Meningitis

Question 1

What is meningitis.

Answer 1

Infection of the meninges.

Question 2

What are the commonest causes of meningitis. (7)

Answer 2

Streptococcus pneumoniae (most common). 
Neisseria meningitidis. 
Haemophilus influenae. 
Listeria monocytogenes. 
Mycobacterium tuberculosis. 
Can also be caused by viral and fungal infections.

Question 3

Who is at higher risk of developing meningitis.

Answer 3

Immunosuppressed individuals.

Question 4

What are the symptoms of meningitis. (5)

Answer 4

Headache. 
Photophobia. 
Nausea. 
Vomiting. 
Neck pain.

Question 5

What are the physical signs of meningitis. (6)

Answer 5

Fever. 
Neck stiffness. 
Confusion. 
Drowsiness. 
Petechiae. 
Kernig's sign.

Question 6

What is Kernig’s sign.

Answer 6

Hamstring spasm when attempting to straighten leg.

Question 7

What investigations should be carried out in a patient with meningitis. (9)

Answer 7

FBC. 
LFTs. 
UandEs. 
Coagulation screen. 
Blood culture. 
CXR. 
Lumbar puncture. 
CT if there are any neurological signs or reduced consciousness. 
CSF sample can be sent for PCR (to identify meningiococcus, AFB and viruses).

Question 8

When should you not perform a lumbar puncture in a patient with meningitis.

Answer 8

If the patient has a petichae rash, without the results of the clotting profile.
As you need to exclude DIC as a cause.

Question 9

What is a normal lumbar puncture result. (4)

Answer 9

No neutrophils.

0.6 glucose ratio.

Question 10

What is a bacterial meningitis lumbar puncture result. (4)

Answer 10

Very high neutrophils.
Raised lymphocytes.
Raised protein.
Low glucose ratio.

Question 11

What is a viral meningitis lumbar puncture result. (4)

Answer 11

Raised neutrophils.
Very high lymphocytes.
High protein.
Normal glucose ratio.

Question 12

What is a fungal meningitis lumbar puncture result. (4)

Answer 12

High neutrophils.
Very high lymphocytes.
Very high protein.
Low glucose ratio.

Question 13

What are the complications of meningitis. (7)

Answer 13

Seizures. 
Hydrocephalus. 
Cerebral venous/sagittal sinus thrombosis. 
Neurological sequelae. 
DIC. 
Multi-organ failure. 
Death.

Question 14

What is the treatment for meningitis.

Answer 14

Start empirical antibiotics immediately.

Question 15

What antibiotics are commonly used for meningitis. (2)

Answer 15

Third generation cephalosporins (eg cefotaxime).

Plus ampicillin if Listeria is suspected.

Question 16

If TB is the causative organism of meningitis, when do you start specific treatment.

Answer 16

You can usually wait until the results of the CSF results are available.

Question 17

Who (besides doctors and nurses) must you keep in close contact with in a case of meningitis.

Answer 17

The microbiologists.

Question 18

Who is offered chemoprophylaxis in meningitis cases.

Answer 18

To those who have had close contact with a patient with meningiococcal meningitis.

Question 19

What drug is given as chemoprophylaxis in cases of meningitis.

Answer 19

Rifampicin (usually).