Meningitis

Question 1

what kind of bacteria is Neisseria meningitidis

Answer 1

gram negative diplococcus

aka meningococcus

Question 2

what is Meningococcal septicaemia

Answer 2

meningococcal bacterial infection in the bloodstream

Question 3

what does the presence of the non-blanching rash in Meningococcal septicaemia indicate?

Answer 3

the infection has caused DIC and s/c haemorrhages

Question 4

most common cause in 0-3 months?

Answer 4

• GBS (most common in neonates)
• strep
• listeria monocytogenes

Question 5

how is GBS usually contracted during birth?

Answer 5

transferred from GBS in mothers vagina

Question 6

most common cause in 3 months - 6 years?

Answer 6

• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae

Question 7

most common cause in 6 years - 60 years?

Answer 7

• N meningitides

- strep pneu

Question 8

most common cause in >60 years?

Answer 8

• Strep pneu
• N meningitides
• Listeria monocytogenes

Question 9

most common cause in immunosuppressed?

Answer 9

listeria monocytogenes

Question 10

2 special tests?

Answer 10

kernigs

brudzinskis

Question 11

management of bacterial meningitis in the community?

Answer 11

IM benzylpencillin and immediate hospital transfer

Question 12

management of bacterial meningitis in the hospital?

Answer 12

ideally blood culture + LP before (if pt acutely unwell, don’t delay antibiotics)

IV Ceftriaxone + Dexamethasone (given with/ just before first dose of Abx)

Question 13

what test should be sent for suspected meningococcal disease?

benefits of this over blood culture?

Answer 13

meningococcal PCR

faster, will still be + after antibiotics

Question 14

prophylaxis against meningococcal infection?

Answer 14

single dose ciprofloxacin

Question 15

Most common cause of viral meningitis?

Answer 15

HSV
Enterovirus
VZV

Question 16

test for suspected viral meningitis?

Answer 16

CSF for viral PCR

Question 17

treatment of viral meningitis?

Answer 17

mainly supportive

aciclovir for HSV meningitis

Question 18

complications of meningitis?

Answer 18

hearing loss
seizures, epilepsy
cognitive impairment and learning disability
memory loss
focal neurological deficits e.g. limb weakness or spasticity

Question 19

CSF, Bacterial meningitis

1) appearance
2) glucose
3) protein
4) WCC
5) opening pressure

Answer 19

1) cloudy
2) low (<1/2 plasma)
3) high
4) increased polymorphs
5) elevated

Question 20

CSF, Viral meningitis

1) appearance
2) glucose
3) protein
4) WCC
5) opening pressure

Answer 20

1) clear/ cloudy
2) normal/ slightly low
3) normal/ high
4) increased lymphocytes
5) normal/ elevated

Question 21

CSF, Tuberculous meningitis

1) appearance
2) glucose
3) protein
4) WCC
5) opening pressure

Answer 21

1) slightly cloudy, fibrin web
2) low (<1/2 plasma)
3) high
4) slightly increased lymphocytes
5) elevated

Question 22

CSF, Fungal meningitis

1) appearance
2) glucose
3) protein
4) WCC
5) opening pressure

Answer 22

1) cloudy
2) low
3) high
4) slightly increased lymphocytes
5) elevated

Question 23

antibiotic choice if history of immediate hypersensitivity reaction to penicillin or to cephalosporins?

Answer 23

chloramphenicol