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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Define meningism?

A

symptom complex characterised by headache, photophobia, vomiting and muscle spasm leading to a stiff neck

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2
Q

Define meningitis

A

Infection of the meninges, leading to inflammation and signs of meningeal irritation

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3
Q

the 5 steps of pathogenesis of meningitis?

A

1- attachment to mucosal epithelial cells
2- transgression of the mucosal barrier
3- survival in the bloodstream
4-entry into CSF
5-production of overt infection in the meninges

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4
Q

the common bacterial causes of meningitis?

A

neisseria meningitidis,
streptococcus pneumoniae,
e.coli and group b streptococci (in neonates)

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5
Q

the common viral causes of meningitis?

A

enteroviruses (echovirus, parechoviruses, coxsackie A and B, polio),
mumps,
Herpes simplex virus

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6
Q

What bacteria is the likely cause of meningitis in a patient with a shunt?

A

coagulase negative staphylococci

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7
Q

Non-infective causes of meningitis?

A 
tumour cells in csf,
adverse drug reactions, 
chemicals, 
diseases of unknown aetiology,
leptospirosis, 
lyme disease
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8
Q

What is aseptic meningitis?

A

syndrome when the csf shows an excessive no. of lymphocytes

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9
Q

differential diagnoses for meninigism?

A 
subarrachnoid haemorrhage, 
migraine, 
flu, 
tonsillitis, 
pneumonia, 
sinusitis, 
UTI
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10
Q

what presentation should always make you consider meningitis?

A 
history of URTI + 1 of:
vomiting, 
headahce, 
stiff neck, 
lethargy,
clouding of consciousness
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11
Q

Risk factor for meningitis?

A

recent skull trauma,
alcoholism,
diabetes mellitus

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12
Q

What is kernig’s sign?

A

with hip flexed, you can’t straighten the leg due to hamstring spasm in meningism

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13
Q

When do you see Kernig’s sign?

A

meningitis

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14
Q

Investigations for meningitis?

A 
blood cultures, 
lumbar puncture,
fbc,
U&Es,
LFT
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15
Q

When should you not take a lumbar puncture?

A

If there are signs of a space occupying lesion eg focal neurological signs

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16
Q

CSF tests carried out?

A 
gram stain, 
differential cell count,
antigen detection test, 
bacterial culture, 
mycobacterial or fungal culture, 
PCR for viruses, 
PCR for bacteria,
glucose, 
protein
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17
Q

normal CSF colour and wcc?

A

gin colour,

5 wc/mm3

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18
Q

define xanthochromia?

A

yellowish appearance of CSF, several hours after bleeding into the subarachnoid space

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19
Q

Main difference between bacterial and viral meningitis?

A

cell number and protein increased in both, but more so in bacterial,
neutrophils predominant cell in bacterial,
lymphocytes predominant cell in viral,
glucose reduced in bacterial

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20
Q

Antibiotics used in bacterial meningitis?

A

Benzylpenicillin,
ceftriaxone
(penetrate csf when meninges inflammed)

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21
Q

what age groups are more commonly affected by meningococcal meningitis?

A

children,

young adults

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22
Q

What bacteria causes meningococcal meningitis?

A

neisseria meningitidis,

gram -ve

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23
Q

what is the name and characteristic of the meningitis rash?

A

purpuric rash,

doesn’t blanche on pressure

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24
Q

what is chronic meningococcaemia?

A

illness lasts for weeks/months,

rash, joint pains, fever, endocarditis

25
Q

Treatment of meningococcal meningitis or sepsis?

A 
early suspect- parenteral penicillin, 
ceftriaxone,
after results- benzylpenicillin, 
supportive therapy, 
discharge- rifampicin or ciprofloxacin (only adults)
26
Q

Bad clinical prognostic markers for meningitis?

A

antibiotic delay,
extremities of ages,
purpuric lesions,
shock with absence of signs of meningitis and hyperpyrexia

27
Q

Bad lab prognostic markers for meningitis?

A

presence of Disseminated intravascular coagulation
metabolic acidosis,
absence of polymorph leucocytes

28
Q

Who should be notified if a patient has meningococcal infection?

A

Local consultant of health protection,

arrange prophylaxis for all close people

29
Q

what age groups are more commonly affected by pneumococcal meningitis?

A

any age but more commonly adults

30
Q

predisposing factors to pneumococcal meningitis?

A 
pneumonia, 
sinusitis, 
endocarditis, 
head trauma, 
alcoholism or splenetomy
31
Q

bacterial cause of pneumococcal meningitis?

A

streptococcus pneumoniae,
gram +ve,
alpha haemolytic

32
Q

treatment for pneumococcal meningitis?

A

if resistant/1st line- ceftriaxone
benzylpenicillin,

vaccine- for >65, or high risk groups, routine childhood vaccines

33
Q

inital presentation of pneumococcal meningitis?

A

altered consciousness,

focal neurological signs

34
Q

complications of pneumococcal meningitis

A 
loss of hearing, 
cn deficts, 
hemiparesis, 
hydrocephalus,
seizures
35
Q

Presentation of haemophilus influenzae meningitis?

A 
mild URTI, 
rapid deterioration, 
otitis/ pharyngitis,
seizures, coma,
gram-ve cocci and bacilli
36
Q

haemophilus influenzae meningitis treatment?

A

dexamethasone,
rifampicin (prophylaxis),
conjugate Hib Vaccine

37
Q

Listeria monocytogenes meningitis?

A

gram +ve bacillus,
neonate and adult meningitis,
>55 treatment IV ampicillin

38
Q

How does tuberculous meningitis occur?

A

rupture od a subependymal tubercle into the subarachnoid space,
post primary event following miliary TB or pleural effusion

39
Q

Investigation presentations of tuberculous meningitis?

A 
CSF white cell increased and mixed, 
\+ve for acid and alcohol fast bacilli, 
CSF glucose reduced,
gram stain -ve,
culture
40
Q

Clinical presentation of viral meningitis?

A

rapid onset of headache,
photophobia,
low grade fever,
stiff neck

41
Q

Investigations for viral meningitis?

A

PCR of CSF,
throat swabs,
stool culture,
HIV test

42
Q

treatment for viral meningitis?

A

enterovirus and parechoviruses- self limiting,
chronic- IV immuniglobulkin,
HSV- aciclovir

43
Q

Risk factors for cryptococcal meningitis?

A

HIV,
diabetes,
lymphoma,
immunosuppressive drugs

44
Q

Investigations for fungal meningitis?

A

gram stain with india ink,

csf and serum cryptococcal polysaccharide antigen

45
Q

presentation of fungal meningitis?

A 
low grade fever, 
nausea, 
headache, 
lethargy, 
confusion, 
abdominal pain
46
Q

Treatment of fungal meningitis?

A

parenteral amphotericin + flucytosine OR

fluconazole

47
Q

Prevention of fungal meningitis?

A

chemoprophylaxis with fluconazole after a cryptococcal meningitis episode

48
Q

How does neonate meningitis differ from adult?

A

symptoms are non specific and not well localised,

bacteria commonly involved- group b strepctococci, e.coli, l.monocytogenes, enteroviruses and parechoviruses

49
Q

if a pregnant women consumes contaminated pate, soft cheese and goat’s milk what are they putting their baby at risk of?

A

meningitis caused by listeria monocytogenes, gram +ve

50
Q

treatment of listeria monocytogenes meningitis?

A

ampicillin + gentamicin

51
Q

Group B streptococci responsible for neonate meningitis, gram +ve or -ve?

A

gram +ve,
commensal in female genital tract,
sensitive to benzylpenicillin and amoxycillin

52
Q

What strain of e.coli is more likely responsible for neonate meningitis?

A

K1 strain

53
Q

Describe early onset neonate meningitis?

A

within 3 days of birth,
associated with prematurity, difficult or prolonged birth,
resp distress,
bacteraemia,
organisma aquired from mother’s genital tract

54
Q

Describe late onset neonate meningitis

A

more than 1 week after birth,

bacteraemia and meningitis

55
Q

investigations into bacterial neonate meninigitis

A

neonatal csf,
blood culture,
maternal blood culutres and genital tract cultures

56
Q

investigations into viral neonate meninigitis

A

neonatal csf,
edta blood,
faeces and nasopharyngeal secretions

57
Q

Treatment or neonate meningitis?

A

parenteral ampicillin and gentamicin or cefotaxime

58
Q

prevention of neonate meningitis?

A

chemoprophylaxis to prevent group b strep meningits to high risk mums- amoxicillin or co-amoxiclav

Infection (15 decks)

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