meningitis Flashcards
causes of viral meningitis
non-polio enteroviruses - coxsackie, echovirus
mumps
herpes (HSV), CMV, herpes zoster
HIV
measles
risk factors for viral meningitis
patients of age extremes - <5 + elderly
immunocompromised - renal failure, diabetes
IV drug users
viral meningitis investigations
lumbar puncture -> lymphocytes !
viral PCR
viral meningitis mangement
supportive (should be self limiting 7-14days)
if any question of bacterial or encephalitis or if immunocomp
—> start broad spectrum Abx with CNS penetration - ceftriaxone + aciclovir IV
if HSV -> aciclovir
causes of meningitis in age 0-3months
Group B strep = commonest
E.coli
listeria monocytogenes
causes of meningitis in 3months-60years
neisseria meningitidis
strep pneumoniae
haemophilus influenzae
causes of meningitis in > 60 yrs
strep pneumoniae
neisseria meningitidis
listeria monocytogenes
commonest cause of meningitis in immunosuppressed
listeria monocytogenes
CSF in bacterial meningitis
cloudy
glucose in the low half of normal
protein = high
WCC = 10-5000
CSF in viral meningitis
clear/cloudy
glucose - on the higher end of normal
protein - normal/raised
WCC - 15-1000
CSF in TB meningitis
slightly cloudy, fibrin web
glucose - low !
protein - high
WCC - 30-300
CSF in fungal meningitis
cloudy
glucose - low
protein - high
WCC - 20-200
testing for TB meningitis
Ziehl-Neelsen is only 20% sensitive in detecting
PCR often used - 75% sensitivity
managment of suspected meningococcal disease in GP
IM benzylpenicillin
-> immediate transfer to hospital
management of patients without indication for delayed LP in meningitis
IV access - bloods + blood cultures
lumbar puncture
- if cant be done within 1hr, IV antibiotics after blood cultures
IV antibiotics
IV dexamethasone
- must be given with 12hrs of Abx
- DONT give in sepsis or immunocompromised or kids <3mnths
IV antibiotics given in meningitis
3mnth-60yrs - ceftriaxone
> 60yrs = ceftriaxone + amoxicillin(or ampicillin)
add IV vancomycin if;
- recent prolonged/multiple antibiotic use
- travel to areas with highly resistant pneumococci
do we CT all patients with meningitis
nah
CT not normally indicated
when should lumbar puncture be delayed
- signs of severe sepsis or rapidly evolving rash
- severe resp/cardiac compromise
- significant bleeding risk
signs of raised ICP
- focal neuro signs
- papilloedema
- continuous or uncontrolled seizures
- GCS <=9
warning signs requiring urgent senior review in meningitis
rapidly progressive rash
poor peripheral perfusion
resp rate <8 or >30
pulse <40 or >140
low pH, WBC or lactate
GCS <12 or drop of 2 points
poor response to fluid resus
Management of patients with signs of raised intracranial pressure
get critical care input
secure airway + high-flow oxygen
IV access → take bloods and blood cultures
IV dexamethasone
IV antibiotics as above
arrange neuroimaging
Management of patients with signs of severe sepsis or a rapidly evolving rash
get critical care input
secure airway + high-flow oxygen
IV access → take bloods and blood cultures
IV fluid resuscitation
IV antibiotics as above
(fluids + NO dexamethasone or neuroimaging)
inital Abx therapy age <3months
IV cefotaxime + amoxicillin (or ampicillin)
inital Abx therapy age <=60rs
IV ceftriaxone + amoxicillin (or ampicillin)
inital Abx therapy age 3yrs-59yrs
IV ceftriaxone
