Infections - Clinical management of meningitis

Question 1

Bacterial meningitis:

Answer 1

infection of surface of the brain (meninged) by bacteria&raquo_space; inflammation. Infecting bacteria usually travelled there from another mucosal surface via patients blood stream.

Question 2

most common infecting bacteria

Answer 2

meningococcus
pneumococcus
haemophilus

Question 3

who can meningitis effect a lot?

Answer 3

babies and young children

Question 4

transmission of meningitis;

Answer 4

aerosol droplets or direct contact with secretions from upper respiratory tract > frequent or prolonged close contact

Question 5

risk factors of meningitis

Answer 5

smoking
immunocompromised state
incomplete immunisation status
PMHx
Contiguous infections
livinh in crowded households
patient age
winter months
incomplete immunisation status

Question 6

complications

Answer 6

death

cerebral infarct stroke

neurological complications

physical complications

Question 7

symptoms?

Answer 7

fever, nausea/vomiting, lethargy, headache, muscle pain, difficulty breathing, unsettled behaviour, refusing food/ drink

less common;
childs/ shivering

specific symptoms
non-blanching rash
stiff neck
cold hands
hypotension
photophobia
back rigidity

Question 8

symptoms in adults

Answer 8

fever, cold hands and feet
vomiting
confusion and irritability
pale blotchy skin
stiff neck
convulsions/ seizues
severe headache
dislike bright lights
drowsy

Question 9

symptoms in children?

Answer 9

fever, cold hands and feet
refusing food and vomiting, fretful, dislike being handled
rapid breathing
usual vcry, moaning
stiff enck
refusing food and vomiting
drowsy, floppy, unresponsive
pale, blotchy skin. spots/ rash
tense, bulging fontanelle
convulsions/ seizures

Question 10

Diagnosis

Answer 10

thorough history;
another type of meningitis
cancer
encephalitis
HIV infection
haemorrhage

physical examination
temp/HR/BP/conscious level

Photosensitivity + non-blanching rash

Diagnostic tests
lumbar puncture - take a sample of spinal fluid

Ct scan of head - identoify other causes

Blood tests- bacteria via from bloodstream to brain, take blood cultures
FBC - elevated White cells

Question 11

treatment of meningitis:

Answer 11

1. Patient age
2. allergies
3. presence of risk factors; pregnancy, immuno-comprimised, active cancer, diabetes or alcohol misuse
4. risk of penicillin resistant bacteria - recent travel (in last 6 months) where penicillin resistance pneumococci is prevelant

Question 12

what would you use for treatment for meningitis no pen allergy?

Answer 12

cetriaxone (IV)

Question 13

what would you use for treatment for meningitis with pen allergy?

Answer 13

chloramphenicol (IV)

Question 14

if penicillin resistance suspected? what to ADD?

Answer 14

vancomyocin (IV) or Rifampicin (IV)

Question 15

if viral enephalitis suspected, ADD?

Answer 15

aciclovir (IV)

Question 16

treating OVER the age of 60?

Answer 16

DUAL ANTIBACTERIAL:

no pen allergy
cetriaxone (IV) + amoxicillin (IV)

pen allergy
chloramphenicol (IV) + co-trimoxazole (IV)