Meningitis Flashcards
Cause of meningitis in age 0-3 months
Group B Streptococcus (neonates)
E. coli
Listeria monocytogenes
Cause of meningitis in age 3 months to 6 years
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Cause of meningitis in 6 to 60 years
Neisseria meningitidis
Streptococcus pneumoniae
Cause of meningitis in age >60 years
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Most common cause of meningitis in immunocompromised patients
Listeria
CSF:
- cloudy
- low glucose
- high protein
- high polymorphs
Bacterial
CSF:
- clear/cloudy
- glucose 60-80% plasma glucose
- Normal protein
- lymphocytes
viral
CSF:
- slightly cloudy, fibrin web
- low glucose
- high protein
- lymphocytes
Tuberculous
CSF:
- cloudy
- low glucose
- high protein
- lymphocytes
Fungal
How can we confirm the presence of TB meningitis?
Ziehl-Neelsen (only 20% sensitive)
PCR is sometimes used (sensitivity = 75%)
All patients should be transferred to hospital urgently.
If patients are in a pre-hospital setting (e.g. GP surgery) and meningococcal disease is suspected then what should be given?
IM benzylpenicillin
Warning signs in meningitis
- rash
- poor peripheral perfusion/ poor response to fluids
- Resp rate < 8 or > 30
- Brady/tachycardia
- Acidosis
- lactate > 4
- GCS < 12
Diagnostic investigation
Lumbar puncture (LP)
Management of meninigitis
- IV antibiotics
=> cefotaxime/ceftriaxone +/- amoxicillin - IV dexamethasone
Management of patients with signs of raised ICP
- critical care input
- secure airway
- high-flow oxygen
- IV dexamethasone + Abx
- neuroimaging
What should CSF be tested for?
- glucose, protein, microscopy and culture
- lactate
- meningococcal + pneumococcal + TB PCR
- enteroviral, herpes simplex and varicella-zoster PCR
What contacts require meningitis prophylaxis?
household/close contacts especially those exposed to respiratory secretion
risk to contacts is highest in the first 7 days but persists for at least 4 weeks.
What antibiotics should be used as meningitis prophylaxis for close contacts?
oral ciprofloxacin or rifampicin
What is meningitis?
inflammation of the leptomeninges and the cerebrospinal fluid of the subarachnoid space
Viral causes of meningitis
coxsackie virus
echovirus
mumps
herpes simplex virus (HSV)
cytomegalovirus (CMV)
herpes zoster viruses
HIV
measles
Risk factors for the development of viral meningitis
- extremes of age
- immunocompromised
- IVDU
Clinical features of viral meningitis
headache
neck stiffness
photophobia
confusion
fevers
focal neurological deficit
seizures
CSF findings in viral meningitis
Normal cell count
Lymphocyte predominant
Glucose 2/3 of serum glucose
Protein high
CSF investigation used to look for viral meningitis
PCR
Management of viral meningitis
- IV Abx if there is any suspicion of viral infection
- aciclovir if you think it may be HSV related
- otherwise supportive management
