Meningitis Flashcards
What are the most common bacterial causes of meningitis?
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Listeria monocytogenes
What are the most common viral causes of meningitis?
Echoviruses
Coxsackie A and B
Poliovirus
Herpes viruses
What are the most common fungal causes of meningitis?
Cryptococcus neoformans
Mycobacterial meningitis
Candida
What are the non-infective causes of meningitis?
Malignancy
Chemical meningitis
Drugs - NSAIDs, trimethoprim
Sarcoidosis
SLE
What are the clinical features of meningitis?
Headache
Pyrexia
Neck stiffness
Photophobia
Nausea and vomiting
Focal neurology
Seizures
Non-blanching rash
What is Kernig’s sign?
Patient is supine with hips flexed at 90 degrees
- Positive test if there is pain on passive extension of the knee
What is Brudzinski’s sign?
Positive sign - reflexive hip and knee extension when a patient’s neck is flexed
What is the acute management of suspected bacterial meningitis?
IV cefotaxime
What is the acute management of suspected bacterial meningitis in very young and old patients?
IV cefotaxime + IV amoxicillin ( to cover for listeria)
What is the management of patients with a non-blanching rash in community?
IM benzylpenicillin and immediate transfer to hospital
What are the investigations for meningitis?
Lumbar puncture
Bloods - FBC, U&E, glucose, clotting
ABG
Blood cultures
CT head
What are the features of CSF in bacterial meningitis?
Cloudy appearance
WBC - 1000-2000
Predominantly neutrophils
Protein raised
Low glucose
Elevated opening pressure
What are the features of CSF in viral meningitis?
Clear appearance
WBC - <300
Predominantly lymphocytes
Protein normal or elevated
Glucose normal
Normal or elevated opening pressure
What are the features of CSF in fungal meningitis?
Cloudy appearance
WBC <500
Predominantly lymphocytes
Protein rasied
Low glucose
Elevated opening pressure
What medication may be given to those with meningitis to reduce the chance of long term neurological deficit?
IV dexamethasone
