Meningitis

Question 1

What is meningitis

Answer 1

inflammation of the meninges which line the brain and spinal cord
CSF is contained within the meninges in the subarachnoid space

Question 2

What is the most common cause of bacterial meningitis

Answer 2

Neisseria meningitides which is a gram negative diplococcus AKA meningococcus

Question 3

What are the three main causes of bacterial meningitis

Answer 3

• Neisseria meningitides
• Strep pneumoniae
• haemophiliac influenzae

Question 4

What are the two causes of bacterial meningitis specific to neonates

Answer 4

• group B strep
• listeria monocytogenes

Question 5

What causes a non-blanching rash in meningitis

Answer 5

meningococcal septicaemia- the infection in the bloodstream

Question 6

What are the most common causes of viral meningitis

Answer 6

• enteroviruses (eg coxsackie virus)
• herpes simplex virus (HSV)
• varicella zoster virus (VZV)

Question 7

What are the typical symptoms of meningitis?

Answer 7

• fever
• neck stiffness
• photophobia
• vomiting
• headache/ altered consciousness
• seizures

Question 8

What are the typical symptoms of meningitis in neonates

Answer 8

• hypotonia (floppy)
• poor feeding
• lethargy
• hypothermia
• bulging fontanelle

Question 9

What are the two special tests for meningitis

Answer 9

• Kernigs sign
• Brudinskis sign

Question 9

According to NICE guidelines what children require lumbar puncture

Answer 9

• under 1 month presenting with seizure
• 1 to 3 months who are unwell or have low/ high white cell count

Question 10

What is kernigs sign

Answer 10

lie patient flat on back, flex knee and hip to 90 and slowly straighten knee whilst hip still flexed- creates slough stretch in meninges
will produce spinal pain/ resistance to movement

Question 11

What is Brudinskis sign

Answer 11

lie patient flat on back and gently use hands to lift head and neck off bed- flexing chin to chest
causes patient to flex hips and knee involuntarily

Question 12

What level does the spinal cord end?

Answer 12

L1 to L2

Question 13

What level is a lumbar puncture performed at

Answer 13

L3-4/ L4-5 intervertebral space

Question 14

Appearance of CSF in meningitis

Answer 14

bacterial- cloudy
viral- clear

Question 15

How do bacteria and viruses live in CSF

Answer 15

• bacteria swimming will release proteins and use up glucose
• viruses may release protein but dont require glucose

Question 16

White cell count in CSF

Answer 16

bacterial more neutrophils
viruses more lymphocytes

Question 17

Management of bacterial meningitis

Answer 17

• medical emergency
• children given IM or IV benzylpenicillin in primary care
  < 3months cefotaxime and amoxicillin (to cover listeria)
  > 3 months ceftriaxone

Question 18

When is vancomycin added to meningitis treatment

Answer 18

if the risk of penicillin resistant pneumococcal infection ( eg recent foreign travel/ prolonged antibiotic exposure)

Question 19

Why are steroids (eg dexamethosone) used in meningitis treatment

Answer 19

to decrease risk of hearing or neurological problems

Question 20

What prophylaxis is given to meningitis close contacts

Answer 20

single dose cirpofloxacin

Question 21

What are the complications of meningitis

Answer 21

• hearing loss
• seizures and epilepsy
• cognitive impairment and learning disability
• memory loss
• focal neurological deficit