Meningitis Flashcards
Define meningitis
Describes an inflammation of the meninges, usually due to infection. (meninges are the lining of the brain and spinal cord)
Name 5 common causes of bacterial meningitis
Neisseria meningitidis (most common)
Streptococcus pneumoniae (most common in adults)
Haemophilus influenzae
Group B streptococcus (GBS)
Listeral monocytogenes
What 2 pathogens commonly cause meningitis in neonates?
Group B streptococcus (GBS) (as HBS can colonise the vagina)
Listeria monocytogenes
Define meningococcal meningitis and meningococcal septicaemia.
Meningococcal meningitis - When the bacteria infects the meninges and the CSF
Meningococcal septicaemia - When the bacteria infects the bloodstream.
What rash is commonly seen in meningococcal septicaemia?
Non-blanching rash
What are the 3 most common causes of viral meningitis?
Enteroviruses (coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)
What diagnostic test is performed to diagnose viral meningitis?
Viral PCR testing on CSF sample
What is used to treat HSV and VZV (viral meningitis)?
Aciclovir
Give 6 typical symptoms of meningitis
Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness/Seizures
How may meningitis present in babies/neonates?
Non-specific symptoms;
Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
When do NICE recommend performing a lumbar puncture on a child with suspected sepsis? (2)
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
When performing a lumbar puncture, which vertebrae is the needle inserted?
L3/L4 or L4/L5 vertebral space
What tests are performed on a sample of CSF when investigating meningitis? (5)
Bacterial Culture
Viral PCR
Cell Count
Protein levels
Glucose levels
What may CSF test results show in a patient with bacterial meningitis? (5)
Appearance - Cloudy
Protein - High (bacteria release proteins)
Glucose - Low (bacteria eat glucose)
White Cell Count - High (neutrophils)
Culture - Shows Bacteria
What may CSF test results show in a patient with viral meningitis? (5)
Appearance - Clear
Protein - Mildly raised/normal
Glucose - Normal (viruses don’t eat glucose)
White cell count - High (lymphocytes)
Culture - Shows viruses
Is bacterial meningitis a medical emergency?
Yes. Should be treated immediately.
A child presenting with suspected meningitis and a non-blanching rash should be given what immediately?
Benzylpenicillin (IM or IV)
Under 1 = 300mg
1-9 years = 600mg
Over 10 = 1200mg
What antibiotics are given to babies with suspected meningitis?
Under 3 months - Cefotaxime + Amoxicillin (to cover listeria)
Above 3 months - Ceftriaxone
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)
Vancomycin
What medication is used to reduce the frequency and severity of hearing loss and neurological complications in patients with bacterial meningitis?
Steroids (Dexamethasone)
Is bacterial meningitis and menigococcal infection an notifiable disease?
Yes. Both should be notified to the UK Health Security Agency
When is the exposure risk highest for people in close contact with an individual with a meningococcal infection?
Risk is highest within 7 days before onset of illness.
Risk decreases 7 days after the diagnosis.
What is given as post-exposure prophylaxis for meningococcal infection?
Single dose of Ciprofloxacin (preferred) or rifampicin
Give 5 complications of meningitis
Hearing loss (key complication)
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Focal neuological deficits (limb weakness or spasticity)
In what circumstances should a lumbar puncture be delayed? (4)
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)
How should patients with signs of raised ICP be managed? (6)
Get critical care input
Secure airway + high flow oxygen
IV access > take bloods and blood cultures
IV dexamethasone
IV antibiotics (ceftriaxone/cefotaxime)
Arrange neuroimaging
If a lumbar puncture is performed for suspected meningitis, what should it be tested for? (5)
glucose, protein, microscopy and culture
lactate
meningococcal and pneumococcal PCR
enteroviral, herpes simplex and varicella-zoster PCR
consider TB investigations
Bacterial meningitis - What is the initial empirical therapy for child aged <3 months?
IV cefotaxime + amoxicillin (or ampicillin)
Bacterial meningitis - What is the initial empirical therapy for aged 3 months - 50 years?
IV cefotaxime (or ceftriaxone)
Bacterial meningitis - What is the initial empirical therapy for patients aged >50?
IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
Bacterial meningitis - What is the treatment for meningococcal meningitis?
IV benzylpenicillin or cefotaxime (or ceftriaxone)
Bacterial meningitis - What is the treatment for pneumococcal meningitis?
IV cefotaxime (or ceftriaxone)
Bacterial meningitis - What is the treatment for meningitis caused by haemophilus influenzae?
Intravenous cefotaxime (or ceftriaxone)
Bacterial Meningitis - What is the treatment for meningitis caused by Listera?
IV amoxicillin (or ampicillin) + Gentamicin
