Meningitis

Question 1

What is meningitis?

Answer 1

An acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs.

Question 2

How do organisms pass the blood-brain barrier to reach the CNS?

Answer 2

• Bacteraemia /viraemia/parasitaemia
• Direct spread –Chronic infections in cranial bones, ears, sinuses,
oral cavity or upper respiratory tract
• Neuronal spread
– infection of peripheral neurons, axonal transport, replication and cell-to-cell spread of infection to connecting neurons in the CNS

Question 3

What are the clinical symptoms?

Answer 3

The most common symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). Children often exhibit only nonspecific symptoms, such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash.

Question 4

What investigations can be done?

Answer 4

Lumbar Puncture is an important test in the diagnosis of CNS infection.
CSF findings = “the Gold standard” in the diagnosis of meningitis. The changes in the CSF may be characteristic of a certain type of meningitis.

Question 5

What are the complications of bacterial meningitis?

Answer 5

Seizures, infarcts, hydrocephalus, transtentorial herniation.

Question 6

What’s the management of meningitis?

Answer 6

• Supportive care
• Specific antimicrobial therapy eg. Penicillin, Ceftriaxone, Meropenem, Chloramphenicol
• Steroids (this is debatable whether it’s a good thing)
• Surgical intervention
• Prophylaxis (antibiotics, vaccines)