Infection- Meningitis

Question 1

what is it?

Answer 1

inflammation on meninges, which line brain and spinal cord

Question 2

Most common organisms

• adults
• neonates

Answer 2

Bacterial

• adults
  
  • strep pneumoniae (pneumococcus)
  • neisseria meningitidis (meningoccous)
• neonates
  
  • Group B Strep - aquired via childbirth through passage via vagina where they often reside without causing any harm

Viral

• HSV
• Enterovirus
• VZV

Question 3

Presentation?

Answer 3

Adults

• fever, neck stiffness, photophobia
• seizures, headache, reduced consciousness, vomiting

Kids

• non-specific, lethargy, hypotonia
• bulging fontanelles
• non-blanching petechial rash in meningococcal septicaemia

Question 4

what 2 special tests can you do?

Answer 4

• Kernig’s sign
  
  • patient supine, hip & knees flexed, extend leg passively. If leg extension causes pain= positive test
• Brudzinski’s sign
  
  • passive forward flexion of neck causes pt to involuntarily raise knees or hips in flexion= positive

Question 5

Ix?

Answer 5

• In ALL kids <1 year old presenting with unexplained fever–> LP
• Bloods- FBC, U&E, Coagulation screen
• Blood culture
• meningococcal PCR if suspected
• LP
  
  • bacterial culture, viral PCR, cell count, glucose, protein
  • send blood glucose sample to lab at same time to compare with CSF sample

Question 6

Outline the results for viral and bacterial LP

Answer 6

Question 7

What are contra-indications to doing an LP?

Answer 7

CT scan before doing LP if:

• signs of raised ICP
• petechial rash

as may cause uncal herniation

Question 8

Mx?

Answer 8

Bacterial

• empirical abx therapy
• Dexamethasone IV for 4 days

Viral- anti-viral

Kids

• Community: If symptoms of meningitis plus non-petechial rash: stat dose IM/IV BenPen
• Hospital:
  
  • <3 months: Cefotaxime + Amoxicillin
  • > 3months (including adults): Ceftriaxone

+ Vancomycin if suspected penicillin resistant pneumococcus

Aciclovir if HSV

Question 9

When is Post-exposure Prophylaxis given?

Answer 9

In the case of meningococcal infection, in people who have had close prolonged contact in 7 days prior to disease onset

Give one-off dose of Ciprofloxacin

Question 10

Complications?

Answer 10

• hearing loss- key complication
• memory loss
• cognitive impairment
• focal neurological deficit
• seizures & epilepsy