Meningitis Flashcards
What does pyogenic meningitis look like under a microscope?
Neutrophils in the sub arachnoid space.
What is the commonest cause of viral meningitis?
Enteroviruses (e.g. ECHO)
Investigations for viral meningitis.
Viral stool culture
Throat swab
CSF PCR
Commonest causes of bacterial meningitis in neonates.
Listeria, group B strep, E.coli
Commonest causes of bacterial meningitis in children
Haemophilus influenzae
Commonest causes of bacterial meningitis in ages 10-21
Neisseria meningitidis
Commonest causes of bacterial meningitis in over 21s
Strep pneumoniae more than neisseria meningitidis
Commonest causes of bacterial meningitis in over 65
More strep pneumo than listeria
What meningitis does neurosurgery or head trauma put you at risk of?
Staphylococcus, gram negative bacilli
What meningitis does fracture of the cribiform plate put you at risk of?
Strep pneumoniae
Complications of meningitis
Purulence
Invasion
Cerebral oedema
Ventriculitis/hydrocephalus
What is the gram stain appearance of meningococcus?
Gram negative diplococci
Is listeria gram positive or gram negative?
Gram positive
What antibiotics for tuberculous meningitis?
Isoniazid, rifampicin, pyrazinamide and ethambutol.
What can cause meningitis in HIV and how do you treat it?
Cryptococcus (fungal)
Fluconazole
When should you not do a LP in meningitis?
If increased ICP possible
Delirium
Give examples of non-infectious causes of aseptic meningitis.
Carcinomatous Sarcoidosis Vasculitis Dural venous sinus thrombosis Migraine Drug (co-trim, IVIG, NSAIDs)
What investigation and management should be given on admission for bacterial meningitis?
Blood culture and coag screen
Antibiotics and steroids as per guidance
Throat swab
Swab or aspirate purpuric lesions
When should patients have CT prior to having a lumbar puncture for meningitis?
Immunocompromised History of CNS disease New onset seizure Papilloedema Abnormal level of consciousness Focal neurological deficit
Should you give antibiotics before or after a lumbar puncture?
If LP will be delayed for more than 30 mins give it before
What is the contact prophylaxis regimen for meningitis?
4 hourly doses of rifampicin orally OR 1 dose of ciprofloxacin orally OR IM ceftriaxone
