Meningitis

Question 1

What is meningitis?

Answer 1

Inflammation of the meninges

Question 2

What is the main cause of bacterial meningitis in children?

Answer 2

Neisseria meningitidis (meningococcus)

Question 3

What type of bacteria is Neisseria meningitidis (meningococcus)?

Answer 3

Gram-negative diplococcus bacteria

Question 4

What is an alternative cause of bacterial meningitis in children?

Answer 4

Streptococcus pneumoniae (pneumococcus).

Question 5

What is the most common cause of bacterial meningitis in neonates?

Answer 5

Group B streptococcus (GBS).

Question 6

How does the child become infected by Group B streptococcus (GBS)?

Answer 6

During birth from GBS bacteria that live harmlessly in the mother’s vagina.

Question 7

What is the classic triad of bacterial meningitis?

Answer 7

Fever
Neck stiffness
Photophobia

Question 8

How does bacterial meningitis present?

Answer 8

• Vomiting
• Headache
• Altered consciousness
• Seizures.

Question 9

What is meningococcal septicaemia?

Answer 9

Occurs when the bacteria is infecting the meninges and the cerebrospinal fluid around the brain and spinal cord.

Question 10

What can meningococcal septicaemia present?

Answer 10

Non-blanching rash

Question 11

How can a neonate with meningitis present?

Answer 11

• Hypotonia
• Poor feeding
• Lethargy
• Hypothermia
• Bulging fontanelle.

Question 12

What physical feature can a neonate with meningitis present with?

Answer 12

Bulging fontanelle

Question 13

What is the main investigation for bacterial meningitis?

Answer 13

Lumbar puncture

Question 14

What 2 special tests can you do to look for meningeal irritation?

Answer 14

• Kernig’s test

* Brudzinski’s test

Question 15

What is a positive Brudzinski’s test?

Answer 15

Patient will involuntarily flex their hips and knees.

Question 16

What will a positive Kernig’s test cuase?

Answer 16

Spinal pain or resistance to movement.

Question 17

What is the community management of suspected meningitis and non-blanching rash?

Answer 17

Urgent stat injection (IM or IV) of benzylpenicillin

Then transfer to hospital

Question 18

What would you ideally do in a hospital with a child presenting with suspected meningitis?

Answer 18

Do a lumbar puncture and bloods prior to giving antibiotics

Question 19

What would you send bloods for?

Answer 19

Meningococcal PCR to check for meningococcal disease

Question 20

What antibiotics would you give to a child under 3 months in the hospital?

Answer 20

cefotaxime plus amoxicillin

Question 21

What antibiotics would you give to a child over 3 months in the hospital?

Answer 21

Ceftriaxone

Question 22

What is the main complication of bacterial meningitis?

Answer 22

Hearing loss

Question 23

What should be given to prevent hearing loss?

Answer 23

Dexamethasone

Question 24

What would you find in the CSF of someone with bacterial meningitis?

Answer 24

Cloudy
High protein
Low glucose
Mainly neutrophils

Question 25

What is the most common cause of viral meningitis?

Answer 25

Enterococcus

Question 26

How is viral meningitis diagnosed?

Answer 26

A sample of the CSF from the lumbar puncture should be sent for viral PCR testing.

Question 27

What is usually the management of viral meningitis and why?

Answer 27

usually supportive management as it is less severe than bacterial meningitis

Question 28

What can be used to treat viral meningitis caused by HSV or VZV?

Answer 28

IV acyclovir

Question 29

How would the CSF of viral meningitis appear?

Answer 29

Clear
Normal or slightly raised protein
Normal glucose
High leucocytes

Question 30

What is the post exposure prophylaxis for bacterial meningitis?

Answer 30

Single dose of ciprofloxacin

ideally within 24 hours of diagnosis