Meningitis

Question 1

What is septicaemia?

Answer 1

Disease of the blood caused by the attack of meningococcal bacteria which multiply and produce poisons that attack blood vessel walls- causes blood to lack out.

Question 2

What is meningitis?

Answer 2

When meningococcal bacteria cross the blood brain barrier causing infection of CNS.

Question 3

What causes meningitis?

Answer 3

*bacteria/virus crosses BBB
*causes inflammation of meninges- arachnoid and pia mater.

Question 4

What can cause viral meningitis?

Answer 4

*herpes virus (HSV-2)
*mumps/measles
*human enteroviruses- polioviruses- most common cause of viral

Question 5

How is fungal meningitis caused?

Answer 5

*cryptococcus neoformans-most common-soil
*candida albicans (premature babies)

Question 6

What causes bacterial meningitis?

Answer 6

*Neisseria meningitidis- most common
*E. coli- most common in neonates

Question 7

What type of bacteria is neisseria meningitidis?

Answer 7

*Aerobic gram negative diplcoccus
*Has a polysaccharide capsule (g-ve feature) to resist phagocytosis

Question 8

What are the N. meningitidis serogroups?

Answer 8

*Men A- African/Middle East
*Men B-most common in uk and Europe
*Men C- rare - may occur in clusters in UK
*Men W135- travellers from Hajj pilgrimages to Saudi
*Men Y- North America- very rare uk

Question 9

Who is most at risk of meningitis?

Answer 9

*children <9 years, peak <1 years
*secondary peak 15-19 years

Question 10

How is nieisseria meningitidis transmitted?

Answer 10

*carried in nasopharynx
*if penetrates mucosal cells- enters blood- crosses BBB in 50% cases
*transmitted via droplets/secretions from upper respiratory tract
*need frequent prolonged contact

Question 11

How is most at risk of N.meningitidis?

Answer 11

*young age
*cancer patients
*immunocomp
*>65 years

Question 12

What is the pathophysiology of N. meningitidis?

Answer 12

*colonises in nasopharynx
*invades submucosa by overcoming host defences - immunity, phagocytes
*invades blood
*crosses BBB
*replicates in cerebral spinal fluid
*initiates inflammatory response
*puss and abscess forms

Question 13

What are symptoms of N. meningitidis?

Answer 13

Neurological signs
*bulging fontanelle- baby soft spot
*stiff neck or back
*kernigs sign- can’t fully extend leg
*brudzinskis test- lifting neck causes flexing of legs and thighs
Circulatory signs
*non-blanching rash- doesn’t disappear on pressure
*cold limbs
*shock/hypotension

Question 14

What are characteristics of the petechial/purpuric rash?

Answer 14

*starts as cluster of pin prick blood spots (petechiae)
*spread to form bruises under skin (purpurae)
*anywhere on body
*does not disappear upon pressure

Question 15

What are signs and symptoms of infants with meningitis?

Answer 15

*fever
*high pitched whimper
*blank stare, inactivity, hard to wake
*poor feeding
*blotching skin

Question 16

What complications can happen after meningitis diagnosis?

Answer 16

*neurological- seizures, hearing loss, motor deficits
*physical- amputations, scars

Question 17

How is N. men diagnosed?

Answer 17

*Lumbar puncture with examination of cerebral spinal fluid
~cloudy turbid appearance
~raised protein levels
~low glucose levels
*blood tests for CRP- c reactive protein (elevated) and WBC’s (elevated)

Question 18

How is N. men treated?

Answer 18

Urgent
*benzylpenicillin sodium-ambulance
Meningococci- benzyl or cefotaxime- 7 days
Pneumococci-cefotaxime + dexamethasone - 14 days
Haemophilus influenzae- cefotaxime + dexamethasone- 10 days
Listeria- amoxicillin + gentamicin- 21 days

Question 19

What is the reason for adjunctive corticosteroid therapy?

Answer 19

*regulates inflammatory response
*reduces cerebral spinal fluid pressure
*dexamethasone initiated before/with first dose antibiotics-continue for 4 days
*DONT GIVE TO IMMUNOCOMP, POST ANTIBIOTIC THERAPY, <1 MONTH OLD

Question 20

What other management is needed along with antibiotic treatment?

Answer 20

*fluid treatment- careful monitor of electrolyte balance-avoid brain swelling/shock

Question 21

Should meningitis or septicaemia be notified?

Answer 21

*suspected and confirmed cases should be notified to local health protection disease
*in hospital- infection prevention and control team

Question 22

When is chemoprophylaxis needed and what drugs are used?

Answer 22

*prolonged contact with case in house during 7 days before onset of illness in original patient
*ciprofloxacin- single dose- unpredictable in patients with epilepsy
*rifampicin- second line- twice daily for two days

Question 23

Which meningococcal vaccines can be given?

Answer 23

Childhood
*MenC conjugate vax (with flu vax)- 12 months old-booster at 13-15 years
*MenB vax- 2,4 and 12 months
*Men ACWY vax- <25 years attending uni

Travel
*MenACWY conjugate vax- travelling to areas of high risk
*entry requirement for Saudi for hajj pilgrimages