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Popular SAQ topics > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Define meningitis

A

Describes an inflammation of the meninges, usually due to infection. (meninges are the lining of the brain and spinal cord)

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2
Q

Name 5 common causes of bacterial meningitis

A

Neisseria meningitidis (most common)
Streptococcus pneumoniae (most common in adults)
Haemophilus influenzae
Group B streptococcus (GBS)
Listeral monocytogenes

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3
Q

What 2 pathogens commonly cause meningitis in neonates?

A

Group B streptococcus (GBS) (as HBS can colonise the vagina)

Listeria monocytogenes

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4
Q

Define meningococcal meningitis and meningococcal septicaemia.

A

Meningococcal meningitis - When the bacteria infects the meninges and the CSF

Meningococcal septicaemia - When the bacteria infects the bloodstream.

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5
Q

What rash is commonly seen in meningococcal septicaemia?

A

Non-blanching rash

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6
Q

What are the 3 most common causes of viral meningitis?

A

Enteroviruses (coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

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7
Q

What diagnostic test is performed to diagnose viral meningitis?

A

Viral PCR testing on CSF sample

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8
Q

What is used to treat HSV and VZV (viral meningitis)?

A

Aciclovir

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9
Q

Give 6 typical symptoms of meningitis

A

Fever

Neck stiffness

Vomiting

Headache

Photophobia

Altered consciousness/Seizures

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10
Q

How may meningitis present in babies/neonates?

A

Non-specific symptoms;

Hypotonia
Poor feeding
Lethargy
Hypothermia

Bulging fontanelle

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11
Q

When do NICE recommend performing a lumbar puncture on a child with suspected sepsis? (2)

A

Children who are;

Under 1 month, presenting with fever

1-3 months and are unwell or have a low or high white blood cell count

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12
Q

When performing a lumbar puncture, which vertebrae is the needle inserted?

A

L3/L4 or L4/L5 vertebral space

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13
Q

What tests are performed on a sample of CSF when investigating meningitis? (5)

A

Bacterial Culture

Viral PCR

Cell Count

Protein levels

Glucose levels

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14
Q

What may CSF test results show in a patient with bacterial meningitis? (5)

A

Appearance - Cloudy

Protein - High (bacteria release proteins)

Glucose - Low (bacteria eat glucose)

White Cell Count - High (neutrophils)

Culture - Shows Bacteria

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15
Q

What may CSF test results show in a patient with viral meningitis? (5)

A

Appearance - Clear

Protein - Mildly raised/normal

Glucose - Normal (viruses don’t eat glucose)

White cell count - High (lymphocytes)

Culture - Shows viruses

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16
Q

Is bacterial meningitis a medical emergency?

A

Yes. Should be treated immediately.

17
Q

A child presenting with suspected meningitis and a non-blanching rash should be given what immediately?

A

Benzylpenicillin (IM or IV)

Under 1 = 300mg
1-9 years = 600mg
Over 10 = 1200mg

18
Q

What antibiotics are given to babies with suspected meningitis?

A

Under 3 months - Cefotaxime + Amoxicillin (to cover listeria)

Above 3 months - Ceftriaxone

19
Q

If there is a risk of penicillin-resistant pneumococcal infection (e.g recent foreign travel/prolonged antibiotic exposure), what should be added? (treatment of bacterial meningitis)

A

Vancomycin

20
Q

What medication is used to reduce the frequency and severity of hearing loss and neurological complications in patients with bacterial meningitis?

A

Steroids (Dexamethasone)

21
Q

Is bacterial meningitis and menigococcal infection an notifiable disease?

A

Yes. Both should be notified to the UK Health Security Agency

22
Q

When is the exposure risk highest for people in close contact with an individual with a meningococcal infection?

A

Risk is highest within 7 days before onset of illness.

Risk decreases 7 days after the diagnosis.

23
Q

What is given as post-exposure prophylaxis for meningococcal infection?

A

Single dose of Ciprofloxacin (preferred) or rifampicin

24
Q

Give 5 complications of meningitis

A

Hearing loss (key complication)

Seizures and epilepsy

Cognitive impairment and learning disability

Memory loss

Focal neuological deficits (limb weakness or spasticity)

25
Q

In what circumstances should a lumbar puncture be delayed? (4)

A

Signs of severe sepsis or a rapidly evolving rash

Severe respiratory/cardiac compromise

Significant bleeding

Signs of raised ICP (focal neuro deficits, papilloedema, continuous/uncontrolled seizures, GCS <12)

26
Q

How should patients with signs of raised ICP be managed? (6)

A

Get critical care input

Secure airway + high flow oxygen

IV access > take bloods and blood cultures

IV dexamethasone

IV antibiotics (ceftriaxone/cefotaxime)

Arrange neuroimaging

27
Q

If a lumbar puncture is performed for suspected meningitis, what should it be tested for? (5)

A

glucose, protein, microscopy and culture

lactate

meningococcal and pneumococcal PCR

enteroviral, herpes simplex and varicella-zoster PCR

consider TB investigations

28
Q

Bacterial meningitis - What is the initial empirical therapy for child aged <3 months?

A

IV cefotaxime + amoxicillin (or ampicillin)

29
Q

Bacterial meningitis - What is the initial empirical therapy for aged 3 months - 50 years?

A

IV cefotaxime (or ceftriaxone)

30
Q

Bacterial meningitis - What is the initial empirical therapy for patients aged >50?

A

IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

31
Q

Bacterial meningitis - What is the treatment for meningococcal meningitis?

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

32
Q

Bacterial meningitis - What is the treatment for pneumococcal meningitis?

A

IV cefotaxime (or ceftriaxone)

33
Q

Bacterial meningitis - What is the treatment for meningitis caused by haemophilus influenzae?

A

Intravenous cefotaxime (or ceftriaxone)

34
Q

Bacterial Meningitis - What is the treatment for meningitis caused by Listera?

A

IV amoxicillin (or ampicillin) + Gentamicin

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