meningitis

Question 1

Meningitis is inflammation of the meninges. The meninges are the lining of the brain and spinal cord. This inflammation is usually due to a bacterial or a viral infection.

most common cause of bacterial

Answer 1

Bacterial meningitis is inflammation of the meninges caused by a bacterial infection. The most common causes of bacterial meningitis in children and adults is Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus).

Question 2

in neonates most common cause of bacterial is

Answer 2

In neonates the most common cause is Group B Streptococcus (GBS). GBS is usually contracted during birth from the GBS bacteria that can often live harmlessly in the mothers vagina.

Question 3

symtoms

and in neonates

Answer 3

fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures. Where there is meningococcal septicaemia children can present with a non-blanching rash

Neonates and babies can present with very non-specific signs and symptoms such as hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.

Question 4

tests to look for meningeal irritation

Answer 4

Kernig’s test involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges and where there is meningitis will produce spinal pain or resistance to this movement.

Brudzinski’s test involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. A positive test is when this causes the patient to involuntarily flex their hips and knees.

Question 5

lumbar puncture what level

Answer 5

L3-4 space

Question 6

CSF 
appearance 
protein 
glucose 
in both bacterial and viral meningitis

Answer 6

bacterial - cloudy, high protein and low glucose

viral - midly clear , may be raised/normal , normal

Question 7

most common cause of viral meningitis

Answer 7

The most common causes of viral meningitis are herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV). A sample of the CSF from the lumbar puncture should be sent for viral PCR testing.

aciclovir

Question 8

if suspected meningitis in community what should be given

Answer 8

benzylpenicillin - IV or IM

< 1 year – 300mg
1-9 years – 600mg
> 10 years and adults – 1200mg

Question 9

in hospital treatment

Answer 9

< 3 months – cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy from the mother)
> 3 months – ceftriaxone

dexamethasone too if bacterial

vancomycin if resistance

Question 10

should public health be notified

Answer 10

yes