Meningitis Flashcards
What is meningitis?
Inflammation of the meninges
What are the different classifications of meningitis?
bacterial/pyogenic
viral/aseptic
What are some early symptoms of meningitis?
headache
leg pains
cold hands and feet
abnormal skin colour
What are the later symptoms of meningitis?
meningism: stiff neck, photophobia, Kerning’s sign
reduced conscious level, coma
seizure and focal CNS signs
petechial rash - non blanching
Do you get altered consciousness in viral meningitis?
No - this is what differentiates it from bacterial
What is a late sign of bacterial meningitis?
papilloedema
What are the most common organisms causing bacterial meningitis?
strep. pneumoniae (older ages) Neisseria meningitidis (younger)
What are the most common organisms causing meningitis in neonates?
listeria
group B strep
E coli
What is the most common organism causing meningitis in children?
H influenzae
What is the most common organism causing meningitis in 10-21 year olds?
meningococcal (Neisseria meningitidis)
Who is at risk of listeria?
neonates
old people
immunocompromised
What is the headache like in viral meningitis?
severe - onset 1-6hours
What viruses cause viral meningitis?
enteroviruses e.g. echo, coxsackie
self limiting
What is worse - bacterial or viral meningitis?
bacterial
How is viral meningitis diagnosed?
viral PCR - stool culture, throat swab
What is the CSF like in bacterial meningitis?
turbid v high WBC high neutrophils high protein low glucose
What is the CSF like in viral meningitis?
clear
high WCC
protein normal/slightly raised
glucose normal
What is the management of bacterial meningitis?
immediate Abx
ABCDE
blood culture
CT
What are red flags in meningitis?
seizure
GCS >2 or <12
focal neurology
What antibiotics do you give immediately in bacterial meningitis?
ceftriaxone IV
also dexamethasone IV
penicillin allergic:
chloramphenicol and vancomycin
What antibiotics do you add if you suspect listeria?
add amoxicillin or ampicillin
penicillin allergic: co-trimoxazole only
What is prophylaxis for contacts in bacterial meningitis?
children: rifampicin
adults: ciprofloxacin
