Meningitis - 221

Question 1

What age group is at highest risk of developing meningitis?

Answer 1

Neonates, less than 2 months

Question 2

What type of bacterial meningitis is most common in a neonate?

Answer 2

Group B Strep most common at 39%

Question 3

What type of bacterial meningitis is most common in a baby 3 months - 3 years?

Answer 3

S. pneumoniae at 45%, followed by N. meningitidis at 34%

Question 4

What type of bacterial meningitis is most common in children aged 3-10?

Answer 4

S. pnuemoniae and then N. meningitidis

Question 5

What bacterial meningitis in most common in older children/teenagers?

Answer 5

N. meningitidis

Question 6

Name 5 risk factors for meningitis

Answer 6

Age (under 5 and over 60)DiabetesRenal insufficiencyAdrenl insufficiencyCystic fibrosisImmunosuppressionVP shunt

Question 7

What is the mortality risk with bacterial meningitis?

Answer 7

5-10%

Question 8

WHat is the most dangerous form of viral meningitis? How do you treat it?

Answer 8

Herpes simplex virus, type 1 most common. Aciclovir IV for ~10 days

Question 9

There are 2 patterns of presentation of bacterial meningitis - what are they?

Answer 9

• Develops progressively over several days, usually preceded by febrile illness- Acute and fulminant, develops over hours, signs of sepsis may be present, severe brain oedema

Question 10

How would you diagnose meningitis?

Answer 10

A, B, C, D. Look for meningism, check blood glucose. Bloods, Blood gas, Full neuro exam, LP if no signs of ICP increase

Question 11

When is LP contraindicated?

Answer 11

Increased ICP, coagulation disorder, infection at site of needle entry, brain abscess

Question 12

What might you see in the CSF in bacterial meningitis?

Answer 12

Cloudy on appearance, raised neutrophils, raised protein, low glucose

Question 13

What might you see in the CSF in viral meningitis?

Answer 13

Clear appearance, raised lymphocytes

Question 14

What are the 3 symptoms associated with meningism?

Answer 14

Neck stiffness, photophobia, headache

Question 15

Describe Kernig’s sign

Answer 15

Patient supine. Flex knee and hip -> patient cannot extend knee or they flex the opposite knee

Question 16

Describe Brudzinski’s sign

Answer 16

Patient supine, flexes lower extremities during passive flexion of neck

Question 17

What antibiotic would you give to a neonate with bacterial meningitis?

Answer 17

Ampicillin, cefotraxime

Question 18

What antibiotic would you give to a baby ~ 3 months old, with meningitis?

Answer 18

Ampicillin and a cephalosporin, cefotaxime or ceftriaxone

Question 19

What antibiotic would you give to an older child with meningitis?

Answer 19

Cephalosporins, cefotaxime or ceftriaxome

Question 20

You are a gp and see a patient with suspected bacterial meningitis. What do you do?

Answer 20

IM penicillin. 999

Question 21

In an adult with meningitis, what might you give them as well as Abx?

Answer 21

Corticosteroids

Question 22

What are the routes of microbial entry into the CNS? Give at least 1 example of each

Answer 22

BloodDirect implantation -> traumaLocal extension -> from sinus, teeth or earsPNS -> rabies, HSV, shingles

Question 23

Why are bacteria more likely to have entered the CNS at the choroid plexus?

Answer 23

Endothelium is fenestrated, permeability increased, tight junctions are weaker, increased paracellular and transcellular flux

Question 24

85% of viral meningitis’ are caused by what viruses?

Answer 24

Enteroviruses e.g., echovirus, coxsackie a + b, poliovirus.

Question 25

Which antibiotic to treat meningitis is the only antibiotic that does not require further prophylactic treatment as it wipes out the carrier state? How is this drug give?

Answer 25

Ceftriaxone

Injection

Question 26

What is the first choice drug for prophylaxis? (Meningitis)

Answer 26

Ciproflaxacin

Question 27

What is the prophylactic dosage for adults, children and infants 1 month -4 years?

Answer 27

Adults 500mg
5-12 years 250mg
1month-4years 125mg