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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q

what are the features of meningism?

A

headache
stiff neck
photophobia
vomiting

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2
Q

what are the causes of meningism?

A

meningitis
SAH
infection accompanied by bacteraemia
severe viral infections i.e. influenza can also cause meningitism

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3
Q

what is characteristic of the neck stiffness in meningism?

A

stiffness on passive flexion (looking down to the feet)

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4
Q

what is neck stiffness with lateral or rotational movements indicate?

A

local cause in the cervical joints

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5
Q

by what mechanism does molecules pass through the blood brain barrier?

A

active transport

lipid solubility

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6
Q

what are the 5 steps of the pathogenesis of meningitis?

A 
attachment to mucosal epithelial cells
transgression of the mucosal barrier
survival in the blood stream
entry into CSF
production of infection in the meninges with or without brain infection (encephalitis)
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7
Q

what are the bacterial causes of meningitis?

A

neisseseria meningitidis
streptococcus pneumoniae
e.coli
group B strep

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8
Q

what are the common organisms responsible for meningitis in neonates?

A

e.coli
group B streptococci
listeria monocytogenes

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9
Q

what are the viral causes of meningitis?

A

enteroviruses;

  • cocksackie A and B
  • polio
  • echoviruses
  • parechoviruses

mumps
HSV

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10
Q

what is aseptic meningitis?

A

non-infective meningitis
usually caused by tumour cells in the CSF which cause an elevated lymphocyte and protein count
no organism is cultures or detected

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11
Q

what cranial nerves palsies may occur with meningitis?

A

VI, VII, VIII

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12
Q

what are risk factors for meningitis?

A

recent skull trauma
alcoholism
diabetes

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13
Q

if the presentation of meningitis is acute and rapidly progressive what is the most likely cause?

A

meningococcal

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14
Q

what is Kernig’s sign?

A

with the hip flexed, the patient leg cannot be straightened due to hamstring spasm in meningism

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15
Q

if FBC shows a low white cell count (leucopenia) what does this indicate?

A

septicaemia or disseminated intravascular coagulation
= poor prognosis
(the infection should cause it to rise)

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16
Q

what is the predominant cell types in bacterial and viral meningitis in the CSF?

A

bacterial - neutrophils

viral - lymphocytes

17
Q

what antibiotics are used to treat meningitis?

A

benzylpenicillin given 4 hourly

or ceftriaxone

18
Q

what strain of meningococcal meningitis is most common?

A

groups B and C

ratio 3:2

19
Q

what strain of meningococcal meningitis is there a vaccine for?

A

group C

20
Q

what are the features of fulminant meningococcal septicaemia?

A

sudden onset of symptoms with rapid deterioration of consciousness, renal failure, disseminated intravascular coagulation, fever and septicaemic shock

21
Q

what is the mortality rate for fulminant meningococcal septicaemia?

A

50% die within first 24 hours of illness

22
Q

what are bad prognostic markers of meningitis?

A 
DIC
metabolic acidosis
absence of polymorph leukocytosis 
delay in instigation of therapy
extremities of age
purpuric lesions
shock with absence of signs of meningism
hyperpyrexia
23
Q

what is the most common organism that causes meningitis in adults?

A

streptococcus pneumoniae

24
Q

what are predisposing factors for pneumococcal meningitis?

A 
alcoholism
splenomegaly 
head trauma
endocarditis
sinusitis 
pneumonia
25
Q

what is the treatment for pneumococcal meningitis?

A

ceftrixone
(or benzylpenicillin but there are now resistant strains)

dexamethasone to minimise risk of complications

26
Q

what are complications of pneumococcal meningitis?

A 
loss of hearing 
hydrocephalus 
seizures 
hemiparesis 
cranial nerve defects
27
Q

a patient 5 years old presents with a mild upper respiratory tract infection followed by a rapidly deteriorating meningitis. what is the most likely causative organism?

A

haemophillus influenzae

28
Q

what is the treatment for haemophilias influenzae (type B) meningitis?

A

cefotaxime

29
Q

name 2 spirochetes that can cause aseptic meningitis?

A

leptospirosis and lyme disease

30
Q

what is the most common cause of meningitis in HIV patients?

A

cryptococcal meningitis (fungal)

31
Q

what investigations should be carried out to diagnose cryptococcal meningitis?

A

LP for measurement of CSF

serum cryptococcal polyssacharide antigen

32
Q

what is the treatment for cryptococcal meningitis?

A

parenteral amphotericin + flucytosine

or high dose fluconazole as an alternative to this combination

33
Q

how is cryotoccal meningitis prevented in HIV patients?

A

chemoprophylaxis with fluconazole

34
Q

what are predisposing factors for neonatal meningitis?

A

low birth weight
maternal diabetes
prolonged rupture of membranes

35
Q

what is the treatment for neonatal meningitis caused by E.coli?

A

cefotaxime

36
Q

what is the treatment for neonatal meningitis caused by listeria monocytogenes ?

A

ampicillin + gentamicin for 3 weeks or longer

37
Q

what is the treatment for group B strep meningitis in neonates?

A

benzoyl penicillin and amoxicillin

Infection (13 decks)

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