Meningitis Flashcards
What are the most common causes of bacterial meningitis in adults and children? What is the most common cause in neonates?
Meningococcus
Streptococcus pneumoniae
Group B streptococcus (GBS)
-GBS present harmlessly in mother’s vagina so neonate can contract during birth
What is meningococcal septicaemia and what is the characteristic sign in someone with the infection?
Meningococcus infection of bloodstream
Cause “non-blanching rash”= due to infection causing DIC and subcutaneous haemorrhage
What are the typical symptoms associated with meningitis? How does this change for neonates and babies?
Children/adults:
- fever
- neck stiffness
- vomiting
- headache
- photophobia
- seizures
- altered consciousness
- potentially non-blanching rash
Neonates + babies:
- hypotonia “floppy baby”
- poor feeding
- lethargy
- hypothermia
- bulging fontanelle
What special tests can be performed when meningitis suspected?
Kernig’s test
- flex hip and knee at 90 degrees
- straighten knee and keep hip flexed to stretch the meninges = produces spinal pain
Brudzinski’s test:
- patient on back and lift head and neck
- +ve= causes patient to flex hips and knees
How can you investigate what type of meningitis person has? What results would you expect to see for each?
Lumbar puncture Bacterial ‣ Cloudy ‣ High protein content ‣ Low glucose ‣ High neutrophils ‣ Positive bacteria culture Viral ‣ Clear ‣ Mild raised or normal protein ‣ Normal glucose ‣ High lymphocytes ‣ Negative bacteria culture
‣ Negative bacteria culture TB ‣ A little cloudy ‣ High protein ‣ Low glucose ‣ High macrophages and high lymphocytes = differentiates from bacterial • T-lymphocytes important for fighting TB
How is bacterial meningitis managed in the community?
Meningococcal septicaemia and bacterial meningitis are medical emergencies
Need stat injection of benzylpenicillin before transfer to hospital
How is bacterial meningitis managed in hospital?
Blood culture and CSF sample taken
-used to determine the correct type of antibiotics to give
Meningococcal PCR if meningococcal disease suspected
DEX + BROAD SPECTRUM ABX
<3months= cefotaxime + amoxicillin
>3months= ceftriaxone
Dexamethasone (steroids) also give to decrease severity and frequency of hearing loss associated with meningitis= decreases cerebral swelling
What should those exposed to patient with meningococcal infection be managed?
Prophylactic single dose ciprofloxacin
What are the causes of viral meningitis? How is the cause diagnosed and what are the treatment options?
Herpes simples virus (HSV)
Enterovirus
Varicella zoster virus (VZV)
viral PCR of CSF sample
Supportive treatment
Aciclovir in confirmed HSV meningitis
What are the possible complications associated with meningitis if untreated?
Hearing loss
Seizures + epilepsy
Cognitive impairment or learning disability
Memory loss
Focal neurological deficit= limb weakness/spasticity
You do a lumbar puncture for suspected meningitis to determine the cause. It comes back with a low glucose and high protein? What are the possibilities and how do you differentiate?
Bacterial or TB
Need to look at which WC are raised:
- Bacterial= neutrophilia
- TB= T lymphocytes
You do a lumbar puncture for a suspected meningitis and find that there is lymphocytosis. What are the options and how would you differentiate?
Viral or TB
Can look at appearance and glucose
Viral= clear + normal glucose
TB= slightly cloudy + low glucose
How would you treat meningitis TB? How does this differ to other types of TB?
RIPE
- Rifampicin
- Isoniazid
- Pyrizinamide
- Ethambutol
Needs to be a 1 year treatment regime rather than usual 6 month due to TB meningitis meaning the TB infection originates from CNS
