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R - Infections (Unknown) > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is Meningism?

A

A symptoms complex that can occur in meningitis, subarachnoid haemorrhage, bacteraemia & viral infections including:

  • Headache
  • Photophobia
  • Vomiting
  • Stiff neck (on flexion, lateral is more likely a joint problem)
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2
Q

What are the most common causes of bacterial meningitis?

A

Meningococcus (most common in kids)
Pneumococcus (most common in adults)
Haemophilus Influenzae B

In neonates:

  • E. Coli
  • Group B Strep
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3
Q

What’s the most common causes of viral meningitis?

A 
Mumps
HSV
Enteroviruses
- Echovirus
- Coxsackie A & B
- Parechoviruses
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4
Q

What organisms do meningitis in people with ventricular shunts?

A

Most often Coagulase -ve Staph e.g. Staph Epidermidis

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5
Q

What can cause non-infective meningitis? aka Aseptic Meningitis

A

Tumour cells
Drugs
Sarcoid
SLE

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6
Q

What are the common symptoms of meningitis?

A 
Vomiting
Headache
Stiff Neck
Fever
Photophobia
Lethargy
Clouded Consciousness
Rashes

Tachy/bradycardic

Shock
DIC
Renal Failure

Sometimes Cranial nerve palsies

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7
Q

How does the timeline indicate a specific cause?

A

Acute (<24hrs) rapidly progressive is most likely meningococcal

Subacute (onsets over 1-7days) may be viral, bacterial or fungal

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8
Q

Risk factors for meningitis?

A

Recent Skull Trauma
Alcoholism
DM

Exposure

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9
Q

What physical signs do we test for in meningitis?

A
  • Neck stiffness by passively flexing chin to chest

- Kernig’s sign (can’t straighten leg due to hamstring spasm)

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10
Q

What tests to do if you suspect meningitis?

A
  • Blood culture
  • LP

FBC

  • Neutrophylic leucocytosis in bacterial
  • Leucopenia in advanced infection
  • Thrombocytopenia in DIC
  • Abnormal clotting & increased FDPs

U&Es
LFTs

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11
Q

What tests are run on CSF from an LP?

A
  • GLucose (vs serum level)
  • Protein
  • Gram stain
    (ZN maybe)
  • Diff cell count
  • Antigen detection
  • Culture
  • PCR
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12
Q

Describe the appearance of Bacterial CSF?

A
  • Turbid
  • Greatly increased cells
  • Neutrophil dominant
  • Low Glc
  • Greatly increased protein
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13
Q

Describe viral CSF?

A 
Clear or turbid
Moderately high cells
Lymphocyte dominant
Normal Glc
Moderately high protein
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14
Q

Describe Fungal CSF?

A 
Clear to Turbid
Moderately high cells
Lymphocyte/mixed dominant
Low Glc
Greatly increased protein
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15
Q

Describe normal CSF?

A

Clear
Low cell no.
Lymphocyte dominant
60% of blood glc

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16
Q

Where does bacterial meningitis usually start?

A

The Nasopharynx

17
Q

What therapy is used for Bacterial Meningitis?

A

IV Benzylpenicillin or Ceftriaxone

Dexamethasone

Supportive Therapy

In adults give ciprofloxacin or Rifampicin on discharge to eradicate from nasopharynx

18
Q

What are the bad prognostic factors in bacterial meningitis?

A
  • Delay in Abx
  • Extremes of age
  • Purpuric lesions
  • Shock
  • Hyperpyrexia
  • DIC
  • Acidosis
  • No leucocytosis
19
Q

What do we do prophylactically with meningococcus?

A

Rifampicin or ciprofloxacin in close contacts

20
Q

What sets pneumococcal presentation apart from other bacteria?

A

Takes 1-2 days versus rapid onset of meningococcus

more likely to have focal neuro signs and alt consciousness

Often comes with skull fractures or sinus/ear infection

21
Q

Who is at highest risk of TB meningitis?

A

In the uk elderly men or alcoholics

22
Q

How do we spot TB meningitis?

A

Meningism, low fever and other TB

Subacute/slower onset

23
Q

How is a viral meningitis likely to present?

A

Non-specific prodrome

Then rapid development of meningism

24
Q

What else should we test for in viral meningitisis?

A

HIV

25
Q

How do we treat viral meningitis?

A

Supportive
IF crhonic –> IV immunoglobulin

If HSV –> IV Aciclovir

26
Q

Who gets Cryptococcal Meningitis?

A

Mostly HIV sufferers
but sometimes DM, lymphoma and immunosuppressed patients

IT comes from pigeon droppings

27
Q

How do you diagnose fungal meningitis?

A
  • Gram staining & India Ink

CSF & Serum Cryptococcal Polysaccharide Antigen

Culture

28
Q

How does fungal meningitis present?

A

Subacute onset of non-specific symptoms incl fever, headache, nausea, lethargy, confusion & abdo pain

Meningism is less common

29
Q

How do we treat and prevent cryptococcal meningitis?

A

IV Amphotericin +/- flucytosine

Long term Fluconazole for HIV patients after an episode as 2* prophylaxis

30
Q

Predisopising factors in a neonate?

A
  • LBW
  • Prolonged rupture of membranes
  • Maternal DM
31
Q

How does neonatal meningitis present?

A

Type 1 - Early onset

  • Within 3 days birth
  • Resp distress, bacteraemia & meningitis
  • From mum’s genital tract
  • 50% mortality

Late Onset:

  • > 1wk after
  • Bacteraemia & meningitis without resp involvement
  • got by cross infection
  • 10-20% mortality
32
Q

How do you treat a baby with meningitis?

A

IV Ampicillin = group B strep & Listeria
IV Gentamicin or cefotaxime = gram negative bacilli (E.coli)

IVIG for enteroviruses or parechoviruses

33
Q

How do you prevent meninigitis in neonates?

A

High risk mum’s get amoxicillin or co-amoxiclav during labour:

  • Pre-term
  • Prolonged labour
  • H/o
  • Intrapartum fever

In enterovirus or parechovirus meningitis we cohort, use hygiene and ~ IVIG for close contacts

34
Q

Potential side effects of meningitis include?

A

Deafness

Orchitis & testicular atrophy in mumps

Death

Cranial nerve deficits

Hydrocephalus

Seizures

Hemiparesis

R - Infections (Unknown) (16 decks)

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