Meningitis Flashcards
what are the CSF findings in tubercular meningitis?
- raised protein
- raised lymphocytes
- polymorphonuclear cells
- turbid appearance with fibrin web formation
what are the CSF findings in viral meningitis?
- normal openng pressure
- raised protein
- normal glucose
- lymphocytic predominance
what are the CSF findings in bacterial meningitis?
- raised protein
- low glucose
- neutrophilic predominance
- cultures +ve
what is meningism?
- headache
- photophobia
- vomiting
- myalgia
- fever
- neck stiffness
what is the antibiotic management of bacterial meningitis in hospital?
2g IV ceftriaxone BD
what additional antibiotic is given to young/old patients to cover listeria?
IV amoxicillin
what additional antibiotic is given if viral encephalitis is suspected?
IV aciclovir
what is the antibiotic management of bacterial meningitis in the community?
IM benzylpenicillin
what antibiotic is used in penicillin allergic patients?
chloramphenicol
what is the cause of meningitis with a non-blanching rash?
neisseria meningitidis
what are the common bacterial causes of meningitis?
- streptococcus pneumoniae (gram +ve diplococci)
- neisseria meningitidis (gram -ve diplococci)
- haemophilus influenzea
- listeria monocytogens - often seen in extremes of ages
what are the viral causes of meningitis?
- enteroviruses - echoviruses, coxsackie viruses A&B, poliovirus
- HSV2
- HSV1
- paramyxovirus - complications of mumps
- measles and rubella virus
- varicella zoster virus - complication of chicken pox
- arboviruses
- rabies virus
what is the most common cause of acute bacterial meningitis in young adults in the UK?
neisseria meningitidis
what are the fungal causes of meningitis?
crytococcus neoformans
what patient sub-group are more at risk of fungal meningitis?
immunosuppressed population
what are the parastic causes of meningitis?
- ameoba - acanthamoeba (associated with keratitis and meningitis from contract lens fluid contamination)
- toxoplasma gondii
what are the non-infective causes of meningitis?
- malignancy
- chemical meningitis
- drugs
- sarcoidosis
- systemic lupus erythematosus
- behcets disease
what is the management of cryptococcal meningitis?
- IV amphotericin B and oral flucyotsine for 2 weeks
- maintenance therapy with oral fluconazole for 8 weeks
- long-term low dose oral fluconazole
how do you diagnose cryptococcal meningitis?
- very high CSF opening pressure
- cryptococcal antigen testing
- india ink staining
what investigations should be undertaken in meningitis?
- blood tests - FBC, U&Es, clotting, glucose
- arterial blood gas
- blood cultures
- CT head
- lumbar puncture
what are the possible complications from meningitis?
- septic shock
- DIC
- coma
- subdural effusions
- SIADH
- seizures
- death
what are some of the delayed complications from meningitis?
- hearing loss
- cranial nerve dysfunction
- hydrocephalus
- intellectual deficits
- ataxia
- blindness
