Meningitis

Question 1

newborn causative organisms

Answer 1

group B strep, Strep pneumoniae, E coli, Listeria monocytogenes

Question 2

infant causative organisms

Answer 2

H influenza, Strep pneumonias, Neisseria meningitides

Question 3

Young adults causative organisms

Answer 3

Neisseria meningitides, Strep pneumoniae

Question 4

Prophylatic Abx for close contacts

Answer 4

Rifampicin

Question 5

test results for bacterial cause

Answer 5

High opening pressure
Turbid appearance
High white cell count
Could have positive Gram stain
High protein
Very low glucose
Neutrophils present

Question 6

test results for viral cause

Answer 6

Normal or slightly increased opening pressure
Clear appearance
Low white cell count (<200)
Gram stain is negative
Normal or slightly high protein
Normal or slightly low glucose
Lymphocytes may be present

Question 7

Viral meningitis

Answer 7

Mostly caused by enteroviruses (Coxsackie A and B). mumps and EBV. Self-limiting. Supportive, hydration, analgesia.

Question 8

Treatment for bacterial

Answer 8

Notify a proper officer & PHE of the local authority urgently on suspicion of meningitis or meningococcal septicaemia!!!!!!!!
IM benzylpenicillin prehospital/in community. IV Ceftriaxome (if over 3months). If under 3months add amoxicillin. If been travelling abroad add vancomycin.

Question 9

Clinical presentation of bacterial meningitis

Answer 9

• Non-specific symptoms = Fever, n+v, lethargy, irritability, poor feeding, ill appearance, headache, myalgia, respiratory symptoms, diarrhoea, sore throat.
• Specific symptoms = non-blanching rash, neck stiffness, cap refill >2secs, cold peripheries, hypotensive, back rigidity, bulging fontanelle, photophobia, focal near deficit signs, seizures, paresis, unusual skin colour.

Question 10

positive signs

Answer 10

Kernig’s (painful passive knee extension when hips are flexed), Brudzinski (hips will flex when head is bent forwards)

Question 11

Meningism components

Answer 11

Neck stiffness, photophobia, positive Kernig’s

Question 12

Ix

Answer 12

FBC
CRP
Coagulation screen
Blood culture and PCR
Blood glucose
ABG
LP after head CT to see if it is appropriate and safe.

Question 13

Signs and symptoms between bacteria meningitis and meningococcal septicaemia

Answer 13

Both have: fever, n+v, lethargy, irritability + difficulty settling, poor feeding, headache, myalgia, SOB, chills, non-blanching rash, altered mental state.
Seen in meningitis but NOT septicaemia = photophobia, Kernig’s sign, Brudzinski’s, paresis, social euro impairments, bulging fontanelle, back rigidity, neck stiffness.

Question 14

Risk factors for bacterial meningitis

Answer 14

Young age. Poor spleen functioning. Immunocompromised (HIV, chemotherapy). Smoking and passive smoking. Overcrowded living conditions.

Question 15

Complications of bacterial meningitis

Answer 15

Hearing loss, seizures, motor deficit, cognitive impairment, hydrocephalus, visual disturbance, death.

Question 16

Differential diagnosis for bacterial meningitis

Answer 16

Viral meningitis.
Fungal meningitis
Tuberculosis meningitis
Brain or spinal abscess
SLE
Cranial osteomyelitis
Petechiae can be caused by EBV, enteroviruses, platelet and clotting factor deficiencies.

Question 17

Signs of shock in children

Answer 17

Capillary refill time >2 seconds
Unusual skin colour
TC and/or hypotension
Respiratory symptoms or breathing difficulty
Leg pain
Cold peripheries
Toxic/moribund state
Altered mental state/decreased conscious level
Poor urine output

Question 18

Treatment of suspected bacterial meningitis but no non-blanching rash

Answer 18

Transfer immediately to secondary care but do not give antibiotics in community.

Question 19

Further treatment for acute meningitis

Answer 19

Dexamethasone if over 3months following LP and CSF msc

Question 20

Components to measure in an LP

Answer 20

Opening pressure, glucose, protein, white cell count, microscopy, culture and sensitivity.

Question 21

Septic screen

Answer 21

FBC - white cell count, CRP and ESR
Blood cultures 
CXR - look for pneuonia
Throat swab
Urine dip for UTI and urine sample for MSC
LP for meningitis

Question 22

Immediate treatment for septicaemia

Answer 22

ABCD.
IV access
Fluid bolus of 20ml/Kg of 0.9% saline