meningitis

Question 1

The most common causes of viral meningitis in adults are?

Answer 1

enterovirus - echovirus
coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles

Question 2

xx

Question 3

x

Question 4

x

Question 5

x

Question 6

bacterial meningitis presentation ?

Answer 6

rapidly progressive rash

poor peripheral perfusion

respiratory rate < 8 or > 30 /

min or pulse rate < 40 or > 140 / min

GCS < 12 or a drop of 2 points

poor response to fluid resuscitation

Question 7

What predisposes to niesseria meningitis infection ?

Answer 7

C5-c9 complement deficiency - unable to make MAC

Question 8

x

Question 9

x

Question 10

Diagnosis ?

Answer 10

CT scan is not normally indicated

Question 11

Lumbar puncture should be delayed in the following circumstances

Answer 11

signs of severe sepsis or a rapidly evolving rash

severe respiratory/cardiac compromise

significant bleeding risk

signs of raised intracranial pressure
focal neurological signs
papilloedema

continuous or uncontrolled seizures

GCS ≤ 12

Question 12

x

Question 13

Mx of meningitis ?

Answer 13

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults

Question 14

Mx of Meningococcal meningitis

Answer 14

Intravenous benzylpenicillin or cefotaxime (or ceftriaxone)

Question 15

Mx of Pneumococcal meningitis

Answer 15

Intravenous cefotaxime (or ceftriaxone)

Question 16

Meningitis caused by Haemophilus influenzae

Answer 16

Intravenous cefotaxime (or ceftriaxone)

Question 17

If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected then what is given ?

Answer 17

intramuscular benzylpenicillin

Question 18

when do we consider IV dexamethasone in meningitis >

Answer 18

Raised intracranial pressure

particularly if pneumococcal meningitis suspected in adults

preferably starting before or with first dose of antibacterial,

but no later than 12 hours after starting antibacterial;

avoid dexamethasone in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery

Question 19

people who have been exposed to a patient with confirmed bacterial meningitis should be given what prophylactic antibiotics

Answer 19

if they have close contact within the 7 days before onset
= oral ciprofloxacin / rifampicin

Question 20

what else should be offered to close contacts ?

Answer 20

meningococcal vaccination

including booster doses to those who had the vaccine in infancy

Question 21

Common complication of meningitis ?

Answer 21

Sensorineural hearing loss - most significant

Seizures

focal neurological deficit
infective
sepsis
intracerebral abscess
pressure
brain herniation
hydrocephalus

Question 22

Rare complication of meningococcus complication

Answer 22

Waterhouse-Friderichsen syndrome (adrenal insufficiency secondary to adrenal haemorrhage

Question 23

Meningitis caused by Listeria

Answer 23

Intravenous amoxicillin (or ampicillin) + gentamicin