Meningitis Flashcards
What is meningitis
Inflammation of the meninges of the brain
Causes of meningitis
Viral meningitis
Bacrerial meningitis
4 main causes of bacterial meningitis
Streptococcus pneumniae
Neissiera meningitidis
Haemophilus influenzae
Listeria
Causes of meninigitis to look out for in neonates, elderly, immunosupressed
Listeria (unpasteurised dairy)
TB esp w HIV
Meningitis presenting smyptoms
Headache
Fever
Neck stiffness
Altered mental status
>2+ in 95% conditions but often dont have all
What clinical signs can suggest meningitis
Neck stiffness - kerniges, brudzinkis
Rash - non blanching purpuric = meningococcal sepsis
What is kerniges test
Flex hip and extend knee
Positive = pain in back and legs
What is brudzinkis sign
Passively flex head - positive = flexion at hipe to lift lefs
Warning signs of poor prognosis in meningitis
DIC: Rapidly progresive rash
Sev sepsis/shock: Poor peripheral perfusion, cap refill time >4 secs, oliguria and systolic BO <90 (hypotension late sign)
RR<8 or >30
HR <40 or >140
Acidosis <7.3 or BE less than -5
WBC <4
NEURO:
GCS<12 or fluctuating consciousness
Focal neurology
Persistent sizures
Bradycardia and hypertension
Papilloedema
What do poor prognositc features predict the presence of in meningitis
Disseminated intravascular coagulation
Severe sepsis/septic shock
Raised ICP
Investigations for meningitis
Bloods
LP - PCR, gram stain and culture
Brain imaging before LP with criteria
Bloods in meningitis
FBC, U_Es, LFTs, coagulation, CRP, lactate, blood cultures
16SPCR - S.pneumonia and N.meninigitidis
What does meningitis look like on LP
High opening pressure
Cloudy
100-50,0000 WCC
Neutrophils
Low glucose
Protein high >1
What might mean a non classical LP in meninigitis
If need imaging before and LP significantly delayed, prior antibiotic treaetment
When need to do brain imaging before LP
(signs of raised ICP)
New onset or recent seizures
Papilloedmea
Focal neurological deficit
Reduced or deteriorating conscious level (GCS<12)
General principles of meningitis managmenet
A-E assess
Sepsis 6
Antibiotic therapy
When treat outpatients with meningitis
When meningococcal rash, septic shock/severe, iver an hor before can get to hospital - IM benzylpenicillin or ceftriazone
Antibiotic therapy given in hospital for meningitis
Antibiotics within 1 hour if sus (just after take tests)
Cefotazime/ceftriazone
What antibiotic use if penicillin allergic in meningitis
Chloramphenicol
Why use Cefotazime/ceftriazone in meningitis
Cross BBB, high conc in CSF
3rd generation cephalosporin
How can steroids benefit patients with meningitis
Modest reduction in mortality in oneumococcal meningitis
Reduction in hearing loss risk
When give steroids in meningitis
Start dexamethasone ideally just before antibiotics
If cant then in first 12 hours beneficial
4 days
Prognosis of meningococcal infection
Mortality - children 4-8%, adults 7%
Significant morbiditiy - 10%
Prognosis of pneumococcal meningitis
8% child mortality, 20-40% adukt
30-50% of survivors morbidity significant
