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Phase 4 - Infectious Diseases > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges, usually due to infection.

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2
Q

What are the causes of bacterial meningitis?

A
  • Neisseria meningitidis (most common cause)
  • Streptococcus pneumoniae
  • Haemophilus influenzae,
  • Group B strep (most common cause in neonates neonates as bacteria colonises the vagina)
  • Listeria monocytogenes (seen in immunosupressed)
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3
Q

What are the viral causes of meningitis

A

Viral meningitis is more common but less severe.
- Enterovirus (coxsackie)
- HSV
- VZV
- Investigated by PCR of sample and treated with aciclovir if you suspect HSV.

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4
Q

What are the fungal causes of meningitis?

A

Cryptococcus neoformans - mainly affects immunosupressed. Causes a SOL

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5
Q

What are the parasitic causes of Meningitis?

A

Amoebea or toxoplasma gondii (occurs in immunocompromised)

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6
Q

What are the non infective causes on meningitis?

A
  • Malignancy
  • Chemical meningitis
  • Drugs such as NSAIDs or trimethorprim
  • Systemic inflammatory diseases
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7
Q

What are the signs and symptoms of meningitis?

A
  • Headache,
  • Fever,
  • Neck stiffness,
  • Photophobia,
  • Nausea and vomiting,
  • Seziures (less common in viral),
  • Reduced consciousness
  • Features of meningocccocal septicaemia such as a non-blanching petechial rash
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8
Q

What are signs of meningeal irritation?

A
  1. Kernig’s sign - Knee and hip flexed at 90 degrees. Patient experiences pain with knee extension
  2. Brudzinski’s sign - Passive flexion of the neck causes involuntary flexion of hips and knees
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9
Q

What are the differential diagnosis of meningitis?

A
  • Enchephalitis (headaches, fever, altered consciousness, seziures, focal neurological signs and behavioral changes)
  • SAH
  • Brain abscess (headache, fever, N&V, focal neuro deficites, seziures)
  • Sinusitis
  • Migraine
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10
Q

What are the investigations for meningitis?

A
  1. Bloods (FBC, U&Es, Clotting and Glucose)
  2. ABG
  3. Blood cultures,
  4. Head CT
  5. Lumbar puncture for bacterial culture, viral PCR, cell count, protein and glucose (with paired blood glucose) (within 1 hour of arriving at hospital)
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11
Q

What are the contraindications for doing a lumbar puncture?

A
  • Brain shift on CT,
  • Rapid GCS reduction,
  • Respiratory or cardiac compromise
  • Rapidly evolving rash,
  • Infection at the LP sight
  • Coagulopathy
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12
Q

When do you need to CT BEFORE LP?

A

Signs of raised ICP, however do not delay giving antibiotics:
- Focal neurological signs/ CNS signs,
- GCS < 12 (DO CT FIRST),
- Immunocompromised
- Papilloedema,
- Buldging of fontanelle (children)
- DIC
- Seziures

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13
Q

What are the differences in a LP in a bacterial and viral infection

A

Bacterial - Cloudy, raised proteins, reduced glucose and neutrophils.
Viral - Clear, raised protein (not as high as in bacterial), normal glucose and lymphocytes

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14
Q

What are the risk factors for pneumococcal and listeria

A

Pneumococcal - Middle ear disease, head injury, neurosurgery, alcohol and immunosupression.
Listeria - Immunosupression and pregnancy

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15
Q

What are signs of pneumococcal meningitis

A

Focal signs, seziures and VIII palsy.
May have signs of pneumococcal infection elsewhere such as endocarditis
Pneumococcal meningitis has a higher mortality than meningococcal

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16
Q

What is the treatment of suspected bacterial meningitis in the community/hospital

A
  • If there will be a delay of more than 1 hour of transferring patient to hospital then give urgent Benzylpenicillin or ceftriaxone/cefotaxime
  • In hospital give 2g IV of ceftriaxone very 12hours. If over 50years then add amoxicillin
  • Can also give IV Dexamethasone especially in high ICP
17
Q

What is the definitive antibiotic therapy for the different bacterial meningitis?

A

Meningococcal - IV ceftriaxone/benzyl penicillin for 5 days.
Pneumococcal - IV ceftriaxone/benzyl penicillin for 10-14 days.
Listeria - IV amocixillin for 21 days
Add IV dex especially in pneumococcal.

18
Q

Explain the prophylaxis measures for contacts of bacterial meningitis?

A
  • Anyone who has been in close contact with the patient 7 days before onset.
  • Single dose of ciprofloxacin
19
Q

What are the complications of meningitis?

A
  • Septic shock,
  • DIC,
  • Coma,
  • Subdural effusions,
  • SIADH,
  • Seizures,
  • Intracerebral abscess
  • Brain herniation
  • Hydrocephalus
  • Delayed complications eg, hearing loss, CN dysfunction, hydrocephalus, intellectual deficits, ataxia, blindness
  • Death
  • Waterhouse-Friderichsen syndrome
20
Q

What is progressive focal multifocal leucoencephalopathy?

A

Progressive motor dysfunction that occurs due to JC virus. Seen in immunocompromised patients.
- No specific treatment but can give ARVs if HIV positive

21
Q

What are the features of encephalitis, the investigations and treatment?

A

Presents with confusion, fever +/- seizures. Most common is HSV encephalitis
Investigations are LP which shows lymphocytic CSF, temporal lobe changes on EEG and MRI scanning can be done.
Treat with IV aciclovir for 2-3 weeks

22
Q

What is Waterhouse-Friderichsen syndrome?

A

This is where severe bacterial infections causes the blood vessels in the adrenal glands to rupture. It causes an adrenal crisis due to acute adrenal insufficiency

Phase 4 - Infectious Diseases (23 decks)

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