Infectious Diseases Flashcards
What is meningitis?
Inflammation of the meninges that line the brain and spinal cord, usually due to a bacterial or viral infection.
What is the most common causative organism in bacterial meningitis in children and adults?
Neisseria meningitidis (gram negative diplococcus; circular, occurs in pairs; meningococcus)
Streptococcus pneumoniae (pneumococcus)
What is meningococcus septicaemia and what is it the cause of?
Meningococcus bacterial infection in the blood stream.
Causes the non-blanching rash which indicates that the infection has caused DIC and subcutaneous haemorrhages.
What is meningococcal meningitis?
When the bacteria is infecting the meninges and the CSF around the brain and spinal cord.
What is the most common cause of bacterial meningitis in neonates?
Group B streptococcus (GBS)
Usually contracted during birth from GBS bacteria that live harmlessly in the mother’s vagina.
What causes the non-blanching rash?
Meningococcal septicaemia (other causes of bacterial meningitis does not cause the rash)
How do children typically present with meningitis?
- fever
- neck stiffness
- photophobia
- vomiting
- headache
- altered consciousness
- seizures
- non-blanching rash (meningococcal septicaemia)
How do babies and neonates present with meningitis?
Very non-specific signs and symptoms
- hypotonia
- poor feeding
- lethargy
- hypothermia
- bulging fontanelle
According to NICE, when should a lumbar puncture be included as part of investigations for children?
- <1 month presenting with fever
- 1 to 3 months with fever and unwell
- <1 year with unexplained fever and other features of serious illness
What 2 special tests can be performed to look for meningeal irritation?
1) Kernig’s test
2) Brudzinski’s test
What is Kernig’s test?
- lie patient on their back, flex one hip and knee to 90 degrees
- slowly straighten knee whilst keeping hip flexed at 90 degrees
- this creates a slight stretch in the meninges
- in meningitis it will produce spinal pain or resistance to movement
What is Brudzinski’s test?
- lie patient flat on back
- use hands to gently life their head and neck off the bed and flex their chin to their chest
- positive test for meningitis if causes patient to involuntarily flex their hips and knees
What should children in primary care with suspected meningitis and non-blanching rash be given prior to transfer to hospital?
Urgent stat injection (IM/IV) of benzylpenicillin
Do not delay transfer to hospital however.
What investigations would ideally be done if suspect meningitis?
- blood culture
- lumber puncture (CSF)
Prior to starting abx but do not delay if patient is acutely unwell.
What investigation should be done if meningococcal disease is suspected?
- blood tests for meningococcal PCR which tests directly for meningococcal DNA (quicker result than blood culture and will still be positive after abx)
