meningitis Flashcards
what does neutrophils in the SAS suggest?
pyogenic meningitis
what is acute pyogenic meningitis ?
bacterial
what is aseptic meningitis ?
viral meningitis
what is acute encephalitis?
infection of the brain parenchyma
treatment of bacterial community acquired meningitis?
DECE - IV dexamethasone and ceftriaxone
if penicillin allergic, what is the treatment?
DECH - dexamethasone and chloramphenicol
what do you add as listeria cover?
IV ampicilin or amoxicillin (a is start of list)
who gets infected by listeria?
the very young and very old (start and end of list)
when is viral meningitis more common ?
late summer to autumn
which type of viruses would cause meningitis
enteroviruses (eg echovirus)
diagnosis od viral meningitis?
stool culture, throat swab, CSF PCR
treatment of viral meningitis?
supportive as self limiting
causitive orgs bacterial by age
explaining hot neck stiffness infant - e coli child - HI young adult - Nesseria old - strep pneumoniae
what prevents meningitis becoming an access?
pia
what can cause infection in immunocompromised patient s?
listeria monocytogenes
iMono
what causes meningococcal ?
n meningiditis
what are the symptoms in meningococcal meningitis due to?
endotoxin
most common cause of meningitis in children under 4 years old?
H Influenza
what antibiotic is used for listeria and which has no value ?
amoxicilin used, ceftriaxone has no value
previous TB on x ray, poor yield from CSF?
tuberculous meningitis
how do you treat tuberculous meningitis ?
rifampicin and Isoniazid (then add pyrazinimide and ethambutol)
3 clinical signs of bacterial meningitis ?
fever, stiff neck, alteration in consciousness
small, pleomorphic, gram negative rods?
HI
what cells are usually seen in bacterial meningitis?
predominantly polymorphs
CSF glucose in bacterial?
less than 70% of blood glucose
CSF glucose in viral ?
normal
cells in CSF in viral meningitis?
lymphocytes
protein in viral/bacterial/tuberculous?
normal or slightly high in viral
high in bacterial
high or very high in tuberculous
why do you get high protein in bacterial ?
bacterial meningitis leads to a more permeable blood brain barrier, due to increased inflammation. Protein leaks into the SAS from the blood, so you get markedly increased CSF protein levels
what do you give if over 55 to cover listeria?
amox
lumbar puncture, should it always be done?
yes, unless clear contraindication exists
if penicillin allergy, which antibiotic would you give in place of ceftriaxone?
DECH - chloramphenicol
Rapidly developing rash suggests
meningococcal disease
when would you do a CT scan of the head ?
immunocompromised, history of CNS disease, new onset seizure, papilloedema, focal neurological deficit
prophylaxis for contacts?
600mg rifampicin orally 12 hourly for four doses or ciprofloxacin or ceftriaxone (not recommended in children)
