Meningitis Flashcards
What are the predominant causative agents in meningitis?
- Streptococcus pneumoniae
- Neisseria meningitides
- Haemophilus influenzae type b (Hib)
What has helped decrease the cases of meningitis?
- Hib vaccine has helped decreases cases
- Pneumococcal vaccine also helpful in older people
What is common epid of meningitis?
mostly >60 as impaired or waning immunity
What are social RF for meningitis?
- Age
- Crowding: e.g. college, military
- Exposure to others with it
- Immunocompromised ppl
What are medical RF for meningitis?
- Cranial anatomical defects, ventriculoperitoneal shunt
- Cochlear implants
- Sickle cell disease
- Contiguous infection
- Genetic predisposition
What are common symptoms of meningitis?
- Headache
- Neck stiffness
- Fever
- Altered mental status
- Vomiting
- Confusion
- Photophobia
- Seizures
What are the two signs in meningitis?
- Brudzinski’s signs
2. Kernig sign
What is Brudzinski’s sign?
- Passive flexion of neck
- Elicits hip and knee flexion to avoid pain
What is Kernig sign?
- Knee flexed to 90 degrees
- Hip if flexed to 90 degrees
- Extension of the knee is painful or limited in extension
Why is Kernig painful?
- lie child on back, flex knee to right angle to body and completely extend leg at knee joint
- causes stretching of meninges leading to pain which positive sign
What is possible DDx for meningitis?
- Encephalitis
- Viral meningitis
- Drug-induced menigitis
- TB meningitis
- Fungal meningitis
- Malaria
How can you tell the difference between viral and bacterial meningitis in CF?
For Viral:
- CSF pressure normal
- CSF glucose normal
- CSF protein high
- Bacterial culture negative
- Procalcitonin is usually normal
What is the most important test in meningitis?
lumbar puncture
How quickly do you need to do an LP?
Within 1 hour
What bloods do you do in meningitis?
- Blood culture
- Serum pneumococcal and meningcoccal OCR
- Blood glucose
- FBC and differential
- U+Es and electrolytes
- VBG
- LFTs
- Coagulation screen
- Serum HIV
- Serum procalcitonin
How quickly should you do a blood culture?
Within 1 hour
What may the FBC with differential show in meningitis?
- leucocytosis
2, anaemia - thrombocytopenia
What would shock show up as in a VBG?
lactate >4mmol/L
What would a coagulation screen in meningitis show?
sometimes DIC
What do you look for in the CSF analysis?
- Protein
- Glucose
- Lactate
- Microscopy, gram stain, culture, snesitivities
- Cell count
- PCR for pneumoccocus
What would the protein in CSF be like in BM?
elevated 0.5g/L
What would a lactate be like in BM?
> 35mg/dL suggests bacterial rather than viral
What would glucose be like in BM CSF?
<2.5mmol/L in BM
What may show up of metabolic screen for BM?
bacterial meningitis often have metabolic abnormalities
What is the management plan for BM if below 3yo?
IV cefotaxime + amoxicillin
What is the management plan for BM ages 3-50?
IV ceftotaxime
What is the management plant for BM >50?
IV cefotaxime + amoxicillin
What is the management plan for Meningococcal meningitis?
IV benzylpenicillin or ceftotaxime
What is the management plan for Pneumococcal meningitis
IV cefotaxime
What is the management plan of Meningitis caused by haemophilus influenzae?
IV cefotaxime