Bacterial Meningitis Flashcards
Causes: Neonates
Listeria
Group B Streptococci
E.coli
Causes: Children
H. influenza (type b is most common cause of meningitis in children under 4)
Causes: 10-21
Meningococcal
Causes: >21
Pneumococcal > Meningococcal
Causes: Elderly
Pneumococcal > Listeria
Causes: Cribiform plate fracture
Pneumococcal
Causes: Neurosurgery / open head trauma
Staphylococcus
Gram negative rods
Predisposing condition: Immunocompromised
S. pneumoniae
N.menigitis
Listeria
Predisposing condition: Basilar skull fracture
S. pneumoniae
H.influenzae
Beta-haemolytic strep group A
Predisposing condition: Head trauma or post-neurosugery
S. aureus
S.epidermidis
Predisposing condition: CSF shunts
S. aureus
S.epidermidis
Listeria
Neonatal and >55 years
Immunocompromised (especially malignancy)
Tx: IV Ampicillin / Amoxicillin
Lumbar Puncture Bacterial
Protein high
Glucose less than 70% of blood glucose
Lumbar Puncture Viral
Protein normal or high
Glucose normal
Empirical Antibiotic Therapy
IV Ceftriaxone
Add IV Ampicillin / Amoxicillin if Listeria suspected
Penicillin Allergic Therapy
Chloramphenicol IV + Vancomycin IV
Listeria suspected: Co-Trimoxazole
Steroids
Give to all patients suspected of bacterial meningitis
DO NOT GIVE in post-surgical meningitis, severe immunocompromised, meningococcal shock or septic shock
Contact Prophylaxis
Rifampacin 4 doses 12 hourly
Ciprofloxacin single dose
Ceftriaxone IM single dose
Neonatal Meningitis Causes:
i.e. first 4 weeks
Group B Streptococcus
E.coli
Listeria
Group B Streptococcus Meningitis
Occurs within first few days after birth
Acquired from mother (vaginal colonisation)
Tx: Benzylpenicillin + Gentamicin
E.Coli Meningitis
Tx: Cefotaxime + Gentamicin
Listeria Meningitis
Found in foods (soft cheese, pate)
Transplacental infection (causes stillbirth as well as neonatal sepsis/meningitis)
Tx: Amoxicillin + Gentamicin
