CNS

Question 1

BACTERIAL MENINGITIS - MANAGEMENT

Answer 1

EMERGENCY
If there are no signs of raised intracranial pressure (this is assessed clinically) :
* perform lumbar puncture (LP) ASAP to obtain CSF specimen –>processed urgently by Microbiology lab
* take blood culture (especially if pyrexial)
* steroids before antibiotics (in bacterial and tuberculous meningitis)
* antibiotics should be started ASAP, sometimes BEFORE CSF is obtained if the LP procedure is delayed
*If meningitis is strongly suspected but there is no growth on culture (antibiotics prior to LP?) -> pathogen detection by PCR may be considered
* CSF white cell count and Gram stain results should be conveyed to medical team ASAP to guide treatment
* CSF should be cultured -> positive culture following incubation -> perform sensitivities to guide
treatment

Question 2

Bacterial meningitis causational pathogens (6)
* ___ meningitidis
* Streptococcus ___
* H___ influenzae:
* Group __ Streptococcus
* E __
* L__ monocytogenes

Answer 2

• Neisseria meningitidis
• Streptococcus pneumoniae (CAP)
• Haemophilus influenzae: ceftriaxone is it bestie antibiotic?
• Group B Streptococcus (neonates): from raw fish
• E coli (neonates)
• Listeria monocytogenes (neonates, pregnant women, immunocompromised):survives at low temp and needs 21 days treatment eg ice cream

Question 3

BACTERIAL MENINGITIS – PREVENTION?

Answer 3

Vaccination against :
* Streptococcus pneumoniae
* Haemophilus influenzae
* Neiserria meningitidis
Household & close contacts -> chemoprophylaxis (medication to prevent illness) given if meningitis caused by :
* Haemophilus influenzae
* Neiserria meningitidis