USA Y - USA
Strep pneumo under microscope?
Gram + diplococci
What Hib examination findings for meningitis?
Orbital cellulitis
Facial purple cellulitis
Purpura
What does a toxic child look like?
Alertness/arousal/activity
Breathing difficulty
Colour - pallor
Drowsiness/less fluids
Be careful, meningitis can present with?
Just diarrhoea and vomiting
How to diagnose meningococcal disease?
Skin Scraping
BCs
LP
PCR
Contraindications to LP?
Cranial nerve palsies Papilloedema Deep coma GCS<8 Herniation Falling pulse and rising BP Continuous fitting
CSF microscopy in meningitis?
> 1000 polymorphs likely bacteria
<1000 lymphocyte: likely viral
TB: lymphocytes and >1g/L protein
Cerebral malaria: no cells
Paediatric pneumococcal meningitis with intermediate resistant use which drugs?
Vanc + cefotaxime
Paediatric pneumococcal meningitis with low resistant use which drugs?
Penicillin
Abx treatment of meningitis for age 0-6months:
Ampicillin + cefotaxime
Abx treatment of meningitis for age >6months?
Cefotaxime
Abx treatment of meningitis for pneumococcal or LP not done:
Cefotaxime + Vanc
Listeria is inherently resistant to which abx?
Cefotaxime
If GP and suspect meningococcal infection what abx in child <1?
300mg benzoyl penicillin IM
If GP and suspect meningococcal infection what abx in child age 1-9?
600mg
If GP and suspect meningococcal infection what abx in child >9
1200mg benzyl penicillin IM
Corticosteroids in bacterial meningitis?
Not mandatory, usually give before Abx, some benefit in Hib. Most clinicians give
If suspect meningococcus what to do about household?
Prophylaxis
Rifampicin/ceftriaxone/ciprofloxacin
If suspect Hib meningitis what to do about household?
Rifampicin only other kids under 4 ya
