Meningitis Flashcards
Define meningitis
Inflammation of the meninges (lining of brain and spinal cord) usually due to bacterial or viral infection
Aetiology of bacterial meningitis
Streptococcus pneumoniae (pneumococcus)
Neisseria meningitidis ( meningococcus)
Haemophilus influenzae
Listeria monocytogenes (often patients in extremes of age)
Aetiology of viral meningitis
HSV, enterovirus and VZV most common
Non-infective causes of meningitis
Autoimmune disease
Malignancy (leukaemia, lymphoma, other tumours)
Drugs (NSAIDs, trimethoprim)
Clinical features of meningitis
Headache
Fever
Neck stiffness
Photophobia
Nausea and vomiting
Focal neurology
Seizures
Reduced conscious level
Non-blanching rash (meningococcal septicaemia)
Clinical features of meningitis in neonates
Non-specific signs and symptoms
Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
Investigations in meningitis
Blood tests (inc. meningococcal PCR)
ABG
Blood cultures
CT head
LP
What are LP samples sent for in meningitis?
Bacterial culture
Viral PCR
Cell count
Protein
Glucose (paired with blood)
Protein and glucose content of CSF in bacterial meningitis
High protein and low glucose
Bacteria in CSF will release proteins and use up the glucose
Protein and glucose content of CSF in viral meningitis
Mildly raised/normal protein and normal glucose
Viruses don’t use glucose but may release a small amount of protein
Acute management of bacterial meningitis
2g IV ceftriaxone twice daily
Plus IV amoxicillin in young/old patients to better cover listeria
Plus IV aciclovir if viral encephalitis suspected
If penicillin allergic cloramphenicol may be used
Post-exposure prophylaxis in meningitis
Risk highest for people that have had close prolonged contact within 7 days prior to the onset of the illness
Usual choice is single dose of ciprofloxacin
Complications of meningitis
Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Cerebral palsy
Death
