Meningitis

Question 1

What is meningitis?

Answer 1

Inflammation of meninges of brain

Question 2

Is it a notifiable disease?
Who to?

Answer 2

Notifiable to Public Health England

Question 3

Causes of meningitis?

Answer 3

Viral - MC, less severe - enterovirus (coxsackie) + HSV-2 + VZV

Bacteria - LC, More severe - S.pneumoniae, N.meningitidus

Question 4

RF of meningitis?

Answer 4

Extremes of age
Immunocompromised
crowded environment
Non vaccination

Question 5

What is the mc bacteria in neonates 0-3 months?

Answer 5

Group b alpha haemolytic strep - s.agalectine

Listeria
E.Coli
S.pneumoniae

Question 6

What is the mc bacteria in infants 3m to 6 years?

Answer 6

S.Pneumoniae
N.meningitidis

H.influenzae (less common due to vaccine)

Question 7

What is the mc bacteria in Adults 6yrs - 60 years?

Answer 7

S.Pneumoniae
N.meningitidis

Question 8

What is the mc bacteria in Elderly 60+ years?

Answer 8

S.Pneumoniae
N.meningitidis

Listeria

Question 9

N.Meningitidis
What type of bacteria?
vaccine?
mortality?
Sx?

Answer 9

Gram -ve diplococcus
vaccines available; men B + C, men ACWY
10% mortality
Non blanching purpuric rash (meningococcal septicemia - DIC - v easy bleeds)

Question 10

S.Pneumoniae
What type of bacteria?
vaccine?
mortality?

Answer 10

Gram +ve diplococcus in chains
PCV vaccine
25% mortality

Question 11

Group B strep
What type of bacteria?
MC of which age group?
Why?

Answer 11

Gram +ve coccus in chains
MC of neonatal meningitis
Why? colonises maternal vagina

Question 12

Listeria Monocytogenes
What type of bacteria?
MC of which age group?
Found in?

Answer 12

Gram +ve bacillus
Affects extremes of age + maternal (pregnant ladies)
found in cheese

Question 13

Sx of meningitis

Answer 13

Fever, headache, Neckstiffness, photophobia (+ pyrexia)

Question 14

2 signs of meningitis?

Answer 14

Kernig - cannot extend knee without pain when hip is flexed

Brudzinski - when neck flexed, knees + hips automatically flex

Question 15

Dx of meningitis

Answer 15

lumbar puncture + csf analysis - sample taken from L3/4 + analysed

Question 16

When is a lumbar puncture CI?

Answer 16

In high ICP due to tentorial herniation

Question 17

Bacterial
Opening pressure?
Appearance?
WCC?
Protein?
Glucose (vs serum level)?

Answer 17

High
Cloudy yellow
High Neutrophilia
High (>1g/L)
Low (<50% serum level)

Question 18

Virus
Opening pressure?
Appearance?
WCC?
Protein?
Glucose (vs serum level)?

Answer 18

=
Clear, normal
High lymphocytosis
= (<1g/L)
>60% serum level

Question 19

Fungus
Opening pressure?
Appearance?
WCC?
Protein?
Glucose (vs serum level)?

Answer 19

High
Cloudy, fibrinous
High lymphocytosis
High (>1g/L)
<50% serum level

Question 20

Tx for bacteria?

Answer 20

In hospital:
Ceftriaxone / Ceftotaxime (3rd gen cephalosparin) + steroids (dexamethasone)
Listeria = Amoxicillin

Question 21

Tx for viral?

Answer 21

Nothing if enterovirus
Aciclovir = if HSV or VZV

Question 22

Is contact tracing necessary?

Answer 22

Prophylaxis for contacts with 7+ days prolonged contact preceding Sx (live in same house)
One dose of ciprofloxacin

Question 23

In GP, If Px presents with non blanching rash and meningococcal septicaemia suspected, what would be given/happen next?

Answer 23

IM benzylpenicillin + immediate hospital referral

Question 24

2 complications of meningitis

Answer 24

DIC (meningococcal septicaemia)
Waterhouse Friedrichsen syndrome - adrenal insufficiency caused by intraadrenal haemorrhage as a result of meningococcal DIC