Bacteria Meningitis

Question 1

Meningitis

Answer 1

Meningitis
Chapter 18: Infectious Diseases and Infestations
y Sulphadoxine-Pyrimethamine, oral, And
This is an infection of the coverings of the brain, and is most commonly caused by bacteria, viruses, fungi and protozoa. One type, Cerebrospinal Meningitis (CSM), caused by Neisseria meningitides, is common in the Northern and Upper Regions of Ghana, and usually occurs in epidemics during the harmattan season. The presentation may sometimes be confused with cerebral malaria. Meningitis is a medical emergency. Failure to recognise and adequately manage meningitis results in serious complications.
Inform regional or district health authorities immediately in epidemic meningitis.

Question 2

Causes

Answer 2

Causes
y Bacterial
y Neisseria meningitides
y Streptococcus pneumoniae y Haemophilus influenza
y Mycobacterium tuberculosis y Staphylococcus aureus
y Escherichia coli (neonates)
y Viruses e.g. Herpes viruses
y Protozoa e.g. Toxoplasma in HIV-AIDS y Fungi e.g. Cryptococcus neoformans

Question 3

Signs and symptoms

Answer 3

Symptoms
For Adults and Children > 5 years y Fever
y Neck pains
y Severe headaches
y Photophobia
y Change in behaviour
y Convulsions
y Vomiting
Children < 1 year
y Fever
y Irritability
y Refusal to eat
y Poor sucking
y Vomiting
y Drowsiness and weak cry

y Focal or generalized convulsions after which the child is sleepy y Lethargy
y Bulging fontanelle
Signs
For Adults and Children > 5 years
y Fever
y Neck stiffness
y Positive Kernig’s sign
y Altered consciousness
y Coma
Children < 1 year
y Neck retraction
y Presence or absence of neck stiffness y Presence or absence of fever
y Bulging fontanelle
y Coma
y Hypotonia or hypertonia
y Convulsion

Question 4

Investigations

Answer 4

Investigations
y FBC
y Rapid diagnostic test (to exclude cerebral malaria)
y Blood film for malarial parasites (to exclude cerebral malaria)
y Lumbar puncture (only after excluding raised intracranial pressure) y Blood culture and sensitivity

Question 5

Treatment

Answer 5

STG page 496

Role of steroids: Dexamethasone started together with the first dose of the ap- propriate antibiotic has been found to lead to major reduction in hearing loss and death in both children and adults.

Question 6

Referral Criteria

Answer 6

Referral Criteria
Refer all patients not responding to treatment within the first 48 hours for specialist care.

Question 7

Summary of treatment options for Bacterial Meningitis

Answer 7

STG page 499