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Meningitis Flashcards

1
Q

What does the term meningism refer to

A

A headache, photophobia, vomiting and neck rigidity

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2
Q

State the 5 stages in the pathogenesis of meningitis

A
  1. Attachement to mucosal epithelial cells
  2. Transgression of the mucosal barrier
  3. Survival in the blood stream
  4. Entry into CSF
  5. Production of overt infection in the meninges with or without brain infection
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3
Q

State the bacteria that can cause meningitis

A

Neisseria Meningitidis
Strep Pneumoniae
E.Coli and Group B strep in neonates

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4
Q

State the viruses that can cause meningitis

A

Enteroviruses (echo, coxsackie A and B), Poliovirus, mumps, herpes simplex virus

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5
Q

State the percentage of patients with ventriculo-atrial shunts that develop ventriculitis and menngitis

A

10-30% usually caused by coagulase negative staph

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6
Q

Which conditions (infectious) can present with meningism

A

Influenza, tonsilitis, pneumonia, sinusitis, urinary tract infection and any severe bacteraemic illness

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7
Q

Which non infective causes can cause meningism

A

subarachnoid haemhorrage and migrain

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8
Q

Common presentation of meningitis

A

Upper respiratory tract infection with one of the meningsm features

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9
Q

State the neurological signs that can occur in meningitis

A

Cranial nerve palsies (VI, VII, or VIII)

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10
Q

Acute presentation

A

Less than 24 hours of signs and symptoms

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11
Q

Sub-acute presentaion

A

Signs and symptoms present for days usually viral

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12
Q

State illnesses associated with meningitis

A

Recent skull trauma, alcoholism and diabetes mellitus

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13
Q

Kernigs sign

A

With the hip flexed, the patients leg cannot be straightened due to hamstring spasm in meningsm

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14
Q

Other signs in meningitis

A

Neck stiffness

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15
Q

State the investigations conducted in meningitis

A

Blood cultures and lumbar puncture

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16
Q

State the microbiology tests conducted onto CSF

A
  • Gram stain (and ZN if appropriate)
  • Differential cell count (neutrophil polymorphs or lymphocytes)
  • Antigen detection test (latex agglutination)
  • Bacterial culture
  • Mycobacterial or fungal culture (if appropriate)
  • PCR for viruses (if appropriate)
  • PCR for bacteria (if appropriate)
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17
Q

State the biochemical tests conducted in CSF

A
  • Glucose (check serum level at same time)

* Protein

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18
Q

What specimens can be useful in viral meningitis

A

Nasopharyngeal secretions, EFTA blood and faeces

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19
Q

In DIC what will be seen on blood tests

A

low platelets (thrombocytopaenia), abnormal clotting and increased fibrin degradation products (FDP) will be seen.

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20
Q

Normal CSF

A

Gin clear and contains up to 5 WC/mm3

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21
Q

Bacterial meningitis CSF

A

Turbid, increased white cells (neutrophils), reduced glucose and increased protein

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22
Q

Viral meningitis CSF

A

Clear - turbid, moderate increase in cells (lymphocytes), normal glucose and moderate increase in protein

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23
Q

TB meningitis CSF

A

Clear to turbid, moderate increase in cells, reduced glucose and greatly increased proteins

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24
Q

State the principles of treating acute bacterial meningitis

A
  1. Early clinical recognition.
  2. Rapid detection of pathogen.
  3. Rapid initiation of appropriate bactericidal antimicrobial therapy.
  4. Early recognition and treatment of sequelae of septicaemia
    (eg, DIC with shock, hypoxia, acidosis and adrenal insufficiency).
  5. Antibiotic prophylaxis (when appropriate) of close contacts.
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25
State the antibiotics often used in bacterial meningitis
Benzylpenicillin (4 hrly high dose), ceftriaxone.
26
Meningococcal Meningitis is a disease of
young adults and children
27
Describe the microbiology of meningococcal meningitis
Intracellular gram negative diplococci may be seen on gram stain of CSF and antigen tests may be positive for meningococci.
28
State the clinical symptoms of meningococcal meningitis
Meningitis with our without accompanying septicaemia, is the commonest mode of presentation. The patient experiences an acute onset of symptoms of meningism, systemic upset and a petechial skin rash
29
How is fulminant meningococcal septicaemia characterised
suddenness of symptoms causing rapid deterioration and loss of conciousness, fever, septicaemic shock with renal failure and disseminate intravascular coagulation
30
State the earlier signs of meningitis
Leg pains, cold hands and feet and abnormal skin colour
31
Chronic meningococcaemia
Uncommon illness that may last weeks or even months with a rash, joint pains, malaise and fever sometimes complicated by endocarditis.
32
Antibiotic given to patient with meningococcal meningitis prior to transfer to hospital
Parenteral penicillin (3-4MU).
33
State the treatment of meningococcal meningitis
Ceftriaxone and then rifampicin or ciprofloxacin on discharge
34
Most frequent cause of bacterial meningitis in adults
Pneumococcal meningitis
35
State the predisposing factors of pneumococcal meningitis
Pneumonia, sinusitis, endocarditis, head trauma, alcoholism or splenectomy
36
State the appearance o f pneumococci on gram stain
Gram positive diplococci with are alpha haemolytic on blood agar
37
State the important virulence factor of strep pneumococci
Antiphagocytic capsule
38
State the treatment of choice for pneumoccal meningitis
Benzyl penicillin
39
State the initial treatment given to pneumococcal meningitis
Ceftriaxone
40
State the mortality rate of pneumococcal meningitis
30-50%
41
State the complications of pneumococcal meningitis
Loss of hearing, cranial nerve palsies, hemiparesis, hydrocephalus and seizures
42
What medication can be given to reduce chances of pneumococcal complications
Dexamethasone
43
State the vaccination of pneumococcal meningitis and who it is given to
Pneumovax, given to all those over 65 and high risk groups
44
List the high risk groups who should be given the pneumovax vaccine
Splenectomy, diabetes, cardio-resp disease, renal disease and HIV
45
Who does Hib meningitis tend to effect
Young children
46
State the usual picture of Hib meningitis
Mild upper respiratory tract infection followed by rapid deterioration and there are often no signs of meningitis, with fever and drowsiness being more common
47
How does H.influenzae appear on gram stain
Mixture of gram - and gram + cocci and bacilli
48
State the most common form of capsule which occurs in type B h.influenza
type B
49
State the main treatment of H.influenzae meningitis
Cefotaxime
50
State the prophylactic medication given to contact of those with Hib meningitis
Rifampicin
51
State the vaccine available for Hib meningitis
Hib recommended for all infants from two months of age, three doses should be given with an interval of one month between doses
52
State an important cause of neonatal meningitis
Gram + Listeria monocytogenes
53
State the treatment of listeria meningitis in adults over 55
IV ampicillin
54
What does meningitis follow in TB
Rupture of a sub-ependymal tubercle into the subarachnoid space
55
State the presentation of TB meningitis
Lethargy, chronic headache and a change in mentation
56
When should TB meningitis be considered
CSF glucose is reduced and Gram stain and conventional culture are negative, especially in the absence of any previous antibiotic therapy
57
What other investigations can be helpful in TB meningitis
CXR or CT head (showing tuberculoma)
58
What type of HSV can cause meningitis
Type 2
59
State the clinical features of viral meningitis
non-specific prodromal illness, followed by rapid onset of headache, photophobia, low grade fever and a stiff neck. Patients are usually lucid and alert
60
What might be present with enteroviral meningitis
Petechial Rash
61
State the investigation of choice for viral meningitis
PCR of CSF
62
How long does recovery take in Enteroviruses and parechoviruses
72 hours
63
State the treatment of herpes simplex meningitis
Aciclovir IV
64
State the most important cause of fungal meningitis especially in HIV infection
Cryptococcal meningitis
65
State the investigations conducted into fungal meningitis
Gram stain of CSF or India Ink of CSF which shows capsule , CSF and serum cryptococcal polysaccharide antigen
66
State the clinical features of fungal meningitis
Low grade fever, headache, nausea, lethargy, confusion and abdominal pain
67
State the treatment of choice of fungal meningitis
Parenteral amphotericin sometimes in combo with flucytosine or high dose fluconazole
68
How does neonatal meningitis differ from adult meningitis
The symptoms and signs are not specific and the bacteria commonly incolved are group B strep, E.coli and Listeria
69
State the predisposing factors to neonatal meningitis
Low birth weight, prolonged rupture of membranes and maternal diabetes mellitus
70
State the incidence of neonatal meningitis
1/2,500
71
What does listeria cause in pregnant women
a febrile, flu-like, bacteraemic illness which can only be diagnosed by blood cultures. The infection may cause abortion or lead to neonatal sepsis, including meningitis
72
Early onset neonatal meningitis
within 3 days of birth and associated with prematurity or a difficult or prolonged birth. Marked respiratory distress, bacteraemia and a high mortality (50%) are typical. The organism has usually been acquired at birth from the mother’s genital tract.
73
Late onset neonatal meningitis
more than one week after birth. The infection is typified by bacteraemia and meningitis but pulmonary involvement is rare. Mortality is 10-20%. The organism may have been spread by cross-infection from other mothers, babies or healthcare workers.
74
Treatment of neonatal meningitis
``` Parenteral ampicillin (to cover group B streptococci and Listeria) and gentamicin or cefotaxime (to cover the gram negative bacilli) are used in combination, until the causative organism is identified. ```
75
State the mortality of neonatal meningitis
50%

Infection (24 decks)

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