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Yr 3 neuro > meningitis > Flashcards

meningitis Flashcards

1
Q

definition of meningitis

A

Inflammation of the leptomeningeal (pia mater and arachnoid) coverings of the brain, most commonly caused by infection.

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2
Q

aseptic meningitis

A

Characterized by clinical and laboratory evidence for meningeal inflammation and negative routine bacterial cultures.

May be secondary to:

  • Enterovirus (most common cause), mycobacteria, fungi, spirochetes.
  • Autoimmune e.g. Sarcoidosis, Behcet’s disease, Systemic lupus erythematosus.
  • Malignancy (lymphoma, leukaemia, metatstatic carcinomas).
  • Medication (NSAIDs, trimethoprim, azathioprine).
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3
Q

mollaret’s meningitis

A

recurrent benign lymphocytic meningitis

50% exhibit transient neurological manifestations

most common cause is HSV-2

CSF: large granular plasma cells on Papanicolaou’s stain, PCR for HSV DNA.

treat with acyclovir

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4
Q

aetiology opf bacterial meningitis

A

Neonates: Group B streptococci, Escherichia coli, Listeria monocytogenes.

Children: Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae.

Adults: Neisseria meningitidis (meningococcus), Streptococcus pneumoniae, tuberculosis.

Elderly: Streptococcus pneumoniae, Listeria monocytogenes.

TB

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5
Q

aetiology of viral meningitis

A

enteroviruses

mumps

HSV

VZV

HIV

CMV

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6
Q

aetiology of fungal meningitis

A

cryptococcus - associated with HIV

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7
Q

RF for meningitis

A
  • close communities - dorms
  • basal skull fractures
  • mastoidosis
  • sinusitis
  • inner ear infections
  • alcoholism
  • immunodeficiency - transplant/malignancy
  • splenectomy
  • sickle cell anaemia
  • CSF shunts
  • intracranial surgery
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8
Q

epidemiology of meningitis

A

Variation according to geography, age, social conditions.

UK Public Health Laboratory Service receives 2500 notifications/year.

More common in recent visitors to the Haj (meningococcal serogroup W135), epidemics occur in the meningitis belt of Africa(meningococcal serogroup A).

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9
Q

sx of meningitis

A

severe headache

photophobia and neck stiffness and kernig’s sign= meningism

neck or backache

irritability

drowsiness

vomiting

high-pitched crying or fits - common in children

clouding of consciousness

fever

leg pain

cold hands and feet

abnormal skin colour

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10
Q

travel and exposure for meningitis

A

exposure to rodents (Lymphocytic choriomeningitis virus),

ticks (e.g. Lyme borrelia, Rocky Mountain spotted fever),

mosquitoes (West Nile virus, St. Louis encephalitis virus),

sexual activity (HSV-2, HIV, syphilis),

travel (C. immitis, A. cantonensis) and contact with other individuals with viral exanthems (enteroviruses).

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11
Q

signs of meningitis

A

signs of meningism

signs of infection

reduced GCS, coma

seizures +- focal neurological signs +- opisthotonus

shock - prolonged capr refill, DIC, hypotension

zoster - cold sore/genital vesicles

HIV - lymphadenopathy, dermatitis, candidiasis, uveitis

leptospirosis - bleeding +- red eye

mumps - parotid swelling

glandular fever - sore throat +- jaundice, +- nodes

splenectomy scar = immunodeficient

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12
Q

signs of meningism

A

photophobia

neck stiffness

Kernig’s sign - hips flexed, pain/resistance on passive knee extension

Brudzinski’s sign - flexion of hips on neck flexion

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13
Q

signs of infection - meningitis

A

fever

tachycardia

hypotension

skin rash - non-blanching petechiae with meningococcal septicaemia, may ony be 1 or 2 spots

altered mental state

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14
Q

Ix for meningitis

A

blood

throat swab - 1 bacteria and 1 virology

imaging

LP

staining of petechiae scrapings may detect meningococcus in 70%

Additional studies e.g. viral PCR, staining/culture for mycobacteria and fungi, HIV test depending on the clinical presentation/CSF findings

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15
Q

blood for meningitis

A

2 sets of cultures - dont delay AB

UE

FBC - low WCC = immunocomp - get help

LFT

glucose

coagulation

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16
Q

imaging for meningitis

A

CT scan to exclude mass lesion or raised ICP before LP

must be before LP if immunodeficiency, history of CNS disease, low consciouness, fit, focal neurological deficit, or papilloedema

17
Q

LP for meningitis

A

note opening CSF pressure

CSF to microscopy with culture sensitivity and gram staining: (Streptococcus pneumoniae: Gram-positive diplococcic, Neisseria Meningitidis: gram-negative diplococcic), biochem and cytology

18
Q

LP for bacterial meningitis

A

Cloudy CSF,

high neutrophils and protein,

low glucose (CSF: serum glucose ratio of<0.5).

19
Q

LP for TB meningitis

A

fibrinous CSF,

high lymphocytes protein,

low glucose

20
Q

LP for viral meningitis

A

high lymphocytes and protein,

normal glucose

21
Q

ddx for meningitis

A

malaria

encephalitis

septicaemia

subarachnoid

dengue

tetanus

22
Q

Mx for meningitis

A

immediate IV/IM AB if suspected

  • before LP or CT
  • blood cultures 1st
  • third-generation cephalosporin (cefotaxime 2 g qds or ceftriaxone 2 g bd).Benzylpenicillin may be given as initial blind therapy and for sensitive meningococci and pneumococi.
  • amoxicillin and gentamicin for listeria
  • for penicillin and cephalosporin resistant pneumococci: add vancomycin and if necessary rifampicin
  • if anaphylaxis to penicillin or cephalosporins, or resistance - chloramphenicol
  • Give rifampicin for 2 days to patients treated with benzylpenicillin or chloramphenicol (to eliminate nasopharyngeal carriage)

dexamethasone IV

  • 10mg QDS for 4 days
  • given shortly before or with 1st dose of AB
  • continue in Pneumococcal or H. influenzae meningitis = reduced complications: death (S. pneumoniae) and hearing loss (H. influenza)
  • avoid if HIV suspected

resus - ITU

23
Q

prevention of meningitis

A

only for meningococcal meningitis

Notify public health services and consult a consultant in communicable disease control for advice regarding chemoprophylaxis (e.g. rifampicin for 2 days) and vaccination for close contacts

vaccination against meningococcal serogroups A and C.

24
Q

complications of meningitis

A

septicaemia

shock

DIC

renal failure

fits

peripheral gangrene

cerebral oedema

cranial nerve lesions

cerebral venous thrombosis

hydrocephalus

water-house-Friderichsen syndrome - bilateral adrenal haemorrhage

sensineural hearing loss

impaired vestibualr function

epilepsy

diffuse brain function

25
Q

px of meningitis

A

Mortality rate from bacterial meningitis is high (10–40%withmeningococcalsepsis)

in developing countries mortality rate often higher

viral meningitis often self limiting

Yr 3 neuro (32 decks)

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