Meningitis Flashcards
What are contraindications to lumbar puncture in children?
Signs of raised ICP, focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, signs of cerebral herniation.
What should be obtained instead of a lumbar puncture for patients with meningococcal septicaemia?
Blood cultures and PCR for meningococcus.
What antibiotics are recommended for children under 3 months with meningitis?
IV amoxicillin (or ampicillin) + IV cefotaxime.
What antibiotics are recommended for children over 3 months with meningitis?
IV cefotaxime (or ceftriaxone).
What should be considered if the lumbar puncture reveals frankly purulent CSF?
Dexamethasone should be considered.
What are the common causes of meningitis in children aged 0 - 3 months?
Group B Streptococcus, E. coli, Listeria monocytogenes.
What are the common causes of meningitis in children aged 3 months - 6 years?
Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae.
What are the common causes of meningitis in adults aged 6 years - 60 years?
Neisseria meningitidis, Streptococcus pneumoniae.
What are the common causes of meningitis in individuals over 60 years?
Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes.
What are the neurological complications of meningitis?
Sensorineural hearing loss, seizures, focal neurological deficit.
What is a risk associated with meningococcal meningitis?
Waterhouse-Friderichsen syndrome (adrenal insufficiency secondary to adrenal haemorrhage).
What are the CSF findings in bacterial meningitis?
Cloudy appearance, low glucose, high protein, 10 - 5,000 polymorphs/mm³.
What are the CSF findings in viral meningitis?
Clear/cloudy appearance, 60-80% of plasma glucose, normal/raised protein, 15 - 1,000 lymphocytes/mm³.
What are the CSF findings in tuberculous meningitis?
Slight cloudy appearance, low glucose, high protein, 30 - 300 lymphocytes/mm³.
What are the CSF findings in fungal meningitis?
Cloudy appearance, low glucose, high protein, 20 - 200 lymphocytes/mm³.
What is the sensitivity of the Ziehl-Neelsen stain in detecting tuberculous meningitis?
Only 20% sensitive; PCR is sometimes used with a sensitivity of 75%.
CSF findings in meningitis
What is the initial management step for suspected bacterial meningitis?
All patients should be transferred to hospital urgently.
What should be administered if meningococcal disease is suspected in a pre-hospital setting?
Intramuscular benzylpenicillin may be given, as long as this doesn’t delay transit to hospital.
What is the ABC approach in the management of suspected bacterial meningitis?
Airway, Breathing, Circulation, Disability (GCS, focal neurological signs, seizures, papilloedema).
When should a senior review be requested in suspected bacterial meningitis cases?
If any warning signs are present, such as a rapidly progressive rash or poor peripheral perfusion.
What are some warning signs that require senior review?
Rapidly progressive rash, poor peripheral perfusion, abnormal respiratory or pulse rates, pH < 7.3, WBC < 4 * 10^9/L, lactate > 4 mmol/L, GCS < 12, poor response to fluid resuscitation.
What is a key decision regarding lumbar puncture (LP) in suspected bacterial meningitis?
Deciding when/whether to attempt a lumbar puncture, considering the potential delay in treatment.
When should lumbar puncture be delayed?
In cases of severe sepsis, rapidly evolving rash, severe respiratory/cardiac compromise, significant bleeding risk, raised intracranial pressure, focal neurological signs, papilloedema, continuous seizures, or GCS ≤ 12.
What is the management protocol for patients without indication for delayed LP?
IV access, take bloods and cultures, perform lumbar puncture, administer IV antibiotics if LP cannot be done within the first hour.
What antibiotics are recommended for patients aged 3 months to 50 years with suspected bacterial meningitis?
IV cefotaxime (or ceftriaxone).
What additional treatment is recommended for suspected pneumococcal meningitis in adults?
Consider adjunctive treatment with IV dexamethasone, preferably starting before or with the first dose of antibacterial.
What should be done for patients with signs of raised intracranial pressure?
Get critical care input, secure airway, administer high-flow oxygen, take bloods and cultures, give IV dexamethasone and IV antibiotics, and arrange neuroimaging.
What is the management for patients with signs of severe sepsis or a rapidly evolving rash?
Get critical care input, secure airway, administer high-flow oxygen, take bloods and cultures, provide IV fluid resuscitation, and give IV antibiotics.
What blood tests should be conducted for suspected bacterial meningitis?
Full blood count, renal function, glucose, lactate, clotting profile, CRP.
What should be tested in the cerebrospinal fluid (CSF) if an LP is performed?
Glucose, protein, microscopy and culture, lactate, meningococcal and pneumococcal PCR, enteroviral, herpes simplex and varicella-zoster PCR.
What is the BNF recommendation for initial empirical therapy for patients aged < 3 months?
IV cefotaxime + amoxicillin (or ampicillin).
What prophylaxis should be offered to contacts of patients with meningococcal meningitis?
Prophylactic antibiotics should be given to households and close contacts exposed within the 7 days before onset.
What is the drug of choice for prophylaxis in close contacts of meningococcal meningitis?
Oral ciprofloxacin is preferred as it is widely available and requires only one dose.
What should be offered to close contacts when serotype results are available?
Meningococcal vaccination, including booster doses for those who had the vaccine in infancy.
Mx suspected bacterial meningitis
What is viral meningitis?
Viral meningitis is inflammation of the leptomeninges and cerebrospinal fluid attributed to a viral agent. It is generally considered a more benign condition compared to bacterial meningitis.
How common is viral meningitis?
Approximately 3,000 cases of confirmed viral meningitis are reported yearly, but the actual number is likely much higher due to underreporting.
What are the common causes of viral meningitis?
Common causes include non-polio enteroviruses (e.g., coxsackie virus, echovirus), mumps, herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses, HIV, and measles.
What are the risk factors for viral meningitis?
Risk factors include patients at the extremes of age (< 5 years and the elderly), immunocompromised individuals (e.g., patients with renal failure, diabetes), and intravenous drug users.
What are common clinical features of viral meningitis?
Common features include headache, neck stiffness, photophobia (often milder than in bacterial meningitis), confusion, and fevers.
What are less common features of viral meningitis?
Less common features include focal neurological deficits on examination and seizures, which suggest meningoencephalitis.
What is the investigation method for viral meningitis?
A lumbar puncture should be performed to confirm the diagnosis.
What are the cerebrospinal fluid findings in viral meningitis?
Cerebrospinal fluid findings include:
- Opening Pressure: 10 - 20 cm³ H²O
- Cell count: 10-300 cells/µL
- Cell differential: Lymphocytes
- Glucose: 2.8 - 4.2 mmol/L or 2/3 serum glucose
- Protein: 0.5 - 1 g/dL
What is the management approach for viral meningitis?
Management includes supportive treatment while awaiting lumbar puncture results. If bacterial meningitis or encephalitis is suspected, broad-spectrum antibiotics with CNS penetration should be started.
What is the typical prognosis for viral meningitis?
Viral meningitis is generally self-limiting, with symptoms improving over 7 - 14 days, and complications are rare in immunocompetent patients.
When should aciclovir be used in viral meningitis?
Aciclovir may be used if the patient is suspected of having meningitis secondary to HSV.
CSF findings in viral meningitis
