Meningitis

Question 1

when to act

Answer 1

headache, pyrexia, neck stiffness, altered mental state

Question 2

what is the emergency treatment if not yet in hospital

Answer 2

benzylpenicillin- 1.2g IM/IV

Question 3

what organisms are involved in meningitis

Answer 3

meningococcus, pneumococcus. haemophilus influenza, listeria monocytoogenes. CMV, Cryptococcus, TB, immunocompromised- HIV, organ transplant, malignancyt

Question 4

differential

Answer 4

malaria, encephalitis, septicaemia, subarachnoid, dengue, tetanus

Question 5

early features

Answer 5

headache, leg pains, cold hands, abnormal skin colour

Question 6

late features

Answer 6

meningism, conscious level decr, coma, seizures + focal CNS signs, petechial rash

Question 7

what signs are seen in meningism

Answer 7

Kernigs (pain and resistance on passive knee extension with hip fully flexed). Brudzinski- forced flexion of neck ands legs flex

Question 8

what are signs of galloping sepsis

Answer 8

slow capillary refill, DIC, bp drops, temperature and pulse incr or normal

Question 9

management

Answer 9

start antibiotics- cefotaxime for 55 yrs. acyclovir if viral encephalitis suspected.

Question 10

investigations

Answer 10

U&E, FBC, LFT, glucose, coag screen, blood culture, throat swabs, rectal for viruses. serology- EBV, HIV. LP usually done after CT but if GCS 15 can not do it. send CSF for MC&S, gram stain, protein, glucose, virology, lactate. CXR

Question 11

what are the contraindications of LP

Answer 11

suspected intracranial mass lesion, focal signs, papilloedema, trauma, middle ear pathology major coagulopathy. measure opening pressure: 7-18cm CSF is normal. in meningitis may be >40. typically 14-30.

Question 12

what causes a decr in CSF glucose

Answer 12

sepsis, parasitic meningitis, herpes encephalitis, hypoglycaemia, sarcoid, CNS vasculitis.

Question 13

what predicts bacterial meningitis in CSF

Answer 13

CSF lactate level of >3.5 mmol/L