Meningitis

Question 1

Cause of meningitis in age 0-3 months

Answer 1

Group B Streptococcus (neonates)
E. coli
Listeria monocytogenes

Question 2

Cause of meningitis in age 3 months to 6 years

Answer 2

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

Question 3

Cause of meningitis in 6 to 60 years

Answer 3

Neisseria meningitidis
Streptococcus pneumoniae

Question 4

Cause of meningitis in age >60 years

Answer 4

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

Question 5

Most common cause of meningitis in immunocompromised patients

Answer 5

Listeria

Question 6

CSF:
- cloudy
- low glucose
- high protein
- high polymorphs

Answer 6

Bacterial

Question 7

CSF:
- clear/cloudy
- glucose 60-80% plasma glucose
- Normal protein
- lymphocytes

Answer 7

viral

Question 8

CSF:
- slightly cloudy, fibrin web
- low glucose
- high protein
- lymphocytes

Answer 8

Tuberculous

Question 9

CSF:
- cloudy
- low glucose
- high protein
- lymphocytes

Answer 9

Fungal

Question 10

How can we confirm the presence of TB meningitis?

Answer 10

Ziehl-Neelsen (only 20% sensitive)

PCR is sometimes used (sensitivity = 75%)

Question 11

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?

Answer 11

IM benzylpenicillin

Question 12

Warning signs in meningitis

Answer 12

• rash
• poor peripheral perfusion/ poor response to fluids
• Resp rate < 8 or > 30
• Brady/tachycardia
• Acidosis
• lactate > 4
• GCS < 12

Question 13

Diagnostic investigation

Answer 13

Lumbar puncture (LP)

Question 14

Management of meninigitis

Answer 14

• IV antibiotics
  => cefotaxime/ceftriaxone +/- amoxicillin
• IV dexamethasone

Question 15

Management of patients with signs of raised ICP

Answer 15

• critical care input
• secure airway
• high-flow oxygen
• IV dexamethasone + Abx
• neuroimaging

Question 16

What should CSF be tested for?

Answer 16

• glucose, protein, microscopy and culture
• lactate
• meningococcal + pneumococcal + TB PCR
• enteroviral, herpes simplex and varicella-zoster PCR

Question 17

What contacts require meningitis prophylaxis?

Answer 17

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.

Question 18

What antibiotics should be used as meningitis prophylaxis for close contacts?

Answer 18

oral ciprofloxacin or rifampicin

Question 19

What is meningitis?

Answer 19

inflammation of the leptomeninges and the cerebrospinal fluid of the subarachnoid space

Question 20

Viral causes of meningitis

Answer 20

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

Question 21

Risk factors for the development of viral meningitis

Answer 21

• extremes of age
• immunocompromised
• IVDU

Question 22

Clinical features of viral meningitis

Answer 22

headache
neck stiffness
photophobia
confusion
fevers
focal neurological deficit
seizures

Question 23

CSF findings in viral meningitis

Answer 23

Normal cell count
Lymphocyte predominant
Glucose 2/3 of serum glucose
Protein high

Question 24

CSF investigation used to look for viral meningitis

Answer 24

PCR

Question 25

Management of viral meningitis

Answer 25

• IV Abx if there is any suspicion of viral infection
• aciclovir if you think it may be HSV related
• otherwise supportive management