Bacterial Meningitis

Question 1

What are the 5 main types of bacterial CNS infection?

Answer 1

Abscess formation
Intracranial TB
Bacterial meningitis
Neurosyphilis
Neuroborelliosis

Question 2

List 5 signs found in TB meningitis.

Answer 2

Meningism
Cranial nerve palsies (esp. 3, 4, 6, 9)
Papilloedema
Reduced/loss of consciousness
Focal hemisphere signs

Question 3

Which 4 investigations would you do for TB meningitis?

Answer 3

Lumbar puncture (UNLESS there is raised ICP)
CSF cultures
CT scan of head
Chest x-ray

Question 4

What 4 signs would be seen on a lumbar puncture in TB meningitis?

What 3 signs would be seen on a head CT in TB meningitis?

Answer 4

CSF:

• increased opening pressure
• lymphocytes present
• elevated protein
• reduced glucose

HEAD CT:

• hydrocephalus
• brisk meningeal enhancement
• intracranial tuberculoma

Question 5

Outline the management of TB meningitis. (3)

Answer 5

Antibiotics, including:

• Pyrazinamide
• Isoniazid
• Ethambutol
• Rifampicin

Steroids

Surgical ventricular drainage

Question 6

List 6 clinical features of TB meningitis.

Answer 6

Headache
Low grade fever
Vomiting
Lack of energy
Depression
Confusion
Behavioural changes

Question 7

What is the most common cause of bacterial meningitis?

Answer 7

Streptococcus pneumonia

Question 8

Apart from pneumococcus, list 4 other causes of bacterial meningitis.

Answer 8

Meningococcus (Neisseria meningitides)
Listeria
H. influenzae
Staphylococcus species

Question 9

Describe the symptoms of bacterial meningitis. (7)

Answer 9

Headache
Drowsiness
Fever
Neck stiffness
Reduced consciousness
Cranial nerve palsies (esp. 8)
Focal neurological signs

Question 10

Describe the signs found O/E of bacterial meningitis. (4)

Answer 10

Septicaemia
Non-blanching purpuric rash
Kernig’s sign positive
Brudzinski’s sign positive

Question 11

What investigations would you do for bacterial meningitis?

Answer 11

Blood cultures
CT scan
Lumbar puncture

Question 12

What is the purpose of a CT in bacterial meningitis? (2)

Answer 12

Excludes space occupying lesions

Excludes raised ICP

Question 13

What features might you see on a CSF sample in bacterial meningitis? (5)

What further CSF tests could you do? (3)

Answer 13

Cloudy (due to neutrophils)
Neutrophils
High protein
Reduced glucose

FURTHER TESTS:
Gram staining
CSF cultures
PCR (bacterial DNA)

Question 14

How would you treat bacterial meningitis? (3)

Answer 14

Steroids
IV antibiotics
Prophylaxis

Question 15

What is the empirical antibiotic therapy for bacterial meningitis? (2)

Answer 15

If rash present: IV benzylpenicillin

If no rash present: IV ceftriaxone

Question 16

Which antibiotic would you use for bacterial meningitis caused by pneumococcus?

For how long?

Answer 16

Benzylpenicillin

5-7 days

Question 17

Which antibiotics would you use for bacterial meningitis caused by penicillin resistant pneumococcus?

For how long?

Answer 17

Benzylpenicillin PLUS vancomycin/rifampicin

5-7 days

Question 18

Which antibiotic would you use for bacterial meningitis caused by meningococcus?

For how long?

Answer 18

Ceftriaxone

10-14 days

Question 19

Which antibiotic would you use for bacterial meningitis caused by H. influenzae?

For how long?

Answer 19

Ceftriaxone

10-14 days

Question 20

Which antibiotic would you use for bacterial meningitis caused by listeria?

For how long?

Answer 20

Ampicillin, PLUS gentamicin

21 days

Question 21

What types of prophylaxis can you give for bacterial meningitis? (2)

Give some examples of each.

Answer 21

Chemoprophylaxis, e.g.

• Ciprofloxacin (adults)
• Rifampicin (children)

Vaccine, e.g.

• Hib
• Pneumococcus
• Meningococcus