Meningitis

Question 1

Most common causes of community acquired bacterial meningitis are?

Answer 1

Neisseria meningitidis and streptococcus pneumoniae

Question 2

Presentation of meningitis?

Answer 2

• Fever
• Neck stiffness
• Vomiting
• Headache
• Photophobia
• Altered consciousness
• Seziures

Meningococal septicaemia will present with a non-blanching rash

Question 3

Kernig’s test ?

Answer 3

Involves laying a patient on their back, flexing one hip and knee to 90 degress and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees= slight stretch of the meninges- if meningitis= spinal pain or resistance to movement

Question 4

Brudzinski’s test?

Answer 4

Lying patient flat on their back and lifting their head and neck off the bed and flex their chin to their chest
In meningitis this can cause involuntary flexion of their hips and knees

Question 5

CSF findings in bacterial, viral and TB meningitis?

Answer 5

Bacterial:
Opening pressure- raised
Appearance- cloudy
Glucose- low
Protein- high
WBC- high neutrophils

Viral:
Appearance- Clear/cloudy
Glucose- high
Protein- normal/raised
WBC- high lymphocytes

TB:- PCR used in detection of this
Appearance- Slight cloudy, fibrin wed
Glucose- Low
Protein- High
WBC- 10-1,000

Question 6

Management of bacterial meningitis?

Answer 6

In pre hospital setting- IM benzylpenicillin

• IV access- take blood and blood cultures
• Lumbar puncture before IV antibiotics if can be done within an hour if not IV antibiotics should be given asap

Iv antibiotics:
* 3 months- 50 years- cefotaxime
* >50 years- cefotaxime and amoxicillin

IV dexamethasone 10mg 4 times daily for 4 days can be started within 12 hours of antibitoics commencement - it improves outcomes by reducing neurological sequelae

CT scan is not normally indicatated unless there is signs of ICP

Question 7

Management of patients with signs of raised ICP?

Answer 7

• Crit care output
• Secure airway + high flow oxygen
• IV access- take blood and cultures
• IV dexamethasone
• IV antibiotics- cefotaxime
• Arrange neuroimaging

Question 8

Investigations for suspected bacterial meningitis?

Answer 8

• FBC
• Renal function
• Glucose
• Lactate
• Clotting profile
• CRP

Question 9

Management of contacts of bacterial meningitis?

Answer 9

Risk is highest in 1st 7 days but persists fro at least 4 weeks

Should be given oral ciprofloxacin if close contact within the 7 days before onset

Question 10

What is inflammed in viral meningitis and causes of it?

Answer 10

Inflammation of the leptomeninges and the CSF fluid of the subarachnoid space

Causes:
* Enteroviruses e..g. coxsackie virus, echovirus
* Mumps
* HSV
* HIV
* Measles

Question 11

Management of viral meningitis?

Answer 11

If any question of bacterial meningitis or encephalitis- should be started on broad spec antibitoics with CNS penetration e.g. ceftriaxone and aciclovir IV

Usually self limiting with symps improving over 7-14 days

Aciclovir is given if patient is suspected of having meningitis secondary to HSV

Question 12

Common complications of meningtitis?

Answer 12

• Sensorineural hearing loss- most common
• Seizures
• Focal neuro deficit
• Sepsis/ intracerebral abscess
• Pressure= brain herniation/hydrocephalus

Question 13

Ages of doses for meningitis?

Answer 13

• 2 months
• 4 months
• 12-13 months

Question 14

Most common fungal cause of meningitis?

Answer 14

Cryptococcus neoformans

Question 15

How many specimen collection pots will be needed for the CSF fluid in suspected meningitis?

Answer 15

Minimum of 4

Question 16

Alternative 1st line treatment for patient with suspected meningitis with severe penicillin allergy is?

Answer 16

IV chloramphenicol

Question 17

Most appropriate initial investigation for someone with low GCS and seizure?

Answer 17

Blood glucose- hypoglycaemia can be cause of both seizure and reduced GCS