Meningitis

Question 1

Definition

Answer 1

Acute inflammation of the protective coverings - leptomeinges (arachnoid and pia matter) and spinal cord

Question 2

Classification

Answer 2

• Acute pyogenic- bacterial
• aspetic - viral
• chronic - TB, Spirochetal

Question 3

Causes of bacterial meningitis

Answer 3

• neonates - escheria coli, + group B strep
• young adults - Neisseria menigitis
• Adults- neiseeria meningitis (meningococcus), strep pneumonia (pneumococcus), haemophillus influenza

Question 4

cause of viral meningits

Answer 4

enterovirus

Question 5

Early clinical features

Answer 5

• headache
• leg pains
• cold hands and feet
• abnormal skin colour

Question 6

Later

Answer 6

Meningism

• neck stiffness
• photophobia
• kernigs sign (flex the knee at 90 degrees)

Decreased conscious level

Petchial rash - non-blanching

Focal signs CNS

Seizures

Question 7

Investigations

Answer 7

• Throat swab - 1 for bacteria 1 for virus
• FBC
• U and Es
• Retal swab
• Lumbar puncture - raised protein and glucose

Question 8

Management

Answer 8

1. start antiiotics immediately (penicillin) - pre hospital
2. airways, breathing, circulation
3. Blood cultures if possible
4. lumbar puncure- confirm
5. CT prior to LP nly if (mass or cerebral oedema)
6. 3rd Generation Cephalosporins should be used and vancomycin +/- rifampicin should be added if penicillin-resistant pneumococcus is suspected.
7. Patients older than 55 years and those with immunosuppression should receive high dose amoxicillin +/- gentamicin to empirically treat listeriosis.
   Antibiotic therapy should be given prior to CT scanning.
8. CT scans should be performed in patients with suspected pneumococcal meningitis and in all patients >60 years, those with history of CNS disease or immunosuppression and those with reduced LOC, seizures or neurological signs.
9. Dexamethasone 10mg 6 hourly should be administered to all patients with suspected BM either prior to or at the time of antibiotic administration and should be continued for 4 days in those with suspected pneumococcal meningitis.
10. AB therapy should continue for about 7 days in meningococcal and at least 2 weeks in pneumococcal meningitis.
11. All patients with BM should have audiometry assessed following recovery.

Question 9

Public health measures

Answer 9

• all suspected should be reported to public health
• neuro-cognitive dollow up
• immunisation against pnemococcal in splentonised patients

Question 10

Ab therapy

Answer 10

• Treat meningococcal (1 wee)
• Treat pneumococcal 2 weeks

Rifampicin- all houselhold patents and contacts

3rd generation cephalosporins (ceftriaxone - aduls and children, ceftriazone in pregnany) and vancomycin +/- rifampicin if penicillin-resistant pneumococcus suspected

Patients older than 5 should receive a haigh dose of amoxicillin +/- gentamicin to empiraclly treat listerisos