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PHAM02 > meningitis > Flashcards

meningitis Flashcards

1
Q

What is meningitis?

A

inflammation of the membranes covering the brain and spinal cord (meninges)

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2
Q

causes of meningitis

A

– Viruses
– Bacteria
– Fungi

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3
Q

Inc risk of meningitis after what?

A

head trauma

in presence of ventriculo-peritoneal shunts (brian surgery, putting in shunts)

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4
Q

layers of meninges

A

dura matter (out)

arachniod (middle)

pia matter (inner)

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5
Q

most common cause of bacterial meningitis

A

Neisseria meningitidis

(gram negative diplococci)

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6
Q

Neisseria meningitidis

A
  • 13 types (serogroups)
  • characterised by surface structures in the capsule and outer cell membrane
  • 5 responsible for most cases of invasive disease
  • A, B, C, Y and W-135
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7
Q

other bacterial causes

A
  • S. Pneumoniae
    (G+ve cocci)
  • H. influenzae type B
    (G-ve rods)
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8
Q

What does causastive agent depend on?

A

age of pt

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9
Q

viral causes of meningitis

A
  • less severe than bacterial meningitis
  • usually resolves without Tx
  • caused by viruses that live in the intestines
  • Enteroviruses (most common)
  • mumps and measles viruses and herpes viruses
  • poor hygiene may increase the risk of transmission
  • not all people exposed to the virus will develop meningitis
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10
Q

fungal causes of meningitis

A
  • life threatening
  • rare disease
  • usually in pts with compromised immune fxn
  • slow progression
  • difficult to diagnose and treat
  • Cryptococcus, Candida
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11
Q

non-infective causes of meningitis

A
  • complication of head injury, brain surgery, some cancers
  • sometimes drugs
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12
Q

greatest age risk for meningitis

A

< 5 years

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13
Q

common bacterial pathogens in newborns

A
  • Group B streptococci
  • E coli
  • Listeria monocytogenes
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14
Q

common bacterial pathogens in infants

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Streptococcus pneumoniae
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15
Q

common bacterial pathogens in children

A
  • N meningitidis
  • S pneumoniae
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16
Q

common bacterial pathogens in adults

A
  • S pneumoniae
  • N meningitidis
  • Mycobacteria
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17
Q

most common cause in Africa

A

Group A meningococcus

18
Q

vaccine for what casue of meningitis

A

Meningitis A

(Group A meningococcus)

19
Q

Neisseria meningitidis - spread

A
  • normally in nasopharynx
  • transmitted by droplets/ secretions from the URTI
  • spread by close contact (not highly transmissible)
  • epidemics in crowded environments
20
Q

RF

A
  • infants & young children
  • community settings - inc close contact
  • asplenia
  • immunocompromised
  • exposure to active/passive tobacco smoke
  • elderly
  • pregnancy and working with animals inc risk of meningitis with Listeria bacteria
21
Q

presentation of Neisseria Meningitidis

A
  • Bacterial meningitis (15%)
  • Meningococcal septicaemia (25%)
  • Combination of both (60%)
22
Q

classic signs & Sx

A
  • Fever
  • Headache
  • Photophobia
  • Neck stiffness
  • Petechial rash
23
Q

signs and Sx in young children

A
  • fever
  • N&V
  • poor feeding
  • irritability
  • drowsiness
  • confusion
  • sudden fever & rigors
  • muscle & joint aches
  • cold extremeties
  • Sx of raised ICP (bulging fontanelle, irregular breathing, abnormal tone)
  • petechial rash (usually N meningitidis)
24
Q

Petechial rash

A
  • usually in septicaemia but may be absent in meningitis
  • blanching and macropapular in early disease, develops into petechial, non-blanching rash
  • rapidly evolving rash = severe disease
  • non-blanching = MED EMERGENCY

(glass test not in NICE guidance)

25
Q

Kernig’s and Brudzinski’s sign in meningitis

A
  • severe stiffness of the HAMSTRINGS causes an inability to straighten leg when hip is flexed to 90 degrees
  • severe neck stiffness causes hips and knees to flex when the neck is flexed
26
Q

diff between meningitis and sepsis

A

PRODROME SAME
- fever
- N&V
- malaise
- lethargy

MENINGITIS
- severe headache
- neck stiffness
- photophobia
- drowsiness/confusion
** death from inc ICP

SEPSIS
- limb/joint pain
- cold hands/feet
- pale/mottled skin
- oliguria/thirst
- rash
- tachycardia
- rigors
- abdo pain
** death from CV failure

27
Q

diagnosis

A
  • Hx and examination
  • blood tests
  • nasopharyngeal swab through mouth
28
Q

blood tests for diagnosis

A
  • FBC
  • blood films
  • CRP
  • blood culture
  • serology & PCR
  • testing of CSF sample = GOLD STANDARD diagnostic test
29
Q

When to start Tx?

A

empirical Tx initiated on strong clinical suspicion & should not be witheld until cultures taken

30
Q

CSF sample

A
  • Lumbar puncture drains CSF from back below end spinal cord
  • NOT performed if pts:
    – features of raised (ICP)
    – haemodynamic instability
    – clotting abnormalities or thrombocytopenia
  • if meningitis, CSF sample appears turbid
  • causative organism cultured from CSF sample
  • bacteria may not be cultured if ABX have already been administered
31
Q

general Tx for meningitis

A
  • broad spec IV ABX
  • ABX choice depends on most likely causative organism
  • determined by age
  • good CSF penetration essential
  • ABX changes if necessary once causative organism ID
  • guidelines reflect local patterns of resistance
32
Q

empirical Tx - early Tx before hospital if practical

A

benzylpenicillin (NICE)

benzylpenicillin & cefotaxime

(parenteral)

33
Q

When is benzylpenicillin witheld?

A

only in allergy only due to anaphylaxis

34
Q

empirical Tx - hospital

A

ceftriaxone (3rd gen cephalosporin)

1st line over 3 months

35
Q

Tx in under 3 months

A
  • need ABX active against listeria
  • cefotaxime + ampicillin/amoxicillin
  • Listeria most likely in U3mths
36
Q

supportive therapies

A
  • Corticosteroids
  • Intravenous fluids
  • Enteral nutrition
  • Anticonvulsant therapy if app (convulsions from inc ICP, pressure on brain)
  • Management of complications of septicaemia and shock
    – Respiratory support
    – Correction of metabolic disturbances
    – IV fluids
    – Vasoactive therapies
    – Renal replacement therapies if required
37
Q

LT complications

A
  • Hearing loss
  • Orthopaedic complications
  • Skin complications
  • Psychosocial problems
  • Neurological and developmental problems
  • Renal failure
38
Q

When is chemoprophylaxis indicated?

A
  • prolonged close contacts - same household during the 7 days before presentation
  • transient close contacts - directly exposed to large particle droplets/secretions from the RT of pt around time of admin to hospital
  • patient - given as soon as able to take oral meds, unless treated with ceftriaxone
39
Q

When is chemoprophylaxis NOT indicated?

A

– Staff and children attending same nursery/school
– Residents of nursing/residential homes
– Food/drink sharing or similar low level of salivary contact
– Travelling in next seat on same plane/train/bus

40
Q

Chemoprophylaxis options

A
  • given asap after diagnosis
  • choice of ABX includes:
  1. Ciprofloxacin
    - rec for all age groups and pregnancy
    - single dose admin
  2. Rifampicin
    - suitable for all pt groups (without c/i)
    - BD for 2 days
    - interactions
  3. Ceftriaxone
    - injection so only used when other Txs unsuitable
41
Q

vaccination

A

Hib / Men C vaccine
* routine immunisation at 1 year

Quadrivalent Vaccines
* meningococcal polysaccharides A, C, W135 and Y vaccine (ACWY Vax®)
* quadrivalent meningococcal diphtheria-conjugate vaccine (MCV-4)
* suitable for individuals at risk & meningitis patients & close contacts

Men B vaccine
* NHS for babies born after Sept 2015
* Routine immunisation at 2, 4, 12mths

Other vaccines
* 5-in-1 vaccine
- DTaP/IPV/Hib vaccine
- routine imm at 8, 12, 16 weeks

  • Pneumococcal vaccine
  • routine imm at 8, 16 weeks, 1yr
42
Q

reporting meningitis

A

if diagnosis of meningitis suspected, dr legally obliged to report to local health protection unit of the health porteciton agenct

PHAM02 (32 decks)

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