Meningitis

Question 1

Definition of meningitis

Answer 1

Inflammation of the leptomeninges in the brain and spinal cord.

Question 2

Definition of encephalitis

Answer 2

Inflammation of the brain parenchyma.

Question 3

Causes?

Answer 3

Infective
non-infective

Question 4

What kind of bacteria can cause meningitis?

Answer 4

1. Streptococcus pneumoniae (Pneumococcus)
2. Neisseria meningitidis (Meningococcus)
3. Listeria monocytogenes

Question 5

Pathway of infection?

Answer 5

Direct infection
Indirect infection

Question 6

Indirect infection?

Answer 6

1. Dissemination of the blood.
2. continuous spread of infection in nose, eyes, ears.
   3.Retrograde transport along or within peripherial or cranial nerves.

Question 7

Direct infection?

Answer 7

Due to trauma or surgery

Question 8

Clinical features of bacterial meningitis?

Answer 8

1. classic triad of meningitis: fever + headache + neck stiffness.
2. nausea, vomiting
3. photophobia
4. fatigue
5. altered mental status
6. seizures
7. skin lesion, rashes
8. may lead to increased intracranial pressure

Question 9

Clinical features of viral meningitis?

Answer 9

1. Flu like symptoms: low-grade fever, fatigue, muscle pain, upper respiratory symptoms (e.g. sore throat)
2. classic triad of meningitis
3. nausea, vomiting
4. photophobia

Question 10

What’s the 3 examination wich you can detect meningitis?

Answer 10

1. Laboratory tests
2. Lumbar puncture and CSF analysis
3. Head CT

Question 11

CSF analysis in acut bacterial meningitis?
(1.macroscopic appearance, 2. cell count (cell/µL), 3. cell type, 4. protein (g/L), 5. glucose)

Answer 11

1. cloudy, purulent fluid
2. significantly increased >1000
3. Polymorphonuclear cells
   (granulocytes)
4. significantly increased
   >1
5. significantly decreased
   ~1/3 of blood glucose level

Question 12

CSF analysis in viral meningitis or encephalitis?
(1.macroscopic appearance, 2. cell count (cell/µL), 3. cell type, 4. protein (g/L), 5. glucose)

Answer 12

1. clear fluid
2. increased
   100-1000
3. lymphocytes
4. normal or increased
   0,4-1
5. normal or sightly decreased

Question 13

What’s the difference of bacterial and viral meningitis prognosis?

Answer 13

Bacterial prognosis: fatal if left untreated.
Viral prognosis: usually resolves spontaneously in most cases.

Question 14

Treatment of bacterial meningitis?

Answer 14

1. intravenous antibiotics
2. combination therapy (e.g. ceftriaxone, ampicillin, vancomycin)
3. corticosteriod to reduce inflammation (e.g. dexamethason)
4. fever and pain management

Question 15

Treatment of viral meningitis?

Answer 15

usually only symptomatic therapy (fever and pain management)

Question 16

Two types of meningitis prevention?

Answer 16

1. Preexposure prophylaxis- vaccination
2. Postexposure measures-chemoprophylaxis

Question 17

Vaccination to prevent meningitis?

Answer 17

1. Hemophilus influaenzae B: obligatory at 2,3,4 and 18 months
2. Streptococcus pneumoniae: obligatory at 2, 4 and 12 months (PCV13)
3. Neisseria meningitidis- not obligatory
   Nimenrix- against Meningococcus A,C,W135,Y
   Bexsero- against Meningococcus B

Question 18

Postexposure measures?

Answer 18

1. Antibiotic therapy
2. Public measures: notification, reporting, isolation

Indicated for all individuals exposed to an index case (close contacts) if caused by: -Neisseria meningitidis
- Hemophilus
influaenzae

Question 19

Risk factors?

Answer 19

1. crowded living condition (e.g. kindergarten)
2. close contact with an infected person
3. otitis media, sinusitis, mastoiditis, pneumonia, spesis
4. drain, shunt in the brain
5. cancer, chronic illness (e.g. diabetes, chirrosis)
6. AIDS, removal of spleen