Meningitis Flashcards
What does the term meningism refer to
A headache, photophobia, vomiting and neck rigidity
State the 5 stages in the pathogenesis of meningitis
- Attachement to mucosal epithelial cells
- Transgression of the mucosal barrier
- Survival in the blood stream
- Entry into CSF
- Production of overt infection in the meninges with or without brain infection
State the bacteria that can cause meningitis
Neisseria Meningitidis
Strep Pneumoniae
E.Coli and Group B strep in neonates
State the viruses that can cause meningitis
Enteroviruses (echo, coxsackie A and B), Poliovirus, mumps, herpes simplex virus
State the percentage of patients with ventriculo-atrial shunts that develop ventriculitis and menngitis
10-30% usually caused by coagulase negative staph
Which conditions (infectious) can present with meningism
Influenza, tonsilitis, pneumonia, sinusitis, urinary tract infection and any severe bacteraemic illness
Which non infective causes can cause meningism
subarachnoid haemhorrage and migrain
Common presentation of meningitis
Upper respiratory tract infection with one of the meningsm features
State the neurological signs that can occur in meningitis
Cranial nerve palsies (VI, VII, or VIII)
Acute presentation
Less than 24 hours of signs and symptoms
Sub-acute presentaion
Signs and symptoms present for days usually viral
State illnesses associated with meningitis
Recent skull trauma, alcoholism and diabetes mellitus
Kernigs sign
With the hip flexed, the patients leg cannot be straightened due to hamstring spasm in meningsm
Other signs in meningitis
Neck stiffness
State the investigations conducted in meningitis
Blood cultures and lumbar puncture
State the microbiology tests conducted onto CSF
- 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)
State the biochemical tests conducted in CSF
- Glucose (check serum level at same time)
* Protein
What specimens can be useful in viral meningitis
Nasopharyngeal secretions, EFTA blood and faeces
In DIC what will be seen on blood tests
low platelets (thrombocytopaenia), abnormal clotting and increased fibrin degradation products (FDP) will be seen.
Normal CSF
Gin clear and contains up to 5 WC/mm3
Bacterial meningitis CSF
Turbid, increased white cells (neutrophils), reduced glucose and increased protein
Viral meningitis CSF
Clear - turbid, moderate increase in cells (lymphocytes), normal glucose and moderate increase in protein
TB meningitis CSF
Clear to turbid, moderate increase in cells, reduced glucose and greatly increased proteins
State the principles of treating acute bacterial meningitis
- Early clinical recognition.
- Rapid detection of pathogen.
- Rapid initiation of appropriate bactericidal antimicrobial therapy.
- Early recognition and treatment of sequelae of septicaemia
(eg, DIC with shock, hypoxia, acidosis and adrenal insufficiency). - Antibiotic prophylaxis (when appropriate) of close contacts.
State the antibiotics often used in bacterial meningitis
Benzylpenicillin (4 hrly high dose), ceftriaxone.
Meningococcal Meningitis is a disease of
young adults and children
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.
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
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
State the earlier signs of meningitis
Leg pains, cold hands and feet and abnormal skin colour