Meningitis

Question 1

What is meningitis?

Answer 1

Inflammation of the meninges which lines the brain and spinal cord

Question 2

1) What are the 2 commonest causes of meningitis in adults and children?
2) What is the commonest cause of meningitis in neonates?
3) How is this bacteria normally contracted?

Answer 2

1) Neisseria meningitidis and Streptococcus pneumoniae
2) Group B streptococcus
3) During birth from the GBS bacteria that can often live harmlessly in the mother’s vagina

Question 3

1) What type of bacteria is neisseria meningitidis, and as a result, what are they commonly known as?
2) What is meningococcal septicaemia?
3) What is the characteristic feature of meningococcal septicaemia?
4) Name 1 of the 2 things that this feature indicates
5) What is meningococcal meningitis?

Answer 3

1) Gram negative diplococcus - meningococcus
2) When the meningococcus bacterial infection is in the bloodstream
3) Non-blanching rash
4) Disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages
5) When the bacteria is infecting the meninges and the CSF around the brain and spinal cord

Question 4

Name 4 symptoms of meningitis

Answer 4

• Fever
• Neck stiffness
• Vomiting
• Headache
• Photophobia
• Altered consciousness and seizures

Question 5

Neonates and babies can present with very non-specific signs and symptoms, name 2 of these

Answer 5

• Hypotonia
• Poor feeding
• Lethargy
• Hypothermia
• Bulging fontanelle

Question 6

What is bulging fontanelle?

Answer 6

When fluid builds up in the brain or the brain swells, causing increased pressure inside the skull

Question 7

Children seen in the primary care setting with suspected meningitis AND a non blanching rash should receive an urgent stat injection (IM or IV) of what?

Answer 7

Benzylpenicillin

Question 8

1) Ideally, what 2 things should be performed prior to starting antibiotics in the management of meningitis in the hospital?
2) If there’s suspected meningococcal disease, the blood tests should be sent for what?
3) If younger than 3 months, what 2 antibiotics are usually given?
4) If older than 3 months, what antibiotic is usually given?
5) What should be added to these if there is a risk of penicillin resistant pneumococcal infection?

Answer 8

1) Blood culture and a lumbar puncture for CSF
2) Meningococcal PCR
3) Amoxicillin and cefotaxime
4) Ceftriaxone OR cefotaxime
5) Vancomycin

Question 9

What is the usual antibiotic choice in the post exposure prophylaxis of meningococcal infections?

Answer 9

Single dose ciprofloxacin

Question 10

Name 2 common causes of viral meningitis

Answer 10

• Herpes simplex virus (HSV)
• Enterovirus
• Varicella zoster virus (VZV)

Question 11

How is viral meningitis managed?

Answer 11

Milder than the bacterial form so normally supportive management. Acyclovir if HSV is the causative virus

Question 12

1) How does the appearance of CSF differ from bacterial meningitis to viral meningitis?
2) How does the protein content of CSF differ from bacterial meningitis to viral meningitis?
3) How does the glucose content of CSF differ from bacterial meningitis to viral meningitis?
4) What WBCs are associated with viral meningitis and what is associated with bacterial meningitis?

Answer 12

1) Cloudy in bacterial, clear in viral
2) High in bacterial, slightly elevated or normal in viral
3) Low in bacterial, high in viral
4) Neutrophils in bacterial, lymphocytes in viral

Question 13

Name 2 complications of meningitis, and what is the commonest?

Answer 13

• Sensorineural hearing loss (commonest)
• Seizures and epilepsy
• Cognitive impairment and learning disability
• Memory loss
• Focal neurological deficits i.e. limb weakness or spasticity

Question 14

When is CT imaging indicated in meningitis?

Answer 14

When there’s signs of raised ICP i.e. postural headache, papilloedema, seizures, GCS <12