Meningitis

Question 1

What is Meningitis?

Answer 1

An inflammation of the meninges caused by bacteria, viruses or fungi.

Question 2

What are the risk factors of Meningitis?

Answer 2

• young or old (<5, >65)
• Crowding
  > Exposure to pathogens
  > Students
  > Non immunised infants
  > Immunodeficiency
  > Cancer
  > Cochlear implants
  > Anatomical defects

Question 3

What are the signs and symptoms of Meningitis?

Answer 3

> Headache, neck stiffness, photophobia
> Rash
> Fever, vomiting 
> Confusion, altered mental state
> Papilloedema
> Kernig's sign
> Brudzinski's sign

Question 4

What is the epidemiology of Meningitis?

Answer 4

The incidence of bacterial meningitis in Western countries and the US is 0.7 to 0.9 per 100,000 persons per year and has decreased by 3% to 4% in the past 10 to 20 years.

Question 5

What investigations would you do for Meningitis?

Answer 5

> CSF analysis (high protein, low glucose, positive gram stain and culture)
Blood culture (positive)
Bloods- FBC (anaemia, leukocytosis, thrombocytopenia), CRP (high) , U/E (acidosis, low Ca/Mg, or hyper/hypoglycaemia), Coag profile (evidence of DIC)
CT head (normal or raised ICP)
PCR (pos)

Question 6

What is the management of Meningitis?

Answer 6

Bacterial
> Antibiotics (ampicillin and cefotaxime)
> Supportive therapy
> Dexamethasone

Viral
> Supportive care
> Antiviral therapy

Question 7

What are the complications of Meningitis?

Answer 7

> Shock
> ICP
> Hydrocephalus
> Focal neural deficits
> Subdural effusion
> Seizures
> Brain abscess
> Septic deep vein thrombosis
> hearing loss

Question 8

What is the prognosis of Meningitis?

Answer 8

Untreated bacterial- poor

Viral- meh

Question 9

What is Kernig’s sign?

Answer 9

With the patient supine and the thigh flexed to a 90° right angle, attempts to straighten or extend the leg are met with resistance.

Question 10

What is Brudzinski’s sign?

Answer 10

Flexion of the neck causes involuntary flexion of knees and hips.

Alternative sign is passive flexion of the leg on one side causing contralateral flexion of the opposite leg.