Meningitis Flashcards
Four clinical features of meningitis
headache neck stiffness photophobia Reduced GCS seizures if septic- fever, hypotension purpuric rash
Which bacteria causes meningococcal disease?
Neisseria meningiditis
What are the two main features of meningococcal disease?
meningitis and sepsis
Which two signs are positive in meningitis?
Kernig’s: Straightening leg c¯ hip @ 90 degrees
Brudzinski’s: lifting head → lifting of legs
What would confusion indicate in someone with meningitis?
encephalitis
Which bacteria would you worry about in someone with meningitis who has a rash (purpuric=/petechiae)
meningococcal disease, therefore N. mengiditis
Name the three main types of bacteria and their class that cause meningitis
- strep pneumoniae- gram positive diplococci 2. N. meningitidis- gram negative diplococci 3. Listeria monoctyogenes- gram positive rod
What bacteria causes pneumococcal disease?
strep pneumoniae
Three risk factors for developing bacterial meningitis
- Travel from countries with resistant strains 2. Implantable hearing disease- pneumoccocal 3. Alcohol excess- pneumococcal disease 4. IV drug use- staph and strep meningitis 5. Strep suis 6. Tuberculosis
Two signs of pneumococcal meningitis?
neurological focal signs e.g. weakness, seizures, VII palsy, hearing loss.
How does pneumococcal meninigitis presentation differ from other causes of meningitis?
neurological signs
Two indications for CT before performing lumbar puncture?
If GCS <12, CNS signs, seizure, immunocompromised. papilloedema
Three contraindications for LP?
Coagulation disorder Focal neuro signs Thrombocytopaenia ICP signs Haemodynamically unstable
In which meningococcal disease should you treat with steroids?
pneumococcal
Abx for bacterial meningitis?
ceftriaxone
Abx for listeria?
amoxicillin
How to distinguish between viral and bacterial meningitis in CSF?
Bacterial- high WBC with neutrophil polymorph predominance, high protein, low glucose. Viral- high WBC with lymphocyte predominance, slightly raised protein and normal glucose
Triad of meningitis?
fever, nuchal rigidity, altered mental state
Name five cases in which you would do a CT for bacterial meningitis?
older age immunocompromised, LOC, low GCS, neurological signs, seizures, hx of CNS disease
Two complications of meningitis?
hearing loss, seizures, memory loss, focal neurological deficits
Two examples of antibiotics for bacterial meningitis, state route of admin
IV benzyl penicillin
IV chloramphenicol
IM cefotaxime
Suggest four tests to confirm microbiology in meningitis
Blood cultures – blood for Gram stain/culture
Throat swab
Lumbar puncture/CSF – for Gram, culture, PCR
Skin scrape from purpuric lesion
Meningococcal PCR
Acute and convalescent meningococcal antibody titres
