Case 29: Meningitis in a 3 year old unvaccinated boy

Question 1

What are the symptoms for meningitis in an infant?

Answer 1

Lethargy

Irritability

Photophobia

Fever

Anorexia

Question 2

What drug should children with suspected bacterial meningitis be commenced on immediately?

Answer 2

I.V. Cefotaxime

Question 3

What will the appearance of CSF be in bacterial meningitis?

Answer 3

Turbid

Question 4

What will glucose, protein and leucocyte levels be in bacterial meningitis?

Answer 4

Leucocytes: High

Glucose: low

Protein: high

Question 5

What is the Gram stain result for H. influenzae?

Answer 5

Gram negative bacilli - pleomorphic

Question 6

Why isn’t there a slide agglutination test for N. meningitidis?

Answer 6

Because N. meningitidis has a scialic acid capsule

Question 7

What is the result of H. influenzae growth on HBA?

Answer 7

No growth

Question 8

What is the result of H. influenzae growth on HBA with X and V factors?

Answer 8

Small white round colonies

Question 9

What is the requirement for X and V factors by H. influenzae?

Answer 9

Requires both X and V together

Question 10

Will H. influenzae grow on CHA?

Answer 10

Yes

Question 11

Which 3 factors suggest that H. influenzae is the likely pathogen?

Answer 11

Gram -ve

Latex agglutination positive

Growth on CHA

Question 12

Which 3 bacteria commonly cause meningitis in this age group (around 3 years old)

Answer 12

H. influenzae

N. meningitidis

Strep. pneumoniae

Question 13

What is the inherent limitation of a Gram stain?

Answer 13

Not very sensitive, requires 5-10 organisms/ml

Question 14

Which 2 antimicrobials is H. influenzae susceptible to?

Answer 14

Ceftriaxone

Chloramphenicol

Question 15

Is H. influenzae susceptible to Ampicillin?

Answer 15

No

Question 16

When would Chloramphenicol be used to treat H. influenzae instead of Ceftriaxone?

Answer 16

If the patient was penicillin hypersensitive

Question 17

How could meningitis caused by H. influenzae been avoided in this child?

Answer 17

Vaccination – HiB vaccine

99.5 – 100% efficacy

Question 18

With regard to administration of cefotaxime, is this appropriate treatment for suspected bacterial meningitis?

Answer 18

Yes

3rd generation cephalosporins have broad spectrum

Good penetration across BBB