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Head and Neck Clinical Correlations > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges of the brain and spinal cord from infectious or non-infectious causes
> Commonly viral or bacterial in origin
> can also be Fungal, parasitic and non-infectious causes

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2
Q

Describe the epidemiology of bacterial meiningitis?

A

incidence in children in Africa is estimated to be as high as 25 cases per 100 000 children
> Incidence decreasing with meningococcal and pneumococcal vaccines
> Acute bacterial meningitis carries a fatality rate of up to 50%

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3
Q

Name the risk factors for meningitis?

A
  1. Otitis media - middle ear infection
  2. Sinusitis - sinus infection
  3. CSF leak after head trauma or neurosurgery
  4. Sepsis
  5. Immunocompromise
    > HIV, heavy alcohol use, old age
  6. Splenectomy
  7. Diabetes mellitus
  8. Sickle cell disease
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4
Q

Name the pathogens that cause bacterial meningitis?

A
  1. Haemophilus influenzae B
  2. Streptococcus pneumoniae
  3. Neiserria meningitidis
  4. Tuberculous meningitis
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5
Q

Which pathogens cause bacterial meningitis in neonates?

A
  1. group B streptococcus
  2. non-typhoidal salmonella
  3. E.coli
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6
Q

Name the pathogen that causes bacterial meningitis in pregnancy?

A

Listeria monocytogenes

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7
Q

Name the pathogens that causes viral meningitis?

A

Enteroviruses
Polioviruses
Coxsackie virus
Echovirus
Arbovirus
Adenovirus
Herpes simplex virus

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8
Q

Name the pathogen that causes fungal meningitis?

A

Cryptococcus neoformans

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9
Q

State the incubation period for the various forms of meningitis?

A
  1. Bacterial – 3 to 7 days
  2. Viral meningitis – 2 to 14 days
  3. TB meningitis – weeks to months
    > Cryptococcal meningitis and TB meningitis are sub-acute meningitides
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10
Q

Describe the pathophysiology of meningitis?

A
  1. colonisation and penetration of nasopharyngeal mucosal membranes by bacteria
  2. survival of bacteria in blood and transportation via circulation
  3. invasion of the central nervous system
  4. multiplication in subarachnoid space
  5. increased permeability of blood brain barrier
  6. transendothelial migration of granulocytes and monocytes
  7. release of cytokines and prostaglandins
  8. leakage of plasma proteins
  9. cerebral edema > increased ICP > impaired circulation
    - Massive host immune response with release of inflammatory cytokines, which result in activated macrophages and invasion with neutrophils, immunoglobulins, and other markers of inflammation.
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11
Q

Describe the clinical presentation in neonates?

A

Lethargy
Irritability
Poor apetite, vomiting
Fever
Bulging fontanelle
Seizures

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12
Q

Describe the clinical presentation of meningitis in children and adults?

A

Classic triad – fever, headache, neck stiffness
> Classic triad is present in only 50% of patients with meningitis
Altered mental status
Photophobia
Nausea and vomiting
Seizures
Cranial nerve palsies
Petechial rash in N.meningitidis

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13
Q

What are you looking for in a physical examination to diagnose meningitis?

A
  1. Signs of meningeal irritation
    – neck stiffness, Kernig’s and Brudzinski sign
  2. Systemic signs of inflammation
    – fever, hypotension, tachycardia
  3. Signs of raised intracranial pressure
    e.g. papilloedema
  4. Signs of underlying infections
    > Inflammed tympanic membrane
    > Petechial rash in N.meningitis
    > Maculopapular rash in viral meningitis
  5. Focal neurological signs
  6. Altered level of consciousness
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14
Q

Describe Brudzinskis neck sign?

A

severe neck stiffness causes a patients hips and knees to flex when the neck is flexed

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15
Q

Describe Kernigs sign?

A

severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed 90 degrees

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16
Q

What tests are done to diagnose meningitis?

A

FBC
Blood culture
Lumbar puncture - appearance and opening pressure
CSF microscopy, culture and sensitivity
Gram stain, india ink
White cell count and differential
Cryptococcal antigen test (CrAg)
Glucose and protein
Viral PCR
PITC
Serum glucose
Hyponatremia from SIADH
CRP
Brain imaging – CT or MRI brain

17
Q

In which instances do you get brain imaging prior to a lumbar puncture?

A
  1. Focal neurological deficits
  2. Papilloedema
  3. Known Stroke, brain tumour
18
Q

Describe normal CSF findings?

A
  1. opening pressure = <20 cm in adults
  2. appearance = clear
  3. cells/mm3 = <5/mm3
  4. glucose = >50% plasma
  5. protein = <0.5gm/L
19
Q

Describe CSF findings in acute bacterial meningitis?

A
  1. opening pressure = increased
  2. appearance = cloudy, purulent
  3. cells = high >2000 mm3 (mainly neutrophils)
  4. glucose = very low, absent <1 mmol/L
  5. protein = elevated 1-2
  6. diagnosis confirmed = Gm stain and culture
20
Q

Describe CSF findings in tuberculous meningitis?

A
  1. opening pressure = increased
  2. appearance = yellow/cloudy
  3. cells = increased 50-5 (mainly lymphocytes)
  4. glucose = low
  5. protein = high/very high 1-5
  6. diagnosis confirmed = ZN stain and culture
21
Q

Describe CSF findings in cryptococcal meningitis?

A
  1. opening pressure = increased
  2. appearance = clear/cloudy
  3. cells = normal/increased 0-100 (mainly lymphocytes)
  4. glucose = normal/low
  5. protein = normal/elevated 0.5-2
  6. diagnosis confirmed = India ink stain, CRAg/culture
22
Q

Describe CSF findings in viral meningitis?

A
  1. opening pressure = normal/increased
  2. appearance = clear (cloudy)
  3. calls = normal/ increased (mainly lymphocytes)
  4. glucose = normal
  5. protein = normal/elevated 0.5-1.0
  6. diagnosis confirmed = PCR/culture
23
Q

Describe treatment for bacterial menigitis?

A
  1. ceftriaxone
  2. cefotaxime
  3. penicillin and chloramphenicol
    > for 10 - 14 days
24
Q

Describe the treatment for tuberculous meningitis?

A
  1. isoniazid
  2. rifampcin
  3. pyrazinamide
  4. ethambutol/streptomycin
  5. dexamethasone/prednisolone
25
Q

Describe the treatment for cryptococcal meningitis?

A
  1. liposomal amphotericin
  2. flucytosine
  3. fluconazole
    > all 3 for 14 days
26
Q

What are the complications of meningitis?

A

Vasculitis
Thrombosis
Infarction
Raised intracranial pressure
Death
Hearing loss
Cognitive impairment
Epilepsy
Focal neurological deficits

Head and Neck Clinical Correlations (7 decks)

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