ID - Meningitis

Question 1

What type of bacteria is Neisseria meningitidis?

Answer 1

Gram-negative diplococcus

Commonly known as meningococcus

Question 2

What causes a non-blanching rash?

Answer 2

Meningococcal sepsis that has caused disseminated intravascular coagulopathy and subcutaneous haemorrhages

Question 3

What is meningococcal meningitis?

Answer 3

Bacteria infects meninges and CSF around brain and spinal cord

Question 4

What are the most common causes of bacterial meningitis in children and adults?

Answer 4

Neisseria meningitidis
Streptococcus pneumoniae

Question 5

What is the most common cause of bacterial meningitis in neonates?

Answer 5

Group B streptococcus

Question 6

How is Group B strep usually contracted in neonates?

Answer 6

During birth

GBS usually live harmlessly in the vagina

Question 7

How does meningitis present?

Answer 7

Neck stiffness
Photophobia
Altered consciousness
Seizures
Fever
Vomiting
Headache

Question 8

How does meningitis present in neonates and babies?

Answer 8

Non-specific signs and symptoms
- Hypotonia
- Poor feeding
- Lethargy
- Hypothermia
- Bulging fontanelle

Question 9

When is an LP recommended for children?

Answer 9

• Under 1 month with fever
• 1-3 months with fever and unwell
• Under 1 with unexplained fever and other features of serious illness

Question 10

What are the two special tests for meningitis in children and what do they involve??

Answer 10

Kernig’s test
- Lay patient on back
- Flex one hip and knee to 90 degrees then straighten knee while hip flexed at 90 degrees
- Creates slight meninges stretch causing pain or resistance to movement

Brudzinski’s test
- Lay patient on back
- Gently lift head and neck and flex chin to chest
- Patient will involuntarily flex hips and knees

Question 11

How is bacterial meningitis or meningococcal sepsis managed in the community?

Answer 11

If suspected meningitis and non-blanching rash

Urgent IM Benzylpenicillin prior to hospital transfer

If penicillin allergy, transfer should be prioritised over alternative

Question 12

How is bacterial meningitis or meningococcal sepsis managed in hospital?

Answer 12

Ideally blood culture and LP performed before antibiotics

If patient acutely unwell do not delay antibiotics

Meningococcal PCR, tests directly for meningococcal DNA

Low threshold for treatment particularly in babies and young kids

Under 3 months
Cefotaxime + amoxicillin (covers listeria contracted in pregnancy)

Over 3 months
Ceftriaxone

Question 13

When should vancomycin be added to antibiotic treatment for meningitis?

Answer 13

Risk of penicillin resistant pneumococcal infection e.g. recent foreign travel or prolonged antibiotic use

Question 14

Why are steroids also used in bacterial meningitis?

Answer 14

Reduce frequency and severity of hearing loss and neurological damage

Dexamethasone given 4 times daily for 4 days to children over 3 months if LP suggests bacterial meningitis

Question 15

What must be done with all bacterial meningitis and meningococcal infections?

Answer 15

Notifiable disease

Public health must be informed

Question 16

When is risk of transmission highest for meningococcal infections?

Answer 16

Close prolonged contact within 7 days prior to illness onset

Risk decreases 7 days after exposure, if no symptoms, unlikely to develop illness

Question 17

What post exposure prophylaxis is used for meningococcal infections?

Answer 17

Single dose of ciprofloxacin

Given as soon as possible and within 24 hours of initial diagnosis

Question 18

What are the most common causes of viral meningitis?

Answer 18

Herpes simplex virus
Enterovirus
Varicella zoster virus

CSF sample should be sent for viral PCR testing

Question 19

How is viral meningitis tested?

Answer 19

Tends to milder than bacterial and usually only needs supportive treatment

Aciclovir can be used to treat suspected HSV or VZV

Question 20

Where is an LP inserted?

Answer 20

L3-L4 as spine ends at L2

Use the Iliac crest as a guide

Question 21

What layers are passed through in an LP?

Answer 21

SSS ILE DAS

Skin
Subcutaneous fat
Supraspinous ligament

Intraspinous ligament
Ligamentum flavum
Epidural space

Dura mata
Arachnoid mata
Subarachnoid space

Question 22

What is CSF tested for?

Answer 22

Bacterial culture
Viral PCR
Cell count
Protein
Glucose

Question 23

What should be sent at the same time to be compared to CSF?

Answer 23

Blood glucose

Question 24

Fill in the table

Answer 24

Viruses don’t use glucose but bacteria will use it and release proteins

Question 25

What are the key complications of meningitis?

Answer 25

Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Cerebral palsy with focal neurological deficits e.g. limb weakness or spasticity