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
Most common morbidities left with after meningitis
Deafness
Cognitive impiarment
Focal neurological deficits
Epilepsy
Which infection is post exposure prophylaxis used in meningitis
ONLY meningococcal infection
What is the arim of PE prophylaxis meningitis
Eradicate nasal carriage of N.meningitidis
Who is PE prophylaxis for M meninitis offered to
Close contacts - house, halls
High risk exposure - AW secretions intubation etc
Recommended PE prophylaxis for meningococcal meningitiis
Ciprofloxacin oral single dose
Rifampacin 2 days
IM ceftriaxone single dose
What vaccinations available against bacterial meningitis
Haemopholus influenzae B
meningitis ACWY
Men B
Strep pneumoniae
What viruses can cause viral meningitis
Enteroviruses > HSV1+2 >VZV
How differentiate viral vs bacterial meningitis
Difficult clinically
Need PCR - myphocytosis w normal proteina nd glucose, viral PCR
Treatment for viral meningitis
Self limitng and managed supportively (no benefit of antivirals)
Prognosis of viral meningitis
Significant long term morbidity
Slow recovery
Headaches, fatigue, slowed thinking, mood disturbance
Risk factors for a fatal outcome in
meningococcal disease.
apidly progressing rash
Coma
Hypotension and shock
Lactate >4 mmol/L
Low/normal peripheral white blood cell count
Low acute phase reactants
Low platelets
Coagulopathy
Absence of meningitis
What tests do after LP viral memninigtis
PCR for enteroviruses, HSV 1+2, VZV on CSF smaple
What test should all patients with meningitis be offered
HIV
When do CT beore LP
Whem risk of gross cerebral pathology eg sapce occupying lesion, infart, haemorrhage eg post seizure
