Meningitis

Question 1

How common is it + who does it affect

Answer 1

• 2-5 per 100,000 acute bacterial

- Everyone but mainly elderly, infants, young children

Question 2

What are the organisms that cause meningitis

Answer 2

• Meningococcus e.g. neisseria meningitides
• Pneumococcus e.g. strep pneumoniae
• Less commonly –> H. influenza, listeria monocytogenes (neonates), CMV, cryptococcus or TB if immunocompromised

Question 3

What is more common viral or bacterial and which is more benign

Answer 3

Viral more common and more benign

Question 4

How does meningitis spread

Answer 4

• Contact via droplets or secretions from URTI
• N. meningitides - 25% adolescent = asymptomatic carriers
• Pneumococcal disease (strep pneu) - close or direct contact w. resp droplets
• -> pneumococcal vaccine offered

Question 5

What are the non-specific symptoms

Answer 5

• Fever, vomiting, lethargy, irritability, ill appearance, refusing food/drink, headache, muscle ache, resp symptoms

LESS COMMON
- chills/shivering, diarrhoea, abdo pain/distension, sore throat

Question 6

What are the specific symptoms

Answer 6

• Non-blanching rash
• Stiff neck
• Cap refill >2s
• Unusual skin colour
• Shock + hypotension
• Leg pain
• Back rigidity
• Bulging fontanelle
• Photophobia
• Unconsciousness, paresis, seizures, focal neurological deficit

Question 7

What are the signs of meningitis

Answer 7

• Kernig’s sign - unable to extend at knee when hip flexed

- Brudzinski’s sign - pt’s knee + hips flex when neck flexed

Question 8

Describe the rash

Answer 8

• Non-blanching rash
• Scanty petechial rash - red/purple non-blanching macules <2mm
• Purpuric (haemorrhagic) rash >2mm

^^ chance MENINGOCCOAL DISEASE IN INFANT –> If petechiae starts to spread/becomes purpuric/ signs bacterial/ signs meningococcal septicaemia

N.B. pneumococcal meningitis rarely presents w/ rash

Question 9

How do you investigate meningitis

Answer 9

• AVPU, HR + BP, RR, SpO2, °c, cap refill, throat swab (1 viral, 1 bacterial)
• Check for signs of shock
• Lumbar puncture (usually after CT) measure opening pressure (may be >40, normally 7-18cm)
• Send CSF off MC&S, gram stain, protein, glucose, virology/PCR, lactate

Question 10

How do you treat it

Answer 10

Non-blanching rash or meningococcal septicaemia
- Benzylpenicillin/ cefotaxime

W/out non-blanching rash

• do not give Abx unless urgent transfer not poss
• Benzylpenicillin, cefotaxime, chloramphenicol

Corticosteroids used in adjunctive therapy

IDENTIFY THOSE AT RISK + give prophylactic treatment

Question 11

What are the complications + prognoses of meningitis

Answer 11

• Top 10 cause of infection-related death

- Hearing loss (1/3rd)