Meningitis (1*)

Question 1

Bacterial Meningitis:
In children, what are the most common causes?

In neonates, what’s the most common cause?
→ How is this usually contracted?

Answer 1

➊ Neisseria Meningitidis (aka Meningococcus) and Strep Pneumoniae (aka Pneumococcus)

➋ Group B Strep (GBS)
→ During birth from floral GBS living in the vagina

Question 2

How does it present?

Answer 2

• Neck stiffness
• Headache
• Photophobia
• Fever
• Vomiting
• Non-blanching rash – Occurs in Meningococcal Septicaemia
‣ Due to the infection causing DIC and Subcutaneous haemorrhaging
• In babies, symptoms can be very non-specific – Poor feeding, Lethargy, Bulging fontanelle, Hypotonia, Hypothermia

Question 3

Which investigations should be done?

Answer 3

• Kernig’s or Brudzinski’s tests – Done to stretch the meninges and cause resistance to movement
• LP
• Blood and CSF culture
• Meningococcal PCR if suspected

Question 4

How is it managed?

Answer 4

• Community – Benzylpenicillin before hospital admission
• Hospital
‣ < 3 months – Cefotaxime + Amoxicillin
‣ > 3 months – Ceftriaxone
• Steroids e.g. Dexamethasone – Reduces risk of hearing loss

Question 5

Viral Meningitis:
What are the common causes?

How is it managed?

Answer 5

➊ HSV, Enterovirus, VZV

➋ • Supportive management often all that’s needed
• Aciclovir can be used if suspected/confirmed HSV/VZV

Question 6

What are the key complications of meningitis?

How does the CSF in bacterial differ from viral?

Answer 6

➊ * Hearing loss – key one to remember
* Seizures and epilepsy
* LD
* Cerebral palsy

➋ * Bacterial - Cloudy, High protein, Low glucose, High neutrophils
* Viral - Clear, Mildly raised/normal protein, Normal glucose, High lymphocytes

N.B. Glucose is typically low as bacteria uses it up as an energy source. Protein is raised due to bacterial/viral replication.

N.B. TB CSF is very similar to viral CSF, but with a slightly decreased glucose i.e. mixed picture.