Meningitis Flashcards
What is meningitis
Infection and inflammation of the meninges
What is meningism
Headache
Photophobia
Vomiting
Neck stiffness due to spasm on flexion
What can cause meningism
Meningitis
SAH
Migraine
Sinusitis / pneumonia / UTI
What are RF for meningitis
Skull trauma
Alcohol
DM
FH
How do you diagnose meningitis
Blood culture before Ax
LP for definite diagnosis
Bloods - U+E, LFT, FBC
What suggest poor prognosis
Severe sepsis + DIC
May have decreased WCC
What is DIC
Low platelet
Abnormal clotting
Increased fibrin
What do you do with LP
Gram stain = bacterial PCR = viral Differential cell count Antigen detection AAFB on ZN for TB
What does LP look in bacterial
High opening pressure Increased cells Neutrophils predominant Glucose reduced Protein increased
What does LP look in viral
High opening pressure Increased cells Lymphocytes predominant Glucose normall Protein increased
What does LP look in TB
Increased cells
Mixed cell type
Glucose reduced
Protein increased
What causes meningococcal meningitis
Neisseria meningitides
What are the symptoms of meningococcus
Meningism
Systemic upset
Skin rash - petechial
Clouding of consciousness
What are the symptoms of meningococcal septicaemia
Rapid deterioration in consciousness Purpuric rash Fever Septic shock Renal failure Acidosis DIC 50% die in 24 hours
What is CSF like in meningococcal septicaemia
Sterile with no increase in WCC
What is Waterhouse-Fredrickson Syndrome
Bilateral adrenal haemorrhage
Hypotensive
Low N and high K
What is the Rx for meningococcus
Early Ax
All close contacts rifampicin or ciprofloxacin prophylaxis
Vaccination for A+C
What are the symptoms of Chronic Meningococcemia
Rash Joint pain Malaise Fever Due to serum complement deficiency
What causes pneumococcal meningitis
Pneumococci
What are the symptoms of pneumococcus
Meningism
More likely to have altered consciousness
Focal neuro signs
Petechiae is uncommon
What are the RF for pneumococcus
Age Pneumonia Sinusitis Head trauma Endocarditis Alcoholism Splenectomy
What is the Rx for pneumococcus
Benzypen
Ceftriaxone if resistant
Steroid to prevent complications
Pneumococcal vaccine
Who gets pneumococcal vaccine
>65 DM Splenectomy Chronic disease HIV
What are the complications of pneumococcus
Death Loss of hearing Cranial nerve palsies Hemiparesis Hydrocephalus Seizures
What does H influenza B present like ? (gram -ve bacilli)
Mild respiratory tract illness Rapid deterioration Meningism uncommon Fever Lethargy
What is the Rx for H influenza B meningitis
Ceftriaxone
Dexamethasone
Rifampicin for prophylaxis
Hib vaccine
What does listeria monocytogenes present like ?
Febrile flu in pregnant
Abortion
Neonatal sepsis
Meningits
How is listeria monocytogenes Dx
blood culture
How do you treat listeria?
IV ampicillin to cover
How does Leptospirosis and Lyme present ?
Septicaemia Meningism can occur fever rigors myalgia vomiting conjunctival effusion rash hepato-renal damage
How does TB meningitis present?
Meningism Low grade fever Lethargy HEadache Change in mentation Extra-meningeal TB
Why does TB meningitis occur?
Rupture of sub-ependymal tubercle into subarachnoid space
Can be post primary in children
How do you diagnose TB meningitis
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
What are the viral causes of menigitis
Entero - coxsackie / echovirus HSV 2 VZV EBV HIV Mumps Polio
What are the symptom of viral meningitis
Non-specific illness Rapid headache Meningism Usually alert Encephalitis - lethargy, confusion, seizures, focal neuro Rash sometimes present
Dx of viral
PCR of CSF
Throat swab
HIV Dx
Rx of viral
Usually resolves in 72 hours
Acyclovir in HSV
MMR vaccine
What are the complications of mumps
Deaf
Orchitis
Testicular atrophy
What are the fungal causes of menigitis
Cryptococcus neoformans
What are the RF for fungal meningitis
HIV
DM
Lymphoma
What are the symptoms of fungal
Fever headache nausea lethargy confusion abdominal pain meningism less common
How do you diagnose fungal meningitis
India ink of CSF
Gram stain for candida
How do you treat fungal
Parenteral amphotericin
Flucytosin / fluconazole
Long term prophylaxis with fluconazole in HIV
What are common causes of neonatal meningitis
Group B strep E.coli Listeria monocytogenes H influenza B Enterovirus Parechovirus
What are the RF for neonatal meningitis
Low birth weight Prolonged rupture of membrane Pre mature Prolonged birth Maternal DM Intrapartum fever
How do you diagnose neonatal sepsis
CSF + blood culture
Culture of mothers blood and genital tract
EDTA of blood in viral
Treatment of neonatal sepsis
Parenteral amphicillin (cover group B and listeria)
Gentamicin (cover -ve bacilli)
IVIG for entero / parechovirus
How do you prevent neonatal sepsis
Amoxicillin / co-amoxiclav to high risk mother
isolate
IVIG to contacts
What are the complications of neonatal sepsis
Neurological and developmental sequeleae
What are the contraindications to LP
Unstable SKin infection Unstable bleeding disorder Increased ICP Chiari malformations
What are the complications of LP
Spinal headache Nerve root trauma CYsts Infection Disc herniation
What is a spinal headache
Bilateral
Improves when supine
Common in female with low BMI
How do you treat spinal headache
Hydrate
Caffeine
Epidural blood patch
What are the symptoms of nerve root trauma
Feel electric shock / back pain
Altered mental status
Cranial nerve abnormalities
CUshings - Brady, increased BP, irregular breathing
How do you treat nerve root trauma
Remove needle Raised head to increased venous return Mannitol Intubate Corticosteroids Nerve conduction studies
Causative organism of meningitis aged 3 months - 60 y/o
Strep pneumoniae
Causative organism of meningitis < 3 months and > 60 y/o
Listeria monocytogenes
Initial empirical Tx of meningitis aged 3 months - 50 y/o
IV ceftoxamine
Initial empirical treatment of meningitis <3 months
IV ceftoxamine and amoxicillin
