Meningitis Flashcards
newborn causative organisms
group B strep, Strep pneumoniae, E coli, Listeria monocytogenes
infant causative organisms
H influenza, Strep pneumonias, Neisseria meningitides
Young adults causative organisms
Neisseria meningitides, Strep pneumoniae
Prophylatic Abx for close contacts
Rifampicin
test results for bacterial cause
High opening pressure Turbid appearance High white cell count Could have positive Gram stain High protein Very low glucose Neutrophils present
test results for viral cause
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
Viral meningitis
Mostly caused by enteroviruses (Coxsackie A and B). mumps and EBV. Self-limiting. Supportive, hydration, analgesia.
Treatment for bacterial
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.
Clinical presentation of bacterial meningitis
- 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.
positive signs
Kernig’s (painful passive knee extension when hips are flexed), Brudzinski (hips will flex when head is bent forwards)
Meningism components
Neck stiffness, photophobia, positive Kernig’s
Ix
FBC CRP Coagulation screen Blood culture and PCR Blood glucose ABG LP after head CT to see if it is appropriate and safe.
Signs and symptoms between bacteria meningitis and meningococcal septicaemia
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.
Risk factors for bacterial meningitis
Young age. Poor spleen functioning. Immunocompromised (HIV, chemotherapy). Smoking and passive smoking. Overcrowded living conditions.
Complications of bacterial meningitis
Hearing loss, seizures, motor deficit, cognitive impairment, hydrocephalus, visual disturbance, death.
Differential diagnosis for bacterial meningitis
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.
Signs of shock in children
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
Treatment of suspected bacterial meningitis but no non-blanching rash
Transfer immediately to secondary care but do not give antibiotics in community.
Further treatment for acute meningitis
Dexamethasone if over 3months following LP and CSF msc
Components to measure in an LP
Opening pressure, glucose, protein, white cell count, microscopy, culture and sensitivity.
Septic screen
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
Immediate treatment for septicaemia
ABCD.
IV access
Fluid bolus of 20ml/Kg of 0.9% saline
