Meningitis Flashcards
Define meningitis
inflammation of the meninges
What are the causes/risk factors of meningitis?
Bacteria • Streptococcus pneumoniae • Neisseria meningitidis • Haemophilus influenzae (less common now with Hib vaccine) • Listeria monocytogenes (neonates and elderly)
Viruses
• Enteroviruses
• Mumps
• Varicella zoster virus
Risk Factors • Close communities/crowding • Low socioeconomic status • Basal skull fractures • Sinusitis/inner ear infection • Alcoholism • Immunodeficiency • Splenectomy • Sickle cell disease • CSF shunts • Intracranial surgery
What are the symptoms of meningitis?
• Fever • Irritability • Drowsiness • Vomiting • Poor feeding and high-pitched crying in infants
Meningism
• Severe headache
• Photophobia
• Neck stiffness
What are the signs of meningitis?
• Fever • Tachycardia • Hypotension • Skin rash (non-blanching petechiae in meningococcal septicaemia) • Altered mental state
Meningism • Photophobia • Neck stiffness • Kernig’s sign • Brudzinski’s sign
What investigations are carried out for meningitis?
• CT scan – exclude raised ICP before LP
• Lumbar puncture
- MC&S
- Biochemistry and cytology
> Cloudy CSF if bacterial, fibrinous CSF if TB
> ↑ neutrophils
> ↑ protein
> ↓ glucose (CSF:serum glucose ratio <0.5) if bacterial or TB
• Blood cultures x2 –if LP delayed or unsafe to perform
• PCR – not widely available but more sensitive and specific – distinguishes bacterial
and viral meningitis
What is the management for meningitis?
DO NOT DELAY ANTIBIOTIC THERAPY!
• IV cefotaxime or ceftriaxone (3rd generation cephalosporins)
o If in community start oral/IM benzylpenicillin
o If bacterial resistance add vancomycin
o If penicillin allergy use chloramphenicol
• IV dexamethasone with 1st dose of antibiotics for 4 days
• Send to ITU
• Notify public health services
What are the complications of meningitis?
• Septicaemia • Shock • DIC • Renal failure • Seizures • Peripheral gangrene • Cerebral oedema • Cranial nerve palsies • Cerebral venous thrombosis • Hydrocephalus • Waterhouse-Friedrichsen syndrome (bilateral adrenal haemorrhage)
