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Yr 4 - ACC > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis?

A

Meningitis is inflammation of the meninges - the lining of the brain and spinal cord.

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2
Q

What is contained within the meninges?

A

CSF in the subarachnoid space.

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3
Q

Is viral or bacterial meningitis more common?

A

Viral

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4
Q

Is viral or bacterial meningitis often more benign?

A

Viral

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5
Q

What are the 4 most common causes of viral meningitis?

A

1) Enteroviruses (e.g., coxsackievirus)

2) Herpes simplex virus (HSV)

3) Varicella zoster virus (VZV)

4) Cytomegalovirus (CMV)

5) Mumps

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6
Q

3 key risk factors for viral meningitis?

A

1) extremes of age (<5 and the elderly)

2) immunocompromised e.g. renal failure, diabetes

3) IV drug users

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7
Q

Common clinical presentation of viral meningitis?

A
  • headache
  • neck stiffness
  • photophobia
  • confusion
  • seizures

less common:
- focal neuro deficits on exam
- seizures: suggests a meningoencephalitis

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8
Q

Is photophobia worse in viral or bacterial meningitis?

A

Worse in bacterial meningitis

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9
Q

Investigation in viral meningitis?

A

Lumbar puncture –> viral PCR testing on CSF sample

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10
Q

Medical management of viral meningitis?

A

Aciclovir –> used to treat HSV and VZV

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11
Q

Describe different aspects of CSF in bacterial vs viral vs TB vs fungal meningitis:

a) appearance

b) glucose

c) protein

d) white cell count

A

a)
- bacterial: cloudy
- viral: clear/cloudy
- TB: slightly cloudy, fibrin web
- fungal: cloudy

b)
- bacterial: low (<1/2 plasma) (bacteria eat up glucose)
- viral: normal/midly raised (60-80% of plasma)
- TB: low (<1/2 plasma)
- fungal: low

c)
- bacteria: high (>1 g/l) (bacteria poo out protein)
- viral: normal/midly raised
- TB: high (>1 g/l)
- fungal: high

d)
- bacteria: high (neutrophils)
- viral: high (lymphocytes)

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12
Q

Key cell differential found in CSF in viral meningitis?

A

Lymphocytes

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13
Q

Whilst awaiting results of lumbar puncture in viral meningitis, what is treatment?

A

1) supportive

2) if there is any question of bacterial meningitis or of encephalitis, the patient should be commenced on broad-spectrum antibiotics with CNS penetration e.g. IV ceftriaxone and aciclovir
- particularly the case if the patient has risk factors e.g. elderly, immunocompromised

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14
Q

Management of viral meningitis?

A

1) typically self limiting: symptoms improving over the course of 7 - 14 days and complications are rare in immunocompetent patients

2) aciclovir: if suspected meningitis 2ary to HSV

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15
Q

When is aciclovir given in viral meningitis?

A

meningitis secondary to HSV

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16
Q

What are the 5 main causes of bacterial meningitis?

A

1) Neisseria meningitidis

2) Strep. pneumoniae (pneumococcus)

3) Haemophilus influenzae

4) Group B Strep (GBS): particularly in neonates as GBS may colonise the vagina

5) Listeria monocytogenes (particularly in neonates)

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17
Q

Who is bacterial meningitis caused by Group B streptococcus (GBS) more common in?

A

Neonates - as GBS may colonise the vagina

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18
Q

What is Neisseria meningitidis?

A

Gram-negative diplococcus bacteria - circular bacteria (cocci) that occur in pairs (diplo-).

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19
Q

What is meningococcal meningitis?

A

Meningitis caused by the bacteria Neisseria meningitidis

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20
Q

What is the most common cause of bacterial meningitis?

A

Neisseria meningitidis (meningococcus)

21
Q

What meningococcal meningitis?

A

Meningococcal meningitis is when the bacteria infects the meninges and the cerebrospinal fluid.

22
Q

What is meningococcal septicaemia?

A

Meningococcal septicaemia is when the meningococcus bacterial infection is in the bloodstream.

23
Q

What classic symptom does meningococcal septicaemia?

A

Non-blanching rash

24
Q

Clinical features of bacterial meningitis?

A
  • headache
  • fever
  • nausea/vomiting
  • photophobia
  • drowsiness
  • seizures
  • neck stiffness
  • purpuric rash (particularly with invasive meningococcal disease)
25
Q

How can neonates & babies present with meningococcal septicaemia (or sepsis in general)?

A

Non specific symptoms signs & symptoms:
- hypotonia
- poor feeding
- lethargy
- hypothermia
- bulging fontanelle

26
Q

When is lumbar puncture recommended in children with suspected sepsis?

A

1) under 1 month, presenting with fever

2) 1 to 3 months and are unwell or have a low or high WCC

27
Q

What are some contraindications of lumbar puncture?

A

Any signs of raised ICP:

  • focal neuro signs
  • papilloedema
  • significant bulging of the fontanelle
  • disseminated intravascular coagulation
  • signs of cerebral herniation
28
Q

What 2 special tests can look for meningeal irritation?

A

1) Kernig’s test

2) Brudzinski’s test

29
Q

What does Kernig’s test involve?

A

1) Lying patient on their back

2) Flex one hip and knee at 90 degrees

3) Slowly straighten knee whilst keeping hip flexed at 90 degrees

4) This creates slight stretch in meninges –> if there is meningitis: spinal pain, resistance to movement

30
Q

What is Brudzinski’s test?

A

1) Patient lying flato n their back

2) Gently use your hands to lift their head and neck off the bed, flexing their chin to their chest

3) A positive result (indicating meningitis): this causes the patient to flex their hips and knees involuntarily

31
Q

Where is the needle inserted in a lumbar puncture?

A

Usually into the L3-L4 or L4/L5 intervertebral space (spinal cord ends at the L1-L2 vertebral level.)

32
Q

Key cell differential found in CSF in bacterial meningitis?

A

Neutrophils

33
Q

Management of children in 1ary care with suspected meningitis AND a non-blanching rash?

A

Urgent dose of benzylpenicillin (IM or IV) while awaiting transfer to hospital (should not delay transfer).

If there is a true penicillin allergy: transfer should be the priority rather than other antibiotics.

34
Q

Dose of benzylpenicillin given in 1ary care in suspected cases of meningitis in children:
a) under 1 y/o
b) 1-9 y/o
c) over 10 y/o

A

a) 300mg
b) 600mg
c) 1200mg

35
Q

If meningococcal meningitis is suspected, what investigation should be done?

A

Meningococcal PCR –> This tests for meningococcal DNA.

It can give a result faster than blood cultures (depending on local services) and will still be positive after the bacteria has been treated with antibiotics.

36
Q

There should be a low threshold for treating suspected meningitis, particularly in babies and younger children. Always follow the local guidelines.

What are the typical antibiotics used in babies:
a) under 3 months
b) over 3 months

A

a) IV cefotaxime plus amoxicillin (amoxicillin is to cover listeria)

b) IV ceftriaxone (or cefotaxime)

37
Q

Management options in meningitis?

A

1) Abx (or aciclovir)

2) Steroids (only for bacterial meningitis)

3) Fluids

4) Cerebral monitoring

5) 5. Public health notification and antibiotic prophylaxis of contacts

38
Q

Who are steroids avoided in in meningitis?

A

NICE advise against giving corticosteroids in children younger than 3 months

39
Q

When should steroids be considered in meningitis?

A

Dexamethasone should be considered if the lumbar puncture reveals any of the following:

1) frankly purulent CSF
2) CSF WCC >1000/microlitre
3) raised CSF WCC with protein conc >1g/l
4) bacteria on gram stain

I.e. suspected or proven BACTERIAL meningitis.

40
Q

What should be added to drug treatment of bacterial meningitis if there is a risk of penicillin-resistant pneumococcal infection (e.g. recent foreign travel or prolonged antibiotic exposure)?

A

Vancomycin

41
Q

Purpose of steroids in bacterial meningitis?

A

To reduce the frequency and severity of hearing loss and neurological complications.

42
Q

Which types of meningitis are notifiable diseases to the UK Health Security Agency?

A

1) bacterial meningitis
2) meningococcal infection

43
Q

Significant exposure to meningococcal infection puts contacts at risk.

When is the risk highest?

A

Close prolonged contact within 7 days before the onset of the illness.

The risk to contacts decreases 7 days after the diagnosis.

44
Q

What is the usual post-exposure prophylaxis against meningococcal infection?

A

Single dose of ciprofloxacin given as soon as possible after the diagnosis.

45
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

46
Q

Complications of meningitis?

A

1) hearing loss
2) seizures & epilepsy
3) cognitivie impairment & learning disability
4) memory loss
5) focal neuro deficits e.g. limb weakness, spasticity
6) infective: sepsis, intracerebral abscess
7) pressure: brain herniation, hydrocepahlus

47
Q

Patients with meningococcal meningitis are at risk of Waterhouse-Friderichsen syndrome.

What is this?

A

A group of symptoms caused when the adrenal glands fail to function normally.

48
Q
A

Yr 4 - ACC (73 decks)

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