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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis

A

Infection and inflammation of the meninges

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2
Q

What is meningism

A

Headache
Photophobia
Vomiting
Neck stiffness due to spasm on flexion

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3
Q

What can cause meningism

A

Meningitis
SAH
Migraine
Sinusitis / pneumonia / UTI

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4
Q

What are RF for meningitis

A

Skull trauma
Alcohol
DM
FH

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5
Q

How do you diagnose meningitis

A

Blood culture before Ax
LP for definite diagnosis
Bloods - U+E, LFT, FBC

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6
Q

What suggest poor prognosis

A

Severe sepsis + DIC

May have decreased WCC

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7
Q

What is DIC

A

Low platelet
Abnormal clotting
Increased fibrin

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8
Q

What do you do with LP

A 
Gram stain = bacterial 
PCR = viral 
Differential cell count 
Antigen detection 
AAFB on ZN for TB
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9
Q

What does LP look in bacterial

A 
High opening pressure 
Increased cells 
Neutrophils predominant 
Glucose reduced
Protein increased
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10
Q

What does LP look in viral

A 
High opening pressure 
Increased cells
Lymphocytes predominant 
Glucose normall 
Protein increased
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11
Q

What does LP look in TB

A

Increased cells
Mixed cell type
Glucose reduced
Protein increased

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12
Q

What causes meningococcal meningitis

A

Neisseria meningitides

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13
Q

What are the symptoms of meningococcus

A

Meningism
Systemic upset
Skin rash - petechial
Clouding of consciousness

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14
Q

What are the symptoms of meningococcal septicaemia

A 
Rapid deterioration in consciousness 
Purpuric rash 
Fever 
Septic shock 
Renal failure 
Acidosis 
DIC 
50% die in 24 hours
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15
Q

What is CSF like in meningococcal septicaemia

A

Sterile with no increase in WCC

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16
Q

What is Waterhouse-Fredrickson Syndrome

A

Bilateral adrenal haemorrhage
Hypotensive
Low N and high K

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17
Q

What is the Rx for meningococcus

A

Early Ax
All close contacts rifampicin or ciprofloxacin prophylaxis
Vaccination for A+C

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18
Q

What are the symptoms of Chronic Meningococcemia

A 
Rash 
Joint pain
Malaise 
Fever 
Due to serum complement deficiency
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19
Q

What causes pneumococcal meningitis

A

Pneumococci

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20
Q

What are the symptoms of pneumococcus

A

Meningism
More likely to have altered consciousness
Focal neuro signs
Petechiae is uncommon

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21
Q

What are the RF for pneumococcus

A 
Age 
Pneumonia
Sinusitis
Head trauma 
Endocarditis
Alcoholism 
Splenectomy
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22
Q

What is the Rx for pneumococcus

A

Benzypen
Ceftriaxone if resistant
Steroid to prevent complications
Pneumococcal vaccine

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23
Q

Who gets pneumococcal vaccine

A 
>65
DM
Splenectomy
Chronic disease
HIV
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24
Q

What are the complications of pneumococcus

A 
Death
Loss of hearing 
Cranial nerve palsies 
Hemiparesis 
Hydrocephalus 
Seizures
25
Q

What does H influenza B present like ? (gram -ve bacilli)

A 
Mild respiratory tract illness
Rapid deterioration 
Meningism uncommon 
Fever 
Lethargy
26
Q

What is the Rx for H influenza B meningitis

A

Ceftriaxone
Dexamethasone
Rifampicin for prophylaxis
Hib vaccine

27
Q

What does listeria monocytogenes present like ?

A

Febrile flu in pregnant
Abortion
Neonatal sepsis
Meningits

28
Q

How is listeria monocytogenes Dx

A

blood culture

29
Q

How do you treat listeria?

A

IV ampicillin to cover

30
Q

How does Leptospirosis and Lyme present ?

A 
Septicaemia 
Meningism can occur
fever 
rigors
myalgia
vomiting 
conjunctival effusion 
rash 
hepato-renal damage
31
Q

How does TB meningitis present?

A 
Meningism 
Low grade fever
Lethargy
HEadache
Change in mentation 
Extra-meningeal TB
32
Q

Why does TB meningitis occur?

A

Rupture of sub-ependymal tubercle into subarachnoid space

Can be post primary in children

33
Q

How do you diagnose TB meningitis

A 
AAFB on ZN stain of CSF 
Culture more sensitive 
Repeat LP as often -ve 
CXR / CT 
PCR of mycobacterial DNA

ALWAYS CONSIDER IF GLUCOSE REDUCED and no organism cultured

34
Q

What are the viral causes of menigitis

A 
Entero - coxsackie / echovirus
HSV 2
VZV
EBV
HIV 
Mumps 
Polio
35
Q

What are the symptom of viral meningitis

A 
Non-specific illness
Rapid headache 
Meningism 
Usually alert 
Encephalitis - lethargy, confusion, seizures, focal neuro 
Rash sometimes present
36
Q

Dx of viral

A

PCR of CSF
Throat swab
HIV Dx

37
Q

Rx of viral

A

Usually resolves in 72 hours
Acyclovir in HSV
MMR vaccine

38
Q

What are the complications of mumps

A

Deaf
Orchitis
Testicular atrophy

39
Q

What are the fungal causes of menigitis

A

Cryptococcus neoformans

40
Q

What are the RF for fungal meningitis

A

HIV
DM
Lymphoma

41
Q

What are the symptoms of fungal

A 
Fever
headache 
nausea
lethargy
confusion 
abdominal pain
meningism less common
42
Q

How do you diagnose fungal meningitis

A

India ink of CSF

Gram stain for candida

43
Q

How do you treat fungal

A

Parenteral amphotericin
Flucytosin / fluconazole
Long term prophylaxis with fluconazole in HIV

44
Q

What are common causes of neonatal meningitis

A 
Group B strep
E.coli 
Listeria monocytogenes 
H influenza B 
Enterovirus 
Parechovirus
45
Q

What are the RF for neonatal meningitis

A 
Low birth weight 
Prolonged rupture of membrane
Pre mature 
Prolonged birth 
Maternal DM 
Intrapartum fever
46
Q

How do you diagnose neonatal sepsis

A

CSF + blood culture
Culture of mothers blood and genital tract
EDTA of blood in viral

47
Q

Treatment of neonatal sepsis

A

Parenteral amphicillin (cover group B and listeria)
Gentamicin (cover -ve bacilli)
IVIG for entero / parechovirus

48
Q

How do you prevent neonatal sepsis

A

Amoxicillin / co-amoxiclav to high risk mother
isolate
IVIG to contacts

49
Q

What are the complications of neonatal sepsis

A

Neurological and developmental sequeleae

50
Q

What are the contraindications to LP

A 
Unstable 
SKin infection
Unstable bleeding disorder
Increased ICP
Chiari malformations
51
Q

What are the complications of LP

A 
Spinal headache
Nerve root trauma 
CYsts
Infection
Disc herniation
52
Q

What is a spinal headache

A

Bilateral
Improves when supine
Common in female with low BMI

53
Q

How do you treat spinal headache

A

Hydrate
Caffeine
Epidural blood patch

54
Q

What are the symptoms of nerve root trauma

A

Feel electric shock / back pain
Altered mental status
Cranial nerve abnormalities
CUshings - Brady, increased BP, irregular breathing

55
Q

How do you treat nerve root trauma

A 
Remove needle
Raised head to increased venous return
Mannitol
Intubate
Corticosteroids 
Nerve conduction studies
56
Q

Causative organism of meningitis aged 3 months - 60 y/o

A

Strep pneumoniae

57
Q

Causative organism of meningitis < 3 months and > 60 y/o

A

Listeria monocytogenes

58
Q

Initial empirical Tx of meningitis aged 3 months - 50 y/o

A

IV ceftoxamine

59
Q

Initial empirical treatment of meningitis <3 months

A

IV ceftoxamine and amoxicillin

Infection (16 decks)

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