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Z Year3 Neuro Conditions > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What are the predominant causative agents in meningitis?

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitides
  3. Haemophilus influenzae type b (Hib)
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2
Q

What has helped decrease the cases of meningitis?

A
  • Hib vaccine has helped decreases cases

- Pneumococcal vaccine also helpful in older people

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3
Q

What is common epid of meningitis?

A

mostly >60 as impaired or waning immunity

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4
Q

What are social RF for meningitis?

A
  1. Age
  2. Crowding: e.g. college, military
  3. Exposure to others with it
  4. Immunocompromised ppl
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5
Q

What are medical RF for meningitis?

A
  1. Cranial anatomical defects, ventriculoperitoneal shunt
  2. Cochlear implants
  3. Sickle cell disease
  4. Contiguous infection
  5. Genetic predisposition
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6
Q

What are common symptoms of meningitis?

A
  1. Headache
  2. Neck stiffness
  3. Fever
  4. Altered mental status
  5. Vomiting
  6. Confusion
  7. Photophobia
  8. Seizures
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7
Q

What are the two signs in meningitis?

A
  1. Brudzinski’s signs

2. Kernig sign

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8
Q

What is Brudzinski’s sign?

A
  • Passive flexion of neck

- Elicits hip and knee flexion to avoid pain

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9
Q

What is Kernig sign?

A
  1. Knee flexed to 90 degrees
  2. Hip if flexed to 90 degrees
  3. Extension of the knee is painful or limited in extension
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10
Q

Why is Kernig painful?

A
  • 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
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11
Q

What is possible DDx for meningitis?

A
  1. Encephalitis
  2. Viral meningitis
  3. Drug-induced menigitis
  4. TB meningitis
  5. Fungal meningitis
  6. Malaria
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12
Q

How can you tell the difference between viral and bacterial meningitis in CF?

A

For Viral:

  1. CSF pressure normal
  2. CSF glucose normal
  3. CSF protein high
  4. Bacterial culture negative
  5. Procalcitonin is usually normal
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13
Q

What is the most important test in meningitis?

A

lumbar puncture

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14
Q

How quickly do you need to do an LP?

A

Within 1 hour

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15
Q

What bloods do you do in meningitis?

A
  1. Blood culture
  2. Serum pneumococcal and meningcoccal OCR
  3. Blood glucose
  4. FBC and differential
  5. U+Es and electrolytes
  6. VBG
  7. LFTs
  8. Coagulation screen
  9. Serum HIV
  10. Serum procalcitonin
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16
Q

How quickly should you do a blood culture?

A

Within 1 hour

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17
Q

What may the FBC with differential show in meningitis?

A
  1. leucocytosis
    2, anaemia
  2. thrombocytopenia
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18
Q

What would shock show up as in a VBG?

A

lactate >4mmol/L

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19
Q

What would a coagulation screen in meningitis show?

A

sometimes DIC

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20
Q

What do you look for in the CSF analysis?

A
  1. Protein
  2. Glucose
  3. Lactate
  4. Microscopy, gram stain, culture, snesitivities
  5. Cell count
  6. PCR for pneumoccocus
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21
Q

What would the protein in CSF be like in BM?

A

elevated 0.5g/L

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22
Q

What would a lactate be like in BM?

A

> 35mg/dL suggests bacterial rather than viral

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23
Q

What would glucose be like in BM CSF?

A

<2.5mmol/L in BM

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24
Q

What may show up of metabolic screen for BM?

A

bacterial meningitis often have metabolic abnormalities

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25
Q

What is the management plan for BM if below 3yo?

A

IV cefotaxime + amoxicillin

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26
Q

What is the management plan for BM ages 3-50?

A

IV ceftotaxime

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27
Q

What is the management plant for BM >50?

A

IV cefotaxime + amoxicillin

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28
Q

What is the management plan for Meningococcal meningitis?

A

IV benzylpenicillin or ceftotaxime

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29
Q

What is the management plan for Pneumococcal meningitis

A

IV cefotaxime

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30
Q

What is the management plan of Meningitis caused by haemophilus influenzae?

A

IV cefotaxime

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31
Q

What is the management plan of Meningitis caused by listeria?

A

IV amoxicillin + gentamicin

32
Q

What is the general management of meningitis?

A
  1. Empirical antibiotics and supportive care and corticosteroid: dexamethasone 10mg/6h IV
  2. When know pathogen give specific antibiotics
  3. Presume bacterial until proven viral: then stop and supportive care (if ongoing viral consider antiviral therapy)
33
Q

What are possible complications of meningitis?

A
  1. Shock
  2. Elevated ICP
  3. Hydrocephalus
  4. Seizures
  5. Subdural effusion
  6. Hearing loss
  7. Septic DVT
34
Q

What is the mortality rate of BM?

A
  • Community acquire BM: 20% and 30% for pneumococcal meningitis
  • Mortality increases with age
35
Q

What are LT effects of meningitis?

A

1/3 of adults with BM may have cognitive impairement

36
Q

What are the properties (colour, predominant cell, cell count, glucose and protein) of BM CSF?

A
  1. Turbid
  2. Polymorphs (predominant cell)
  3. Cell count 90-1000 or more
  4. <1/2 plasma glucose
  5. > 1.5 protein
  6. Bacteria in smear and culture
37
Q

What are the properties (colour, predominant cell, cell count, glucose and protein) of TB CSF?

A
  1. Fibrin web
  2. Mononuclear predominant cell
  3. 10-1000 cell count
  4. <1/2 plasma glucose
  5. 1-5 protein
  6. Often no bacteria in smear
38
Q

What are the properties (colour, predominant cell, cell count, glucose and protein) of Viral CSF?

A
  1. Clear
  2. Monocular predominant cell
  3. 50-1000 cell count
  4. > 1/2 plasma
  5. <1 protein
  6. No bacteria seen or cultured
39
Q

What layers does meningitis affect?

A

infection that affects the leptomeninges – the arachnoid and pia layer of the brain

40
Q

What are two way in which pathogens can infect the leptomeninges?

A
  1. direct spread

2. haematogenous spread

41
Q

What is direct spread for meningitis?

A
  1. Pathogens can enter either through overlying skin,

2. p through the nose or through an anatomical defect (such as spina bifida or skull fracture)

42
Q

What is haematogeous spread for meningitis?

A
  1. when pathogens enters the bloodstream and moves through the endothelial cells in the blood vessels that make up the blood-brain barrier
  2. pathogen spreads in the CSF and white blood cells enter, release cytokines and recruit even more white blood cells
43
Q

What bacteria usually causes meningitis in neonates?

44
Q

What bacteria usually causes meningitis in childrens?

A
  1. H. influenze

2. strep. Pneumoniae

45
Q

What bacteria usually causes meningitis in teenagers/young adults?

A

Neisseria meningitidis

46
Q

What bacteria usually causes meningitis in elderly?

A
  1. strep. Pneumoniae

2. Listeria monocytogenes

47
Q

What viruses commonly cause meningitis?

A
  • Enteroviruses
  • HSV
  • VZV
  • HIV
    OR TB OR FUNGAL
48
Q

What can neisseria mengitides cause?

A

meningococcal disease which can be very SEVERE

49
Q

How can meningococcal disease present?

A
  1. rapid onset fever and malaise progressing rapidly to signs and symptoms of sepsis and/or meningitis
  2. non-blanching rash should make you worried about meningococcal disease
50
Q

What is the skin rash in meningitis called?

A

petechial or purpuric rash is typically associated with meningococcal meningitis

51
Q

If you suspect meningitis at GP what do you give?

A

benzylpenicillin IM & URGENT REFERAL TO THE HOSPITAL

52
Q

What broad spectrum antibtioics may be given initally?

A
  1. ceftriaxone IV
  2. benzylpenicillin IM
  3. acyclovir if viral
53
Q

What does dexamethasone do?

A

to be reduce cerebral oedema

54
Q

What investigation is done firast?

A
  1. CT head: if reduced conciousness or neurological deficet

2. If neither of those lumbar puncture first

55
Q

What are the common bacterial causes of meningitis?

A
  1. Neisseria meningitidis

2. Streptococcous penumoniae

56
Q

What sort of bacteria is NM?

A
  1. Gram negative

2. Diplocci

57
Q

What sort of bacteria is streptococcus pneumoniae?

A
  1. Gram positive

2. (usually di-) Cocci

58
Q

What are other bacterial causes of meningitis?

A
  1. Haemophilus influenzae type B: gram negative rod/coccobacilli
  2. Listeria: gram +ve
  3. E. coli
  4. Group B strep.
59
Q

What are viral causes of meningitis?

A
  1. Cocksackie virus
  2. Herpes virus (HSV2 > HSV1 )
  3. Enteroviruses
  4. Measles
  5. Mumps
60
Q

What are other causes of meningitis?

A
  1. Borrelia Burgdorferi (causes Lyme disease)
  2. Tuberculosis mycobacterium
  3. Fungi (immunocompromised)
61
Q

What conditions can cause meningitis?

A
  1. Otitis media
  2. Sinusitis
  3. CSF leak after head trauma or neurosurgery
  4. Maternal group B streptococcal infection during birth
  5. Sepsis
62
Q

What are the causative organisms in neonates?

A
  1. Group B streptococcus
  2. E.coli
  3. Listeria monocytogenes
63
Q

What are RF for meningitis in neonates?

A
  1. Extended labour, infection in previous pregnancy

2. Late neonatal infection

64
Q

What are RF for children and teenagers for meningitis?

A
  1. Gram -ve diplococci

2. Unvaccinated

65
Q

What are the causative organisms of meningitis in the children and teenagers?

A
  1. Neisseria meningitides

2. Haemophilus infeluzae

66
Q

What are RF for meningitis in adults and elderly?

A
  1. Gram +ve cocci

2. Elderly, cheese/unpasturied milk, alcoholics

67
Q

What are the causative organisms in meningitis for adults and elderly?

A
  1. Streptococcus pneumoniae

2. Listeria monocyogenes

68
Q

What is the meningial triad?

A
  1. Headache
  2. Photophobia
  3. Neck stiffness
69
Q

What is the rash like?

A

non-blanching

70
Q

When should you avoid LP?

A
  • Neurological signs suggesting raised ICP
  • Superficial infection over LP site
  • Coagulopathy
71
Q

Do you give antibiotics or do an LP first?

A

If patient is stable and no LP contraindications, then perform LP ASAP before starting empiric antibiotics

72
Q

What antibiotics are used in bacteria meningitis?

A

IV Ceftriaxone (3rd generation cephalosporin)

73
Q

What other medications can be given in bacterial meningitis?

A
  1. Consider corticosteroids – Dexamethasone for bacterial meningitis BUT not if meningococcal septicaemia is suspected
    (cover Listeria with ampicillin)
  2. If consciousness affected, consider IV acyclovir to cover encephalitis
  3. Prophylaxis to close contacts: Rifampicin or ciprofloxacin
74
Q

When is amoxicillin used?

A

Listeria (As cephalosporins are ineffective against Listeria species)

75
Q

What is meropenem?

A

extended spectrum beta lactamase

76
Q

What is bacterial meningitis and meningococcal disease?

A

notifiable diseases

Z Year3 Neuro Conditions (34 decks)

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