Meningitis

Question 1

What are some bacterial causes of meningitis? (5)

Answer 1

• Neisseria meningitidis
• Streptococcus pneumoniae (pneumococcus)
• Haemophilus influenzae
• Group B streptococcus (GBS) (particularly in neonates as GBS may colonise the vagina)
• Listeria monocytogenes (particularly in neonates)

Question 2

What type of bacteria is neisseria meningitidis? Gram and shape

Answer 2

Gram negative diplococcus bacteria

Question 3

What is the most common cause of bacterial meningitis?

Answer 3

Neisseria meningitidis

Question 4

What symptom can meningococcal septicaemia cause?

Answer 4

Non-blanching rash

Question 5

What are the most common causes of viral meningitis? (3)

Answer 5

• Enteroviruses (e.g., coxsackievirus)
• Herpes simplex virus (HSV)
• Varicella zoster virus (VZV)

Question 6

What are the typical symptoms of meningitis? (7)

Answer 6

§ Fever
§ Neck stiffness
§ Vomiting
§ Headache
§ Photophobia
§ Altered consciousness
§ Seizures

Question 7

What are some complications of meningitis? (5)

Answer 7

– Hearing loss (a key complication)
– Seizures and epilepsy
– Cognitive impairment and learning disability
– Memory loss
– Focal neurological deficits, such as limb weakness or spasticity

Question 8

What are the 2 special tests done in meningitis?

Answer 8

Kernigs test
Brudzinskis test

Question 9

What is kernigs test?

Answer 9

® Involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees.
® This creates a slight stretch in the meninges.
® Where there is meningitis, it will produce spinal pain or resistance to movement.

Question 10

What is brudzinskis test?

Answer 10

® Involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed, flexing their chin to their chest.
® A positive test, indicating meningitis, is when this causes the patient to flex their hips and knees involuntarily.

Question 11

At what level does the spinal cord end?

Answer 11

L1-L2

Question 12

Where is the needle inserted in a LP?

Answer 12

® The needle is usually inserted into the L3-L4 or L4/L5 intervertebral space.

Question 13

CSF results:
Cloudy, high bacteria, low glucose, WCC high (mainly neutrophils).
What does it suggest?

Answer 13

Bacterial meningitis

Question 14

CSF results:
Clear, mildly raised protein, normal glucose, high WCC (mainly lymphocytes).
What does this suggest?

Answer 14

Viral meningitis

Question 15

What are the protein and glucose results in CSF for viral and bacterial meningitis?

Answer 15

Bacterial:
High protein, low glucose

Viral:
Mildly raised or normal protein, normal glucose

Question 16

What white cells are most seen in CSF of viral and bacterial meningitis?

Answer 16

Bacterial = neutrophils
Viral = lymphocytes

Question 17

What drug is given in primary care setting for suspected meningitis while awaiting transfer to hospital?
What are the doses? (3)

Answer 17

Benzylpenecillin (IM or IV)

◊ Under 1 year – 300mg
◊ 1-9 years – 600mg
◊ Over 10 years – 1200mg

Question 18

What antibiotics are used to treat bacterial meningitis in neonates under 3 months?

Answer 18

Cefotaxime plus amoxicillin

Question 19

What antibiotics are used to treat bacterial meningitis in children over 3 months old?

Answer 19

Ceftriaxone

Question 20

What drug is used to treat viral meningitis?

Answer 20

Aciclovir

Question 21

What drug is used in bacterial meningitis to reduce the risk of hearing loss and neurological complications?

Answer 21

Steroids e.g. dexamethasone