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Paediatric Neurology > Meningitis > Flashcards

Meningitis Flashcards

1
Q

How does meningitis cause hydrocephaly?

A

The release of inflammatory mediators and activated leucocytes, together with endothelial damage, leads to cerebral oedema, raised intracranial pressure, and decreased cerebral blood flow.

The inflammatory response below the meninges causes a vasculopathy resulting in cerebral cortical infarction, and fibrin deposits may block the resorption of CSF by the arachnoid villi, resulting in hydrocephalus.

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2
Q

What causative organisms from 0-3 months?

A

Group B Streptococcus (most common cause in neonates) - acquired from mother
E. coli
Listeria monocytogenes

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3
Q

Causative organisms from 3m to 6y

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

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4
Q

Causative organisms from 6y to 60y

A

Neisseria meningitidis

Streptococcus pneumoniae

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5
Q

Causative organisms > 60y

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

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6
Q

Causative organism in immunosuppressed

A

Listeria monocytogenes

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7
Q

Risk factors for GBS infection?

A

Low birth weight

Prolonged rupture of membranes

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8
Q

What are clinical features of meningitis?

A 
Headache
Fever
Nausea/vomoting
Photophocia
Drowsiness
Seizures
Neck stiffness
Purpuric rash
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9
Q

What does purpura in a febrile chil likely indicate?

A

Meningococcal sepsis

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10
Q

What is Brudzinski’s sign?

A

Flexion of the neck with the child supine causes flexion of the knees and hips

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11
Q

What is Kernig’s sign?

A

With the child lying supine with the hips and knees flexed, there is back pain on extension of the knee

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12
Q

What investigations in meningitis?

A 
FBC
Blood glucose
Blood gas for acidosis
Coagulation screen
CRP
U&E
LFT

Blood culture
Throat swab
Urine
Stool for bacteria

Rapid antigen test for menignitis orgnaisms - blood, CSF or urine

Samples for vital PCT - throat swab, NPA, conjunctiva swab, stool

Lumbar puncture for CSF unless CI

Serum for compareison of titres

PCR of blood and CSF

CXR and Mantoux if TB suspected

CT/MRI

EEG

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13
Q

What are contraindications to LP?

A 
Cardiorespiratory instability
Focal neurological signs
Signs of RICP - coma, high BP, low heart rate, papilloedema
Bulging of fontanelle
DIC
Coagulopathy
Thrombocytopenia
Local infection at the site of LP
If it causes delay instating ABX

MEningococcal septicaemia

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14
Q

CSF Normal - Appearance, Glucose, Protein, WBC

A

Appearance - Clear
Glucose - >= 50% of blood
Protein - 0.14-0.4g/L
WBC - 0-5/mm^3

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15
Q 
CSF - Bacterial meningitis:
Appearance
Glucose
Protein 
WBC
A

Appearance: Turbid
Glucose: LowLow <1/2 plasma
Protein: HighHigh > 1g/L
WBC: Raised polymorphs 10-5000/,,^3

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16
Q

CSF - Viral meningitis

A

Appearance: Clear
Glucose: Normal/Low
Protein: Normal/High
WBC: Lymphocytes raised 15-1000/mm^3

17
Q

CSF - Tuberculosis

A

Appearance: Turbid/clear/viscous - slightly cloudy, fibrin web
Glucose: LowLowLow < 1/2 plasma
Protein: High High High > 1g/L
WBC: Raised lymphocytes 10-1000/mm^3

18
Q

Management of meningitis?

A

Antibiotics

Steroids:
If > 1 month and Haemophilus influenzae give dexamethasone

Fluids
Treat shock

Cerebral monitoring
Mechanical ventilation if respiratory impairment

Public health notifications and antibiotic prophylaxis of contacts:
Ciprofloxacin

19
Q 
What antibiotics if < 3months?
> 3 months
> 50 years
Meningococcal meningitis
Listeria menignitis
A

IV amoxicillin + IV cefotaxime

> 3m
IV Cefotaxime

> 50 years
IV cefotaxime + IV amoxicillin

Meningococcal meningitis
IV benzylbenicillin or cefotazime

Listeria
IV amoxicillin + gentamicin

Chloramphenicol of pen allergic

20
Q

Management of meningitis if in pre-hospital setting

A

Transfer to hospital urgently

Give IM benzylpenicillin while waiting - don’t delay transfer

21
Q

Why should steroids be given?

A

IV dexamethasone to reduce risk of neurological sequelae

22
Q

What management of contacts

A

Prophylaxis to household and close contacts - Ciprofloxacin
People who have been exposed to patient if they have had close contact within 7 days before onset
Meningococcal vaccination offered to close contacts when serotype results are available including booster doses to those who had vaccine in infancy

23
Q

What are neurological sequelae of meningitis?

A 
Deafness/hearing impairment - audiology assessment
Local vasculitis - focal neurological lesions
Local cerebral infarction
Subdural effusion
Hydrocephalus
Brain herniation
Cerebral abscess
sepsis
24
Q

What are causes of viral meningitis?

A

Enteroviruses
Epstein Barr virus
Adenovirsues
Mumps

Diagnose by culture or PCR of CSF, stool, urine nasopharyngeal aspirate, throat swabs and serology

25
Q

When are Meningitis B vaccinations given?

Men ACWY

A

2 months
4 months
12-13 month

ACWY - 13-18 years and to students up to 25

Paediatric Neurology (12 decks)

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