meningitis

Question 1

what symptoms are associated with meningitis

Answer 1

deafness, paralysis ,
speech problems
neuropsychiatric problems

Question 2

what three layers cover the skull?

Answer 2

dura mater, arachnoid mater, subarachnoid space and pia mater

Question 3

what does the subarachnoid space contain?

Answer 3

csf and blood vessels

Question 4

define meningitis?

Answer 4

inflammation of the leptomeningeal covering 
4 branches:
1. infection 
2. inflammation 
3. parameningeal foci 
4. neoplastic and paraneoplastic

Question 5

viral infectious agents?

Answer 5

Enterovirus and mumps

Question 6

bacterial infectious agents?

Answer 6

meningicocci and pneumococci

Question 7

fungal infectious agents?

Answer 7

cryptococcus neoformans

Question 8

parasitic

Answer 8

Naegleria fowleri

Question 9

bbb?

Answer 9

prevents infection reach the brain

Question 10

how do organisms reach the brain?

Answer 10

1. bacteriamia/viraemia/ parasitaemia : reach blood stream then go into choroid plexus=> cross bbb => reach csf
2. direct spread: chronic infection in cranial bones, ears and sinuses and oral cavity and upper respiratory tract
3. Neuronal spread: infection of the peripheral nerves and cell to cell spread of infection. e.g. dog bit leading to spread of infection

Question 11

Pathogenesis of meningitis?

Answer 11

mucosal colonisation => intravascular survival => meningeal invasion => increased bbb permeability, ceralbral vasculitis and inflammation => oedema and csf flow disturbances=> increase in ICP and decreased cbf and finally result with loss of cerebro-vascular autoregulation

Question 12

factors influencing bacterial mengitis?

Answer 12

1. age
2. geography
3. immune system
4. trauma/ post neurosurgical

Question 13

Bacterial meningitis

neonates specie?

Answer 13

GBS or e coli

Question 14

bacterial meningitis species upto 50 yrs?

Answer 14

s. pneumoniae and N. meningitidis

Question 15

bacterial meningitis more than 50 yrs?

Answer 15

s. pneumoniae and N. meningitidis

Question 16

immunocompromised state bacterial specie?

Answer 16

s. pneumoniae and N. meningitidis

Question 17

clinical manifestations?

Answer 17

head ache, neck stiffness, fever and altered mental state

Question 18

clinical signs?

Answer 18

neck rigidity
kernig’s sign
brudzinski’s sign

Question 19

what test is used to diagnose meningitis?

Answer 19

lumbar puncture

Question 20

what are normal csf values in lumbar puncture?

Answer 20

normally clear, less than 5 lymphocytes and 0.5g protein a

completely sterile in culture

Question 21

bacterial meningitis csf findings?

Answer 21

neutrophilic, 100-500 protein mg/dL, cell count 1000-10000

Question 22

viral meningitis csf comp?

Answer 22

50-1000, lymphocytic, protein <200 mg/dL

Question 23

csf extra tests?

Answer 23

PCR: completed for meningicocci and pneumococci

india ink: pneumococci

Question 24

when to use CT or MRI for LP?

Answer 24

unconsciousness 
seizures
focal neurology 
post trauma 
papilloedema

Question 25

complications of bacterial meningitis?

Answer 25

1. seizures
2. transentorial herniation: uncontrolled infection so it herniates and inflames
3. hydrocephalus- csf becomes sticky so accumulation of fluids in the ventricles and ballooning occurs
4. infarcts

Question 26

Management of meningitis?

Answer 26

supportive care
antimicrobial therapy 
steroids
surgical intervention 
prophylaxis

Question 27

what is key to meningitis diagnosis?

Answer 27

early recognition via checking ABCDE

antibiotic therapy and referral to hospital

Question 28

supportive care for meningitis?

Answer 28

airway, breathing, circulation, nutrition, physiotherapy and rehabilitation

Question 29

what needs checking for specific antimicrobial therapy?

Answer 29

pathogen
sensitivities 
CSF penetration 
allergy 
renal function 
route (I.V. or I.T  or I.M or orally)
duration of therapy

Question 30

good antibiotics for csf penetration?

Answer 30

penicillin, ceftrianxone and chloramphenicol

Question 31

poor antibiotics in csf penetration?

Answer 31

vancomycin and gentamicin

Question 32

neurosurgery in menigitis?

Answer 32

drain pus to relieve pressure in the brain abcess

Question 33

prophylaxis?

Answer 33

antibiotics and vaccines