Meningitis

Question 1

What is meningitis?

Answer 1

A life threatening inflammation of the meninges.

Question 2

What type of meningitis is more common?

Answer 2

Viral more common than bacterial.

Viral often milder, self-limiting, and mistaken for influenza.

Question 3

Which pathogen is commonly responsible for bacterial meningitis in <3 month olds?

Answer 3

Group B streptococcus

Question 4

Which pathogen is commonly responsible for bacterial meningitis in 3 months-45 year olds?

Answer 4

Neisseria meningitides (gram -ve diplococcus)

Question 5

Which pathogen is commonly responsible for bacterial meningitis in >45 year olds?

Answer 5

Streptococcus pneumonia

Question 6

What is this a presentation of?

Headache, fever, leg pains, cold hands and feet, abnormal skin colour.

Answer 6

Early meningitis

Question 7

What is this a presentation of?
Neck stiffness, photophobia, headache, vomiting, low GCS, confusion, coma, focal CNS signs, petechial rash, purpura, may be septic shock.

Answer 7

Late meningitis

Question 8

What is Kernig’s sign and what condition does it suggest?

Answer 8

1. Hip and knee flexed, pain limits passive extension of knee, +ve if: pain, spinal pain, and involuntary flexion of contralateral hip.
2. Meningitis (can also be subarachnoid haemorrhage)

Question 9

What is Brudzinski’s sign and what condition does it suggest?

Answer 9

1. Neck flexion leads to involuntary hip and knee flexion.

2. Meningitis (or meningism)

Question 10

What are the risk factors for meningitis?

Answer 10

Immunosuppression, skull fractures, crowding (university halls, military barracks, Hajj)

Question 11

How should suspected meningitis be investigated?

Answer 11

1. Raised WCC and CRP
2. Blood cultures
3. LFTs, clotting for DIC
4. LP if no raised ICP

Question 12

What is the management for meningitis in primary care (e.g. GP)?

Answer 12

Urgent 1.2 mg IM Benzylpenicillin if rash present and refer.

Question 13

What are the initial steps of emergency investigation and management of meningitis in secondary care (e.g. A&E)?

Answer 13

1. Blood cultures
2. CT before LP if - seizure, focal neurology, GCS <15, papilloedema
3. LP prior to antibiotics if - no evidence of shock, petechial rash, or raised ICP
4. If septicaemia then fluid resus and IV antibiotics first
5. Otherwise - IV ceftriaxone 2g/12h, add amoxicillin if <3 months/>50 years/immunocompromised
6. LP when stable and not septicaemic

Question 14

What does this LP finding in suspected meningitis suggest?
Appearance: cloudy
Glucose: low (<1/2 plasma)
Protein: high (>1g/L)
White cells: 10-5,000 polymorphs/mm^3

Answer 14

Bacterial meningitis

Question 15

What does this LP finding in suspected meningitis suggest?
Appearance: clear/cloudy
Glucose: 60-80% of plasma glucose
Protein: normal/raised
White cells: 15-1,000 lymphocytes/mm^3

Answer 15

Viral meningitis

Question 16

What does this LP finding in suspected meningitis suggest?
Appearance: slightly cloudy, fibrin web
Glucose: low (<1/2 plasma)
Protein: high (>1g/L)
White cells: 10-1,000 lymphocytes/mm^3

Answer 16

Tuberculous meningitis

Question 17

What is the adjunct management alongside antibiotics in suspected meningitis?

Answer 17

1. Airway support
2. Fluid resuscitation
3. If meningitic - IV dexamethasone 10mg

Question 18

What is the prophylaxis therapy for close contacts to meningitis patients and who else should be notified?

Answer 18

1. 1 dose of oral ciprofloxacin

2. Public Health England (outbreak if 2 or more cases in same setting within 4 weeks)

Question 19

What are the complications of meningitis?

Answer 19

1. Cranial nerve palsies, deafness, limb amputation, memory/cognitive impairment.
2. 5% mortality in meningococcal, 35% for listeria