6.1 Bacterial Meningitis

Question 1

How does organism get to meninges?

Answer 1

Nasopharyngeal
Bloodstream
CNS

Question 2

When do you get meningitis?

Answer 2

Once level of bacteraemia crosses a certain threshold

Question 3

What causes colonised bugs in nasopharyx to go into blood stream?

Answer 3

Recent URTI
Smoking
Crowding

Question 4

What promotes proliferation of bacteria in blood stream?

Answer 4

Capsular polysaccharide

Hides from the immune system

Question 5

Why does bacterial meningitis kill you?

Answer 5

Endothelial cell damage: thrombosis, cerebral oedema.

Breakdown of BBB = increase ICP = decreased cerebral blood flow

Question 6

What organisms in neonate cause meningitis?

Answer 6

Group B strep
Ecoli

Strep faecalis
Listeria

Question 7

What organisms cause meningitis in older child?

Answer 7

HiB
Strep pneumonia
Neisseria meningitidis

Question 8

Mening serotypes?

Answer 8

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

Question 9

Strep pneumo under microscope?

Answer 9

Gram + diplococci

Question 10

What Hib examination findings for meningitis?

Answer 10

Orbital cellulitis
Facial purple cellulitis
Purpura

Question 11

What does a toxic child look like?

Answer 11

Alertness/arousal/activity
Breathing difficulty
Colour - pallor
Drowsiness/less fluids

Question 12

Be careful, meningitis can present with?

Answer 12

Just diarrhoea and vomiting

Question 13

How to diagnose meningococcal disease?

Answer 13

Skin Scraping
BCs
LP
PCR

Question 14

Contraindications to LP?

Answer 14

Cranial nerve palsies
Papilloedema
Deep coma GCS<8
Herniation
Falling pulse and rising BP
Continuous fitting

Question 15

CSF microscopy in meningitis?

Answer 15

> 1000 polymorphs likely bacteria
<1000 lymphocyte: likely viral
TB: lymphocytes and >1g/L protein
Cerebral malaria: no cells

Question 16

Paediatric pneumococcal meningitis with intermediate resistant use which drugs?

Answer 16

Vanc + cefotaxime

Question 17

Paediatric pneumococcal meningitis with low resistant use which drugs?

Answer 17

Penicillin

Question 18

Abx treatment of meningitis for age 0-6months:

Answer 18

Ampicillin + cefotaxime

Question 19

Abx treatment of meningitis for age >6months?

Answer 19

Cefotaxime

Question 20

Abx treatment of meningitis for pneumococcal or LP not done:

Answer 20

Cefotaxime + Vanc

Question 21

Listeria is inherently resistant to which abx?

Answer 21

Cefotaxime

Question 22

If GP and suspect meningococcal infection what abx in child <1?

Answer 22

300mg benzoyl penicillin IM

Question 23

If GP and suspect meningococcal infection what abx in child age 1-9?

Answer 23

600mg

Question 24

If GP and suspect meningococcal infection what abx in child >9

Answer 24

1200mg benzyl penicillin IM

Question 25

Corticosteroids in bacterial meningitis?

Answer 25

Not mandatory, usually give before Abx, some benefit in Hib. Most clinicians give

Question 26

If suspect meningococcus what to do about household?

Answer 26

Prophylaxis

Rifampicin/ceftriaxone/ciprofloxacin

Question 27

If suspect Hib meningitis what to do about household?

Answer 27

Rifampicin only other kids under 4 ya