Meningitis - 221 Flashcards
What age group is at highest risk of developing meningitis?
Neonates, less than 2 months
What type of bacterial meningitis is most common in a neonate?
Group B Strep most common at 39%
What type of bacterial meningitis is most common in a baby 3 months - 3 years?
S. pneumoniae at 45%, followed by N. meningitidis at 34%
What type of bacterial meningitis is most common in children aged 3-10?
S. pnuemoniae and then N. meningitidis
What bacterial meningitis in most common in older children/teenagers?
N. meningitidis
Name 5 risk factors for meningitis
Age (under 5 and over 60)DiabetesRenal insufficiencyAdrenl insufficiencyCystic fibrosisImmunosuppressionVP shunt
What is the mortality risk with bacterial meningitis?
5-10%
WHat is the most dangerous form of viral meningitis? How do you treat it?
Herpes simplex virus, type 1 most common. Aciclovir IV for ~10 days
There are 2 patterns of presentation of bacterial meningitis - what are they?
- 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
How would you diagnose meningitis?
A, B, C, D. Look for meningism, check blood glucose. Bloods, Blood gas, Full neuro exam, LP if no signs of ICP increase
When is LP contraindicated?
Increased ICP, coagulation disorder, infection at site of needle entry, brain abscess
What might you see in the CSF in bacterial meningitis?
Cloudy on appearance, raised neutrophils, raised protein, low glucose
What might you see in the CSF in viral meningitis?
Clear appearance, raised lymphocytes
What are the 3 symptoms associated with meningism?
Neck stiffness, photophobia, headache
Describe Kernig’s sign
Patient supine. Flex knee and hip -> patient cannot extend knee or they flex the opposite knee
Describe Brudzinski’s sign
Patient supine, flexes lower extremities during passive flexion of neck
What antibiotic would you give to a neonate with bacterial meningitis?
Ampicillin, cefotraxime
What antibiotic would you give to a baby ~ 3 months old, with meningitis?
Ampicillin and a cephalosporin, cefotaxime or ceftriaxone
What antibiotic would you give to an older child with meningitis?
Cephalosporins, cefotaxime or ceftriaxome
You are a gp and see a patient with suspected bacterial meningitis. What do you do?
IM penicillin. 999
In an adult with meningitis, what might you give them as well as Abx?
Corticosteroids
What are the routes of microbial entry into the CNS? Give at least 1 example of each
BloodDirect implantation -> traumaLocal extension -> from sinus, teeth or earsPNS -> rabies, HSV, shingles
Why are bacteria more likely to have entered the CNS at the choroid plexus?
Endothelium is fenestrated, permeability increased, tight junctions are weaker, increased paracellular and transcellular flux
85% of viral meningitis’ are caused by what viruses?
Enteroviruses e.g., echovirus, coxsackie a + b, poliovirus.
