Meningitis

Question 1

What is meningitis, and what part of the body does it affect?

Answer 1

Meningitis is inflammation of the meninges, which are the protective lining of the brain and spinal cord. The cerebrospinal fluid (CSF) is contained within the meninges.

Question 2

What are the common causes of bacterial meningitis?

Answer 2

• Neisseria meningitidis (meningococcus)
• Streptococcus pneumoniae (pneumococcus)
• Haemophilus influenzae
• Group B streptococcus (GBS)
• Listeria monocytogenes

Question 3

What are the common causes of viral meningitis?

Answer 3

• Enteroviruses (e.g., coxsackievirus)
• Herpes simplex virus (HSV)
• Varicella zoster virus (VZV)

Question 4

What are the typical symptoms of meningitis?

Answer 4

• Fever
• Neck stiffness
• Vomiting
• Headache
• Photophobia
• Altered consciousness
• Seizures

Question 5

How does meningococcal septicaemia present differently from other causes of bacterial meningitis?

Answer 5

Meningococcal septicaemia can cause a non-blanching rash, which is not usually seen in other causes of bacterial meningitis.

Question 6

What are the special tests used to check for meningeal irritation?

Answer 6

• Kernig’s test: Flex the hip and knee to 90 degrees and then extend the knee. Pain or resistance indicates meningitis.
• Brudzinski’s test: Flex the patient’s neck, and if they involuntarily flex their hips and knees, it is positive for meningitis.

Question 7

What is a lumbar puncture, and how is it used to diagnose meningitis?

Answer 7

A lumbar puncture involves inserting a needle into the lower back to collect a sample of cerebrospinal fluid (CSF) for testing. The fluid is analyzed for:
* Appearance (cloudy for bacterial, clear for viral)
* Protein levels (high in bacterial, mildly raised or normal in viral)
* Glucose levels (low in bacterial, normal in viral)
* White cell count (high in neutrophils for bacterial, high in lymphocytes for viral)
* Culture (bacteria in bacterial meningitis, negative in viral)

Question 8

What is the first-line management for bacterial meningitis?

Answer 8

• Benzylpenicillin (IM or IV) should be administered urgently while awaiting hospital transfer (for suspected meningococcus with non-blanching rash).
• Antibiotics based on age:
  
  • Under 3 months: cefotaxime + amoxicillin (to cover Listeria)
  • Above 3 months: ceftriaxone
• Aciclovir is added if viral meningitis (e.g., HSV) is suspected.
• Steroids (e.g., dexamethasone) may be used to reduce the frequency of neurological complications.

Question 9

How is post-exposure prophylaxis managed in the case of meningococcal infection?

Answer 9

Post-exposure prophylaxis is given to those at risk due to close contact with a person diagnosed with meningococcal infection. Ciprofloxacin (single dose) is typically given as soon as possible after diagnosis.

Question 10

What are some complications of bacterial meningitis?

Answer 10

• Hearing loss (a key complication)
• Seizures and epilepsy
• Cognitive impairment and learning disability
• Memory loss
• Focal neurological deficits, such as limb weakness or spasticity