Meningitis Flashcards
What type of bacteria is neissiera meningitidis?
Gram negative diplococcus
What does meningococcal septicaemia cause?
Non blanching rash
What does the non blanching rahs in meningococcal septicaemia indicate the infection has caused?
Disseminated intravascular coagulopathy
SC haemorrhage
What is meningococcal meningitis
When bacteria is infecting meninges and CSF
Most common causes of meningitis
Neissiera meningitidis
Step pneumoniae
Neonates - group B strep
How is group B strep contracted?
During birth - normally in vaginal canal harmless
Presentation of meningitis
Fever
Neck stiff
Vomit
Headache
Photophobia
Altered consciousness
Seizures
Non blanching rash if septicaemia
How do neonates and babies present with meningitis?
Non specific signs and symptoms eg hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
Who do NICE recommend LP for investgiation in?
Under 1 month with fever
1-3 months with fever and unwell
Under 1 year unexplained fever and other features of serious illlness
Special tests to perform for meningeal irritation
Kernigs test
Brudzinkis test
What is kernigs tets
involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges. Where there is meningitis it will produce spinal pain or resistance to movement.
What is brudzinkis test
involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. In a positive test this causes the patient to involuntarily flex their hips and knees.
Comunity treatment children with sus meningitis and non blacnhing rash
IM benzylpenicillin and hospital transfer
Dose is age dependent
What send for if meningococcal disease sus
LP
Meningococcal PCR
Antibiotics for children with meningitis under 3 onths vs over
Under 3 months - ceftriaxone + amoxicillin
Above 3 months - ceftriaxone
Vancomycin
What is amoxicillin given to cover?
Listeria
Whn is vancomycin added to antibiotics for meningitits?
Risk of penicillin resistant pneumococcal infection eg recent travel or prolonged antibiotic exposure
What are strerods used for in meninigitis? (bacterial)
Reduce frequency and severity of hearing loss and neurological damage
Dosage of steroids given to children with meningitis
4 times daily for 4 days in children over 3 months IF LP -> bacterial meneigitnt
What need to do if case of bacterial meningitis found>
Notifiable disease
Public heakth
Who has highest risk of contracting meningitis after contact iwth patient
Contact 7 days prior to onset of illness
Antibiotic choice for prophylaxis against meningitis
Single dose of ciprofloxacin
Given as soon as possible ideally within 24 horurs of initial diagnosis
Common causes of viral meningitis
Herpes simplex virus
Enterovirus
Varicella zoster virus
How to diagnose viral meningitis?
Lumbar puncture - send CSF for viral PCR
How to treat HSV or VZV?
Aciclovir
What is CSF tested for in meningitis?
Bacterial culture
Viral PCR
Cell count
Protein
Glucose
What is CSF tested for in meningitis?
Bacterial culture
Viral PCR
Cell count
Protein
Glucose
Which white cells are high inCSF in viral infection?
Lymphocytes
Bacterial - neutrophils
What is protein and glucose levels in CSF in bacterial vs viral CSF?
Bacterial: protein - High. Glucose - low
Viral: protein normal or slightly raised. Glucose normal
Complications of mennignitis
Haering loss
Seizures and epilepsy
Cognitive impairment and disability
Memory loss
Cerebral palsy - focal neurological deficits ef limb weakness or spasticity
