meningitis

Question 1

clinical presentation specific to meningitis

Answer 1

1) classic triad: headache, backache, nuchal (neck) rigidity
2) photophobia
3) petechiae/purpura
4) kernig sign (backpain when pt hamstring extended and thigh perpendicular to trunk)
5) brudzinski sign (severe neck stiffness
6) bulging fontae (infant)

Question 2

Lumbar puncture results bacterial meningitis

Answer 2

GLUCOSE
- very low

PROTEIN
- raised

WBC
- raised, predominantly neutrophils

Question 3

Lumbar puncture results viral meningitis

Answer 3

GLUCOSE
- normal to slightly low

PROTEIN
- normal to mildly raised

WBC
- raised, predominantly lymphocytes

Question 4

empiric therapy meningitis

Answer 4

1) NEONATES
- ceftriaxone + ampicillin

2) INFANT + CHILDREN
- ceftriaxone + vanco

3) children & adults till 50 yo
- ceftraixone + vancomycin

4) adults > 50yo
- ceftriaxone + vanco + ampicillin

Question 5

meningitis culture directed

Answer 5

1) STREP PNEUMONIAE
- ampicillin
- penicillin resistant and cephalosporin susceptible: ceftriaxone
- both resistant: vanco

2) neisseria meningitis
- penicillin or ampicillin
- penicillin resistant: ceftriaxone

3) listeria monocytogenes
- penicillin or ampicillin
- penicillin allergy: cotrimoxazle, mero

4) group b strep
- penicillin or ampicillin
- penicillin allergy: ceftriaxone

Question 6

meningitis adjunctive corticosteroid

Answer 6

• bacterial meningitis > 6 wks
• risk: reduce inflammation = reduce Abx penetration
• dexamethasone 10-20 mins before or same time as Abx

Question 7

chemoprophylaxis for neisseria meningitis

Answer 7

• for close contact
• short course rifampicin (children) cipro (Adult) ceftriaxone