Bacterial Meningitis

Question 1

Causes: Neonates

Answer 1

Listeria
Group B Streptococci
E.coli

Question 2

Causes: Children

Answer 2

H. influenza (type b is most common cause of meningitis in children under 4)

Question 3

Causes: 10-21

Answer 3

Meningococcal

Question 4

Causes: >21

Answer 4

Pneumococcal > Meningococcal

Question 5

Causes: Elderly

Answer 5

Pneumococcal > Listeria

Question 6

Causes: Cribiform plate fracture

Answer 6

Pneumococcal

Question 7

Causes: Neurosurgery / open head trauma

Answer 7

Staphylococcus

Gram negative rods

Question 8

Predisposing condition: Immunocompromised

Answer 8

S. pneumoniae
N.menigitis
Listeria

Question 9

Predisposing condition: Basilar skull fracture

Answer 9

S. pneumoniae
H.influenzae
Beta-haemolytic strep group A

Question 10

Predisposing condition: Head trauma or post-neurosugery

Answer 10

S. aureus

S.epidermidis

Question 11

Predisposing condition: CSF shunts

Answer 11

S. aureus

S.epidermidis

Question 12

Listeria

Answer 12

Neonatal and >55 years
Immunocompromised (especially malignancy)
Tx: IV Ampicillin / Amoxicillin

Question 13

Lumbar Puncture Bacterial

Answer 13

Protein high

Glucose less than 70% of blood glucose

Question 14

Lumbar Puncture Viral

Answer 14

Protein normal or high

Glucose normal

Question 15

Empirical Antibiotic Therapy

Answer 15

IV Ceftriaxone

Add IV Ampicillin / Amoxicillin if Listeria suspected

Question 16

Penicillin Allergic Therapy

Answer 16

Chloramphenicol IV + Vancomycin IV

Listeria suspected: Co-Trimoxazole

Question 17

Steroids

Answer 17

Give to all patients suspected of bacterial meningitis

DO NOT GIVE in post-surgical meningitis, severe immunocompromised, meningococcal shock or septic shock

Question 18

Contact Prophylaxis

Answer 18

Rifampacin 4 doses 12 hourly
Ciprofloxacin single dose
Ceftriaxone IM single dose

Question 19

Neonatal Meningitis Causes:

Answer 19

i.e. first 4 weeks
Group B Streptococcus
E.coli
Listeria

Question 20

Group B Streptococcus Meningitis

Answer 20

Occurs within first few days after birth
Acquired from mother (vaginal colonisation)
Tx: Benzylpenicillin + Gentamicin

Question 21

E.Coli Meningitis

Answer 21

Tx: Cefotaxime + Gentamicin

Question 22

Listeria Meningitis

Answer 22

Found in foods (soft cheese, pate)
Transplacental infection (causes stillbirth as well as neonatal sepsis/meningitis)
Tx: Amoxicillin + Gentamicin