Meningitis Flashcards
What is meningitis?
Inflammation of the meninges and the CSF.
What are the bacterial causes of meningitis?
Most common: Neiserria meningitides (meningococcal)
Other: streptococcus pneumonia (pneumococcus)
Group B strep
What is the most common bacteria causing meningitis?
Neiserria meningitides
What is the most common bacteria causing meningitis in neonates?
Group B strep
What type of bacteria is neisseria meningitides?
Gram negative diplococcus
What is meningococcal septicaemia?
Infection of the blood causing subcutaneous haemorrhage and disseminated intravascular coagulation.
What is disseminated intravascular coagulopathy?
Tiny blood clots form in the blood blocking small blood vessels.
This uses up platelets and clotting factors resulting in excess bleeding as the blood can’t clot properly when needed.
What are the main signs of meningitis?
Neck stiffness Fever Vomiting Photophobia Non blanching rash Headache Altered consciousness Seizures
Which cause is the non blanching rash specific to?
Meningococcal septicaemia
What are non specific signs seen in neonates?
Poor feeding Hypotonia Lethargy Hypothermia Bulging fontanelles
When should children get a lumbar puncture?
<1 month - all with fever
1-3 months - fever and unwell
<1 year - unexplained fever and unexplained symptoms
What are 2 practical tests done?
Kernigs
Brudzinski
What is kernigs sign?
Patient lies on back and flexes hips and knees, the knee is straightened out and it causes pain (due to spinal cord being stretched)
What is brudzinski sign?
Patient lies on back and the neck is lifted - positive sign is when the patient unvoluntarily flexes the hip and neck too
What is done in primary care if. bacterial meningitis is suspected?
Injection of benzylpenicillin
What tests are done in the hospital?
Blood culture
Lumbar puncture
What antibiotics are given to treat bacterial meningitis?
> 3 months Ceftriaxone/cefotaxime
+Vancomycin added if suspected penicillin resistance
Add amoxicillin if < 1 month
What steroids are given for bacterial meningitis?
4x daily dexamethasone for 4 days
What is the prophylaxis given for bacterial meningitis?
For anyone with contact 7 days before symptoms appeared.
Single dose ciprofloxacin.
What are the causes of viral meningitis?
Herpes simplex virus
Enterovirus
Varicella zoster virus
How is viral meningitis treated?
Milder illness than bacterial meningitis.
Usually supportive treatment.
Acivlovir - for herpes simplex virus or varicella zoster virus.
What are the lumbar puncture results in bacterial meningitis?
Colour - cloudy
White cell count - high (neutrophils)
Protein - >1.5g/L
What is the lumbar puncture results in viral meningitis?
Colour - clear
Protein - mildly raised or normal
White cell count - >1000 (lymphocytes)
What level does the spinal cord end?
L1-L2
What level is a lumbar puncture performed at?
L3-L4
Which white cells does the body produce more of in bacterial and viral infections?
Bacteria - neutrophils
Virus - lymphocytes
What are the complications of meningitis?
Hearing loss Cerebral palsy Learning difficulties Seizures Epilepsy Memory loss
What is the main cause of meningitis in neonates (<1 month)?
Group B streptococcus
EColi
Listeria
what are the main causes of meningitis in older infants and children?
Streptococcus pneumonia
neiserria meningitidis
Haemophilus influezae type B
When should a lumbar puncture NOT be performed?
within 30 minutes of a seizure
