Meningitis Flashcards
Causes of meningitis
Primary vs secondary infection
- Sinusitis
- Otitis media
- Pharyngitis
- Mastoiditis
- Neck
- Respiratory tract
Causative agents of bacterial meningitis
< 1 month:
- Group B streptococcus
- E. coli
- Listeria monocytogenes
1 month - 2 years old:
- Strep pneumoniae
- Hemophilus influenzae type b
- Neisseria meningitidis
- Group B strep
2-50 yo:
- Neisseria meningitidis
- Strep pneumoniae
> 50yo:
- Strep pneumoniae (most common)
Causative agents of viral meningitis
Enterovirus
HSV (2 > 1)
EMV, CMV, VZV
Signs of neonatal meningitis
Lethargy
Muscle hypotonia
Irritability
Poor appetite, vomiting
Hyper/ hypothermia
Dyspnea, abnormal breathing patterns
High pitch crying
Bulging fontanelle***
Seizures
Signs of children/adult meningitis
Fever
Neck stiffness
AMS
Headache
N/V
Photophobia
For meningococcal meningitis, look out for
petechial/purpuric rash
Specific signs for meningitis
Late features of meningitis
Kernig’s sign: inability to fully extend knee when hip is flexed
Brudzinski sign: spontaneous flexion of hip during passive flexion of neck
Management sequence for meningitis
- Collect blood cultures, lactate, DIVC, ABG, FBC, RP
- Start antibiotics STAT
- CT
- Lumbar puncture
Choice of empirical abx for < 1 month
IV ampicillin + IV gentamicin
Choice of empirical abx for 1-3 months
IV ampicillin + IV cefotaxime
Choice of empirical abx for > 3 months
IV ceftriaxone + IV vancomycin + IV ampicillin (for > 50 or immunocompromised or pregnant)
Causative agent of meningococcal meningitis
Neisseria meningitidis
What is required for meningococcal meningitis?
Chemoprophylaxis for close contacts
- Rifampicin vs ciprofloxacin vs ceftriaxone
Viral meningitis management
Supportive treatment
+ IV acyclovir if encephalitis suspected
How to differentiate bacterial vs viral meningitis based on LP
Bacterial meningitis have LOW glucose
Viral meningitis have normal level of glucose
*bacteria eat glucose
