Condition- Meningitis Flashcards
What is Meningitis?
Inflammation of the meninges
List two common causes of meningitis in neonates
- E. Coli
- Group B step
State the main cause of bacterial meningitis in children
H. Influenza
List two of the main pathogens causing bacterial meningitis in adults and teens
Neisserie Meningitis
Strep Pneumonia
List two main pathogens causing meningitis in the elderly
- Strep pneumonia- patients go home after pneumonia and come back with meningitis infection
- Listeria
What is the two most common bacteria causing bacterial meningitis?
- Pneumococcus (Streptococcus pneumoniae)
- Meningococcus (Neisseria meningitidis)
Which subgroup of the population is more at risk of Meningitis caused by Listeria?
Patients on immunosuppressive therapy
Elderly
Alcohol Abusers
Diabetics
- List some viral causes of meningitis…
- List a fungal cause
VIRAL:
- Enterovirus
- Mumps
- HSV-2 (HSV-1 more common in encephalitis)
- VZV
- HIV
FUNGAL:
- Cryptococcus
List some risk factors for developing meningitis…
- Close communities (college halls)
- Exposure to pathogens
Then think about immunocompromised portion of the population:
- For bacterial <5 yrs and >60yrs
- Immunosupressed
- Non-immunised infants
- HIV/AIDs
- Asplenic/ hyposplenic
- Cranial anatomic defects
- Recent infection: sinusitis, inner ear infection, mastoiditis (spreads to meninges)
Describe some of the symptoms of Meningitis…
- Headaches: severe, acute
- Meningismus (triad): Neck stiffness, photophobia, Kernig’s sign
- Fever
- Vomiting
- Photophobia/ phonophobia
- Non-blanching purpuric rash
- Altered mental state
- Seizures
- Reduced consciousness
- INFANTS: irritabilty, not feeding, apnoea
When taking a history of a patient with meningitis it is important you record their travel history and exposure to the following….
- Rodents
- Ticks (lyme borrelia, rocky mountain spotted fever)
- Mosquitoes (west nile virus)
- Sexual Activity (HSV-2, HIV, syphilis)
List some of the signs of Meningitis on physical examination…
Signs of MENINGISMUS
- Photophobia
- Neck stiffness
- Kernig’s test positive
- Brudzinski’s sign positive
General signs of INFECTION:
- Pyrexia
- Tachycardia
- Hypotension
- Pupurea rash
- Altered mental state => decreased GCS and MMSA
Describe what Kernig’s sign and Brudzinksi’s signs are…
KERNIG’S: Hips flexed, there is pain/resistance on passive knee extension
BRUDZINSKI’S: Flexion of hips when neck is flexed
Which investigations would you order for a patient with suspected Meningitis?
- Bedside: Temperature, BP, HR
- Bloods:
- Routine: FBC (WCC), U+Es, CRP, LFT, glucose, coagulation screens (because you get DIC)
- Special: blood cultures + throat swabs + stool sample
- Imaging: CT before LP if mass lesion or raised ICP suspected (e.g. decreased GCS) or focal neuro deficit
- Lumbar Puncture: serum, WCC, Gram-stain, antigen detection, Culture
List some contraindication for doing an LP/ when would you do a CT scan before doing an LP?
- Raised ICP suspected
- Lowered GCS
- Focal neuro deficit
- Papilloedema
- Inner Ear problems=> loss of balance/ hearing
- Trauma