MENINGITIS

Question 1

Type of meningitis common in Nothern and Upper regions of Ghana

Answer 1

Cerebrospinal meningitis (CSM)

Question 2

Which season is CSM most common

Answer 2

Harmattan season

Question 3

Causative agent for cerebrospinal meningitis

Answer 3

Neisseria meningitides

Question 4

Bacterial causes of meningitis

Answer 4

Neisseria meningitides
Streptococcus pneumoniae
Haemophilus influenza
Mycobacterium tuberculosis
Staphylococcus aureus
Escherichia coli (neonates)

Question 5

Viral causes of meningitis

Answer 5

Herpes virus

Question 6

Protozoal causes of meningitis

Answer 6

Toxoplasma gondii in HIV

Question 7

Fungal causes of meningitis

Answer 7

Cryptococcus neoformans

Question 8

Symptoms of meningitis in children less than 1year

Answer 8

Fever
Vomiting
Irritability
Refusal to eat
Poor suckling
Focal or generalized convulsions after which the child is sleepy
Lethargy
Bulging fontanelle

Question 8

Signs of meningitis in adults and children over 5 years

Answer 8

Fever
Neck stiffness
Kernig’s sign
Altered consciousness
Coma

Question 9

Symptoms of meningitis in adults and children over 5 years

Answer 9

Fever
Neck pains
Severe headache
Photophobia
Convulsions
Vomiting

Question 9

Symptoms that occur in both children and adults

Answer 9

Fever
Vomiting

Question 10

Signs of meningitis in children less than 1 year

Answer 10

Neck retraction
Hypotonia or hypertonia
Bulging fontanelle

Presence or absence of neck stiffness
Presence or absence of fever

Coma
Convulsion

Question 10

Investigations in meningitis

Answer 10

FBC
RDT for malaria
Blood film for malaria
Lumbar puncture
Blood culture and sensitivity

Question 10

Signs of meningitis that is present only in children under 1 year

Answer 10

Bulging fontanelle
Hypotonia or hypertonia
Neck retraction

Question 11

Signs of meningitis that can be present or absent in children less than 1 year

Answer 11

Fever
Neck stiffness

Question 12

Non-pharmacological interventions

Answer 12

Tepid sponging
Keep the airway clear
Nasogastric tube feeding if applicable

Question 12

Lumbar puncture is done only after excluding……………..

Answer 12

Increased intracranial pressure

Question 13

Second line treatment for bacterial meningitis

Answer 13

IV Cefotaxime and IV Vancomycin

Question 13

First line treatment for bacterial meningitis

Answer 13

IV Ceftriaxone and IV Vancomycin

or

IV Benzylpenicillin and IV Chloramphenicol

or in penicillin allergy

IV Clindamycin and IV Chloramphenicol

Question 14

Prophylaxis for cerebrospinal meningitis

Answer 14

Tab Ciprofloxacin
or
IM Ceftriaxone

Question 15

Dose of ciprofloxacin for prophylaxis of CSM

Answer 15

Adults
500 mg as a single dose

Children
5-12 years; 250 mg as a single dose

Question 15

Role of steroids in meningitis

Answer 15

Dexamethasone started together with the first dose of the appropriate antibiotic has been found to lead to major reduction in hearing loss and death in both children and adults.

Question 16

Dose of dexamethasone in bacterial meningitis

Answer 16

IV Dexamethasone 4-10 mg 6hourly for 5-7 days

Question 17

Dose of ceftriaxone for prophylaxis of CSM

Answer 17

Adults
250 mg as a single dose

Children
< 12 years; 125 mg as a single dose

Question 18

Dose for IV vancomycin in Bacterial meningitis

Answer 18

Adults and children over 2 years: 15 mg/kg 12 hourly for 7-10 days 1 month-2 years; 15 mg/kg 8 hourly for 10-14days < 1 month; not recommended

Question 19

IV Cefotaxime dose used in Bacterial meningitis

Answer 19

Adults 2g 6 hourly for 7 days Children > 12 years or body weight > 50kg; 2 g 6 hourly < 12 years or body weight < 50kg; 50 mg/kg 6 hourly

Question 20

Dose for IV Clindamycin in bacterial meningitis

Answer 20

Adults 600-900 mg 8 hourly for 14 days Children 13 mg/kg 8 hourly for 14 days

Question 20

IV Chloramphenicol dose in bacterial meningitis

Answer 20

Adults 1g 6 hourly for 14 days Children 25 mg/kg 6 hourly for 14 days

Question 21

Dose for IV/IM Ceftriaxone in bacterial meningitis

Answer 21

Adults 2-4 g daily for 7-10 days Children > 12 years; 2-4 g daily for 7-10 days < 12 years; 50-80 mg/kg for 10-14 days Neonates; 20-50 mg/kg once daily for 21 days

Question 22

Dose for benzylpenicillin in bacterial meningitis

Answer 22

Adults 4 MU 4 hourly for 14 days Children 0.2 MU/kg 6 hourly for 14 days

Question 23

Dose for IV chloramphenicol in bacterial meningitis

Answer 23

Adults 1 g 6 hourly for 14 days Children 25 mg/kg 6 hourly for 14 days

Question 24

Dose for IM Chloramphenicol in bacterial meningits

Answer 24

Adults 100 mg/kg as a single dose Children 100 mg/kg as a single dose

Question 25

Chloramphenicol is not used in these populations....

Answer 25

Children below 2 months Pregnancy Lactation

Question 26

Most likely pathogens for bacterial meningitis in adults under 50 years

Answer 26

Meningococcus Pneumococcus Haemophilus Influenza

Question 27

Most likely pathogens for bacterial meningitis in adults over 50 years

Answer 27

Pneumococcus Listeria Gram-negative bacilli

Question 28

Most likely pathogens for hospital acquired meningitis

Answer 28

Staphylococci, Gram-negative bacilli Pneumococcus Pseudomonas

Question 29

First line antibiotics for managing meningitis in patients under 50 years

Answer 29

Ceftriaxone And Vancomycin

Question 30

Alternative antibiotics for managing meningitis in people under 50 years

Answer 30

Cefotaxime Meropenem Fluoroquinolones

Question 31

First line antibiotics for managing meningitis in patients over 50 years

Answer 31

Ceftriaxone Or Ampicillin And Vancomycin

Question 32

Alternative antibiotics for managing meningitis in patients over 50 years

Answer 32

Fluoroquinolones

Question 32

First line antibiotics for managing hospital acquired meningitis

Answer 32

Ceftazidime with/without Gentamycin

Question 33

Alternative antibiotics for managing hospital acquired meningitis

Answer 33

Meropenem Vancomycin