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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q

How does meningitis present?

A
  • Fever
  • Headache
  • Photophobia
  • Vomiting
  • Neck stiffness
  • Lethargy
  • Clouding of consciousness
  • Cranial nerve palsies can occur
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2
Q

Describe the pathogenesis of meningitis

A
  • Attachment to mucosal epithelial cells
  • Transgression of the mucosal barrier
  • Survival in the blood stream
  • Entry into CSF
  • Production of overt infection in the meninges with or without brain infection
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3
Q

Name the common causes of meningitis

A
  • Bacterial: neisseria meningitidis (meningococcus) and strep pneumoniae
  • Neonates: E. coli and group B strep
  • Viral: enteroviruses (echoviruses, parechoviruses, Coxsackie A/B and polio), mumps and HSV
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4
Q

Name the less common causes of meningitis

A
  • Hib
  • Listeria monocytogenes
  • Mycobacterium tuberculosis
  • Leptospirosis
  • Lyme disease
  • Mycoplasma pneumoniae
  • Crytococcus neoformans
  • HIV
  • VZV
  • EBV
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5
Q

Describe the features of shunt associated meningitis

A
  • 10-30% of patients with ventriculo-atrial/peritoneal shunts
  • Coagulase negative staph account for 50%
  • Removal of the shunt and antibiotic therapy may be neccessary
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6
Q

Describe the features of aseptic meningitis

A
  • Non infective causes: tumour, drugs, chemicals, sarcoidosis, SLE etc.
  • CSF: excessive lymphocytes and elevated protein
  • No organism is cultured or detected
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7
Q

What can delayed treatment of bacterial meningitis cause?

A
  • Deafness
  • Fits
  • Mental impairment
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8
Q

Name the illnesses associated with meningitis

A
  • Recent skull trauma
  • Alcoholism
  • Diabetes mellitus
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9
Q

Name the examination points for meningitis

A
  • Temp.
  • Level of consciousness
  • Skin/conjunctival petechiae
  • Other rashes: vasculitis, macular/maculo-papular, purpuric, pruritic or vesicular
  • Tachycardia or bradycardia
  • BP: hypotension
  • Focal neurological signs
  • Papilloedema (unusual in meningitis)
  • Kernigs sign: cannot straighten leg when the hip is flexed
  • Flex the neck
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10
Q

Which investigations should be done for meningitis?

A
  • Blood cultures
  • Lumbar puncture: culture, PCR etc.
  • FBC: neutrophil leucocytosis or decreased in sepsis or DIC (would also have low platelets, abnormal clotting and increased FDPs)
  • U&Es
  • LFTs
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11
Q

What would you expect to find in the CSF in bacterial meningitis?

A
  • Turbid appearance
  • Greatly increased cells
  • Predominantly neutrophils
  • Decreased glucose
  • Greatly increased protein
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12
Q

What would expect to find in the CSF in viral meningitis?

A
  • Clear to turbid appearance
  • Moderate increase in cells
  • Predominantly lymphocytes
  • Normal glucose
  • Moderate increase in protein
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13
Q

What would you expect to find in the CSF in tuberculous meningitis?

A
  • Clear to turbid appearance
  • Moderate increase in cells
  • Predominantly lymphocytes/mixed
  • Reduced glucose
  • Greatly increased protein
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14
Q

How can bacterial meningitis be treated?

A
  • Antibiotics: benzylpenicillin and ceftriaxone

- Dexamethasone (evidence is incomplete)

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15
Q

Describe the features of felminant meningococcal septicaemia

A
  • Rapid deterioration of consciousness
  • Fever
  • Septic shock with renal failure and DIC
  • CSF is sterile
  • 50% die within the first 24hrs
  • Needs urgent antibiotics and hospitalisation
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16
Q

How is meningococcal meningitis treated?

A
  • Parental penicillin prior to transfer to hospital
  • Acutely unwell: high dose ceftriaxone (after blood cultures)
  • Once cultures are back benzylpenicillin may be substituted with ceftriaxone
  • Discharge: rifampacin or ciprofloxacin to eradiate the bacteria from the nasopharynx
  • Notify public health
17
Q

Name the bad prognostic markers for meningococcal meningitis

A
  • Delay in antibiotic therapy
  • Extremes of age
  • Purpuric lesions
  • Signs of shock
  • Presence of DIC
  • Metabolic acidosis
  • Absence of polymorph leucocytosis
18
Q

Name the predisposing factors for pneumococcal meningitis

A
  • Pneumonia
  • Sinusitis
  • Endocarditis
  • Head trauma
  • Alcoholism
  • Splenectomy
19
Q

How can pneumococcal meningitis be treated?

A
  • Ceftriaxone (can be changed once the penicillin MIC is known
  • Dexamethasone may reduce the number of complications
20
Q

What are the potential complications of pneumococcal meningitis?

A
  • Death (30-50%)
  • Loss of hearing
  • Cranial nerve deficits
  • Hemiparesis
  • Hydrocephalus
  • Seizures
21
Q

How can Hib meningitis be treated?

A
  • Cefotaxime
  • Dexamethasone in severe cases
  • Prophylaxis with rifampicin to close contacts
  • Prevention: vaccine
22
Q

In which patients is listeria monocytogenes meningitis more likely and how can it be treated?

A
  • Neonatal and older adults

- IV ampicillin should be given to adults over 55 who have meningitis before the cause is known

23
Q

How can viral meningitis be treated?

A
  • Enteroviruses and parechoviruses: usually asymptomatic and usually recover by themselves (if chronic e.g. due to immune compromise then IV immunoglobulin
  • HSV: IV aciclovir
24
Q

How can cryptococcal meningitis be treated?

A
  • Parental amphotericin +/- flucytosine
  • Alternatively: high dose fluconazole
  • Secondary prophylaxis: fluconazole for HIV patients
25
Q

What are the predisposing factors for neonatal meningitis?

A
  • Low birth weight
  • Prolonged rupture of membranes
  • Maternal diabetes mellitus
26
Q

How can neonatal meningitis be treated?

A
  • Group B strep: benzylpenicillin or amoxicillin
  • E coli: cefotaxime
  • Listeria monocytogenes: ampicillin + gentamicin for 3 weeks +
  • IV Ig for viruses
27
Q

How can neonatal meningitis be diagnosed?

A
  • CSF and blood cultures
  • EDTA blood
  • Faecal and nasopharyngeal secretions
28
Q

How can neonatal meningitis be prevented?

A

-Amoxicillin or co-amoxiclav for high risk mothers during labour

Infection (15 decks)

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