meningitis Flashcards
meningism
symptom complex:
- headache
- neck stiffness (on passive flexion)
- photophobia
- vomiting
pathogenesis of meningitis 5 steps
- attachment to mucosal epithelium
- transgression of mucosal barrier
- survival in blood stream
- entry into CSF
- production of infection in meninges
common bacterial causes of meningitis in children
Neisseria meningitidis
(meningococcal infection) - MUCH MORE SEVERE
case fatality 5-15%
Streptococcus pneumoniae
(pneumococcal infection )
enter via nasopharynx epithelium
bacterial causes in neonates
E. coli
Group B streptococci
viral causes
- Echoviruses
- Coxsackie A and
B viruses
if suspected - PCR CSF
shunt associated meningitis
ventriculo-atrial / peritonial shunts develop ventriculitis and meningitis - coagulase (-) staphylococci
remove shunt
aseptic meningitis
neoplasm
reaction to drugs
high WBC but nothing cultured in CSF
non infective causes of meningism
SAH
migraine
RFs for meningitis
DM
recent head trauma
Alcoholism
kernig’s sign
hip flexed - can’t straight leg due to hamstring spasm
Tests
Blood cultures
LP: if any ICP then don’t
FBC
CSF results if bacterial meningitis
turbid, increased cells, neutrophils, reduced glc
CSF results if viral meningitis
lymphocytes, normal plc
treating acute bacterial meningitis
- early clinical recognition
- rapid detection of pathogen
- rapid initiation of appt A/Bs
- early recognition of sequelae of septicaemia: DIC, hypoxia, acidosis
- a/b prophylaxis for contacts
Meningococcal Meningitis
Neisseria meningitidis
(meningococcal infection) - commonest cause, presents rapid/acute - due to initial nasopharynx infection
common in children/young adults
MUCH HIGHER MORTALITY RATE THAN pneumococcal disease (strep pneumoniae)
indian, SSA, Middle East
Meningococcal Meningitis
Neisseria meningitidis
group A meningococcal