Meningitis Flashcards
Causes in neonates to 3 months
Group B strep
E.coli and other gram -ve organisms
Listeria monocytogenes
Causes in 1 month 6 years
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Causes in 6 - 60 years
Neisseria meningitidis
Streptococcus pneumoniae
Causes in >60 years
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Causes in immunocompromised
Listeria monocytogenes
Symptoms
Headache
Fever
Nausea/ vomiting
Photophobia
Drowsiness
Seizures
Signs
Neck stiffness
Purpuric rash
Bacterial CSF
Cloudy
Low glucose
High proteins
White cells 10-5000
Polymorphs
Viral CSF
Clear/ cloudy
60-80% of plasma glucose
Normal/ raised protein
White cells 15-1000
Lymphocytes
CSF tuberculous
Slight cloudy, fibrin web
Low glucose
High protein
White cells 10-1000
Lymphocytes
Investigations
Lumbar puncture
Blood cultures and PCR if LP contraindicate
LP contraindications
Focal neurological signs
Papilloedema
Significant bulging of fontanelle
Disseminated intravascular coagulation
Signs of cerebral herniation
Management
Antibiotics
Steroids
Fluids
Cerebral monitoring
Public health notification
Antibiotics
<3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
Steroids
Don’t give if <3 months old
Dexamethasone considered if LP reveals:
- frankly purulent CSF
- CSF WCC >1000
- raised protein content
- bacteria on gram stain
