Meningitis Flashcards
What are the types of meningitis?
Infective:
- Bacterial meningitis
- Viral meningitis
- Fungal meningitis
Inflammatory:
- Sarcoidosis
Drug-induced:
- NSAIDs
- IVIG (IV immunoglobulins)
Malignant:
- Metastatic
- Haematological (Leukaemia, Lymphoma, Myeloma)
What types of bacteria mainly cause bacterial meningitis?
Neisseria meningitidis - meningococcal meningitis
Streptococcus pneumoniae - pneumococcal meningitis
What type of virus mainly causes Viral meningitis?
Enteroviruses
How does meningitis present?
Short onset progressive headache with associated fever and meningism*
Classical triad of:
- Neck stiffness*
- Fever
- Headache +/- neurological features
Less important symptoms:
- Photophobia*
- Nausea & vomiting*
Others:
- Cerebral dysfunction - GCS < 14
- Cranial nerve palsy
- Seizures
- Focal neurological deficits
What are the signs of Meningitis?
Fever
Confusion, drowsiness etc
Photophobia
Petechial rash (Tumbler test)
- Hallmark sign of Meningococcal meningitis but also sign of Viral meningitis
How is meningitis investigated?
Bloods cultures (!)
- Indications - s.o bacterial meningitis
- Bloods also can be used for FBC, U&E’s etc
Either Lumbar puncture or CT head
- Separate slide with indications for each
Other:
- FBC, U&E’s, LFT, coagulation
What are the contraindications to using a Lumbar puncture to investigate meningitis?
Bacterial meningitis
- Petechial rash
- Lumbar puncture not necessary for Bacterial meningitis
Signs of mass lesion:
- Focal neurological deficit - excluding CN palsies
- New-onset seizures
Signs of Raised intracranial pressure:
- Altered consciousness (GCS < 10)
Severely immunocompromised
What Lumbar puncture results would be present in meningitis?
What blood culture results would correspond with what bacterial meningitis?
Gram stain and culture
Gram-positive (blue/violet) in chains - most likely streptococci (pneumococcal meningitis)
Gram-negative - Probably meningococcus
