Meningitis

Question 1

What is meningitis?

Answer 1

Meningitis is the infection of the meninges

Question 2

List the three layers of meninges

Answer 2

Pia mater - the innermost layer.
Arachnoid mater - the middle layer.
Dura mater - the outermost layer.

Question 3

What causes the symptoms experienced by a patient suffering from meningitis?

Answer 3

inflammation of the meninges will result in pressure of the brain, as the area is protected by the skull. This pressure is associated with many of the symptoms experienced by the patient.

Question 4

List the causes of meningitis

Answer 4

Bacterial cause
Viral cause
Fungal cause

Question 5

The bacterial cause of meningitis

Answer 5

Bacterial meningitis is a severe, complicated infection.  It is associated with organisms such as:
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Mycobacterium tuberculosis

Question 6

Viral cause of Meningitis

Answer 6

Although less severe, viral meningitis is more common than bacterial meningitis. It is associated with viruses such as:
• Herpes Simplex Virus
• Mumps Virus
• Varicella Zoster Virus

Question 7

Fungal cause of Meningitis

Answer 7

Although rare and mostly associated with immunocompromised patients, we cannot rule out fungal meningitis. Fungal meningitis is associated with fungi such as:
• Candida albicans
• Cryptococcus neoformans
• Histoplasma

Question 8

List the symptoms of meningitis in babies and toddlers

Answer 8

1. fever, cold hands and feets
2. refusing food
3. vomiting
4. pale, blotchy skin
5. fretful. disliked when handled
6. floppy, listless, unresponsive
7. drowsy, difficult to wake
8. spots/rash
9. rapid breathing and grunting
10. Unusual crying /moaning

Question 9

symptoms of meningitis in children and adult

Answer 9

1. stomach cramps and diarrhoea
2. spots/rash
3. severe headache
4. stiff neck
5. dislike bright light
6. severe muscle pain
7. confusion and irritability
8. drowsy, difficulty to wake
9. vomiting
10. fever, cold and feet

Question 10

What samples are collected to aid in the diagnosis of Meningitis

Answer 10

To aid the diagnosis of the patient, a blood and cerebral spinal fluid (CSF) sample were collected for analysis (Microbiology and Blood Science analysis).

Question 11

Treatment of Meningitis with no known aetiology and also in hospital

Answer 11

Cefotaxime or ceftriaxone

Question 12

other treatments

Answer 12

Dexamethasone (IV) can also be administered within 12 hours of starting antibacterial to reduce:
Rate of hearing loss
Other neurological problems
This has been found to reduce mortality in patients with Streptococcus pneumoniae meningitis. However has no effect on mortality in patients with Haemophilus influenzae and Neisseria meningitidis meningitis.

Dexamethasone can increase the rate of recurrent fever but it has no other adverse events.
Dexamethasone should also be avoided in septic shock, meningococcal meningitis, immunocompromised and meningitis following surgery.

Question 13

Prophylaxis of meningitis

Answer 13

The risk of close contacts, to the patient, contracting the infection is low with meningococcal disease.
The risk is highest in the first 7 days after a case is diagnosed and falls sharply thereafter.
Chemoprophylaxis offered to close contacts of cases, irrespective of vaccination status:
To those who have had prolonged close contact with the case in a household type setting during the seven days before onset of illness (people who are living or sleeping in the same household, pupils in the same dormitory, boy/girlfriends, or university students sharing a kitchen in a hall of residence).
To those how have had contact with a case but only if they have been directly exposed to large particle droplets/secretions from the respiratory tract of a case around the time of admission to hospital

Question 14

When should prophylaxis antibiotics be given ?

Answer 14

Antibiotic prophylaxis should be given ASAP (ideally within 24 hours) after the diagnosis of the primary case.
The rationale of giving antimicrobial treatment to close personal contacts is to:
Eradicate carriage from established carriers who pose a risk of infection to others.
Eradicate carriage in those who have newly acquired the invasive strain and who may themselves be at risk.

Question 15

Prophylaxis choices are as follows:

Answer 15

Ciprofloxacin 500mg stat (adults)
Rifampicin 600mg 12 hourly for two days (adults)
Ceftriaxone 250mg stat IM (unlicensed indication)

Question 16

Many healthcare professionals prefer to prescribe ciprofloxacin due to:

Answer 16

Single dose.
Does not affect hormonal contraceptives.
Doesn’t colour tears, sputum and urine.
It is more readily available in community pharmacies.

Question 17

Follow up after discharge

Answer 17

Patients suffering from bacterial meningitis or meningococcal disease will require specialist follow up. The is due to possible late-onset complications including:

Sensory complications
Neurological complications
Orthopaedic complications
Psychosocial complications
Even if an adult has made an uncomplicated recovery, they may experience headache and fatigue for some time after the acute illness.
Patients suffering from meningitis will need to complete the Driver and Vehicle Licensing Agency document. This will assess their fitness to drive. The document also provides a guide for medical professionals for recommendations on driving restrictions after recovery.