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Infectious disease > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis

A

Inflammation of the meninges of the brain

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2
Q

Causes of meningitis

A

Viral meningitis
Bacrerial meningitis

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3
Q

4 main causes of bacterial meningitis

A

Streptococcus pneumniae
Neissiera meningitidis
Haemophilus influenzae
Listeria

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4
Q

Causes of meninigitis to look out for in neonates, elderly, immunosupressed

A

Listeria (unpasteurised dairy)
TB esp w HIV

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5
Q

Meningitis presenting smyptoms

A

Headache
Fever
Neck stiffness
Altered mental status
>2+ in 95% conditions but often dont have all

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6
Q

What clinical signs can suggest meningitis

A

Neck stiffness - kerniges, brudzinkis
Rash - non blanching purpuric = meningococcal sepsis

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7
Q

What is kerniges test

A

Flex hip and extend knee
Positive = pain in back and legs

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8
Q

What is brudzinkis sign

A

Passively flex head - positive = flexion at hipe to lift lefs

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9
Q

Warning signs of poor prognosis in meningitis

A

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

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10
Q

What do poor prognositc features predict the presence of in meningitis

A

Disseminated intravascular coagulation
Severe sepsis/septic shock
Raised ICP

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11
Q

Investigations for meningitis

A

Bloods
LP - PCR, gram stain and culture
Brain imaging before LP with criteria

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12
Q

Bloods in meningitis

A

FBC, U_Es, LFTs, coagulation, CRP, lactate, blood cultures
16SPCR - S.pneumonia and N.meninigitidis

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13
Q

What does meningitis look like on LP

A

High opening pressure
Cloudy
100-50,0000 WCC
Neutrophils
Low glucose
Protein high >1

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14
Q

What might mean a non classical LP in meninigitis

A

If need imaging before and LP significantly delayed, prior antibiotic treaetment

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15
Q

When need to do brain imaging before LP

A

(signs of raised ICP)
New onset or recent seizures
Papilloedmea
Focal neurological deficit
Reduced or deteriorating conscious level (GCS<12)

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16
Q

General principles of meningitis managmenet

A

A-E assess
Sepsis 6
Antibiotic therapy

17
Q

When treat outpatients with meningitis

A

When meningococcal rash, septic shock/severe, iver an hor before can get to hospital - IM benzylpenicillin or ceftriazone

18
Q

Antibiotic therapy given in hospital for meningitis

A

Antibiotics within 1 hour if sus (just after take tests)
Cefotazime/ceftriazone

19
Q

What antibiotic use if penicillin allergic in meningitis

A

Chloramphenicol

20
Q

Why use Cefotazime/ceftriazone in meningitis

A

Cross BBB, high conc in CSF
3rd generation cephalosporin

21
Q

How can steroids benefit patients with meningitis

A

Modest reduction in mortality in oneumococcal meningitis
Reduction in hearing loss risk

22
Q

When give steroids in meningitis

A

Start dexamethasone ideally just before antibiotics
If cant then in first 12 hours beneficial
4 days

23
Q

Prognosis of meningococcal infection

A

Mortality - children 4-8%, adults 7%
Significant morbiditiy - 10%

24
Q

Prognosis of pneumococcal meningitis

A

8% child mortality, 20-40% adukt
30-50% of survivors morbidity significant

25
Q

Most common morbidities left with after meningitis

A

Deafness
Cognitive impiarment
Focal neurological deficits
Epilepsy

26
Q

Which infection is post exposure prophylaxis used in meningitis

A

ONLY meningococcal infection

27
Q

What is the arim of PE prophylaxis meningitis

A

Eradicate nasal carriage of N.meningitidis

28
Q

Who is PE prophylaxis for M meninitis offered to

A

Close contacts - house, halls
High risk exposure - AW secretions intubation etc

29
Q

Recommended PE prophylaxis for meningococcal meningitiis

A

Ciprofloxacin oral single dose
Rifampacin 2 days
IM ceftriaxone single dose

30
Q

What vaccinations available against bacterial meningitis

A

Haemopholus influenzae B
meningitis ACWY
Men B
Strep pneumoniae

31
Q

What viruses can cause viral meningitis

A

Enteroviruses > HSV1+2 >VZV

32
Q

How differentiate viral vs bacterial meningitis

A

Difficult clinically
Need PCR - myphocytosis w normal proteina nd glucose, viral PCR

33
Q

Treatment for viral meningitis

A

Self limitng and managed supportively (no benefit of antivirals)

34
Q

Prognosis of viral meningitis

A

Significant long term morbidity
Slow recovery
Headaches, fatigue, slowed thinking, mood disturbance

35
Q

Risk factors for a fatal outcome in
meningococcal disease.

A

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

36
Q

What tests do after LP viral memninigtis

A

PCR for enteroviruses, HSV 1+2, VZV on CSF smaple

37
Q

What test should all patients with meningitis be offered

A

HIV

38
Q

When do CT beore LP

A

Whem risk of gross cerebral pathology eg sapce occupying lesion, infart, haemorrhage eg post seizure

Infectious disease (37 decks)

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