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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q 
Causative organisms
Bacterial Neonate [3]
Bacterial Child [3]
Bacterial Adult [2]
Viral [5]
Fungal [3]
A

Neonate:
- GBS, E. Coli, Listeria
Child:
- N. meningitides, streptococcus pneumonia, h. influenza
Adult:
- N. meningitides, streptococcus pneumonia

Viral:

  • Enteroviruses
  • HSV, VZV
  • Mumps
  • EBV
  • HIV

Fungal:

  • Cryptococcus neoformans
  • Coccidioides immitis
  • Histoplasma capsulatum
  • Mycobacterium tuberculosis
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2
Q

Name 3 enteroviruses
Route of transmission
Ix for suspected encephalitis due to enterovirus

A

Polioviruses, coxsackie virus, echovirus

Faecal-oral spread, human to human

PCR the CSF for enterovirus

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3
Q

Pathophysiology [5]

A
  • Bacteria become attached to mucosal epithelial cells
  • Transgression in mucosal barrier
  • Survives in bloodstream, entry into CSF
  • Causes meningitis with(out) brain infection
  • Meningeal inflammation reflected by increased white cells in CSF
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4
Q

Risk factor [4]

A
  • Recent skull trauma
  • Alcohol abuse
  • DM, OM
  • Pneumonia, sinusitis
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5
Q

Presentation
Classic triad
Symptoms [2]
Signs [5]

A

Classic Triad: Fever, neck stiffness and altered mental status

Symptoms

  • Short history of headache
  • Meningism (Stiff neck, photophobia, N/V)

Signs:

  • Cerebral dysfunction e.g. confusion is common and many have a lowered GCS
  • Cranial Nerve Palsies, Seizures and focal neuro deficits can occur
  • Kernig’s sign
  • Brudinski’s sign
  • Cardio: tachy/brady, hypotension
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6
Q

What is Kernig’s sign

What is Brudinski’s sign?

A

o Kernig’s sign: with hip flexed, pt has resistance and pain on knee extension due to hamstring spasm
o Brudinski’s sign: hips flex on bending the head forward

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7
Q

Rash on presentation - ddx [2]

A

Purpuric petechiae - non blanching more likely meningococcal
On skin or conjunctiva

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8
Q

Bloods [7]

A
  • blood cultures (preferably before abx)
  • FBC (neutrophilia (bacterial), lymphocytosis (viral or TB), thrombocytopenia if DIC)
  • U&E and creatinine, LFT, CRP
  • coagulation (DIC)
  • blood glucose
  • VBG (lactate)
  • meningococcal and pneumococcal PCR
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9
Q

Investigations [2]

A

Throat swab for meningococci

Lumbar puncture - record opening pressure (raised) > microbiology and biochemistry

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10
Q

When would an LP be contraindicated?
Why [1]
5 instances where its contraindicated

A

You don’t do it if there’s sign of a mass or swelling as the pressure could cause herniation when you re-pressurise by puncturing it.

  • Focal Neuro deficits
  • New Seizures
  • Papilloedema
  • GCS<10
  • Severe Immunocompromisation
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11
Q

What would you find on an LP in meningitis?
Bacterial 4
Viral 4

A

Bacterial:

  • raised pressure
  • Raised cell count (Mainly Neutrophils)
  • Low Glucose (Bacteria consume it)
  • Very High Protein

Viral:

  • Normal/raised pressure
  • Raised Cell Count (Mainly Lymphocytes)
  • Normal glucose (~60% of blood glucose)
  • Slightly raised protein
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12
Q

Normal features of an LP [5]

A 
Clear
Low cell number
Lymphocytes
Normal glucose
Normal protein
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13
Q

Features of TB [6]

What do you have to order specifically if you suspect cryptococcal meningitis?

A

TB:

  • clear to turbid
  • moderately high cell number
  • lymphocytes
  • low glucose
  • high protein
  • +ve for AAFB

Cryptococal meningitis: do India ink of CSF

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14
Q

Neurological sequelae mechanisms [4]

A
  • Sensorineural hearing loss
  • Epilepsy, paralysis
  • Infective: sepsis, intracerebral abscess
  • Pressure: brain herniation, hydrocephalus
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15
Q

Immediate Management [4]

A

ABCDE
Blood cultures
IV dexamethasone (reduces risk of neurological sequelae)
IV fluids

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16
Q 
Management of meningococcal meningitis
<3m
Children
Adults
>50yo
A 
Initial empirical ab therapy:
	<3m: IV CEFOTAXIME and AMOXICILLIN 
	Children: IV CEFTRIAXONE  
	Adults: IV CEFTRIAXONE or CEFOTAXIME
	>50y/o: IV CEFOTAXIME and AMOXICILLIN (if penicillin allergic then CHLORAMPHENICOL)
17
Q

Management of bacterial meningitis targeted antibiotic therapy:

  • Meningococcal
  • Pneumococcal
  • Haemophilus influenza
  • Listeria
A

Antibiotics once bacterial cause known:
 Meningococcal:
IV CEFTRIAXONE (or CEFOTAXIME) for 7d

	Pneumococcal: 
IV CEFTRIAXONE (or CEFOTAXIME)

 Haemophilus influenza: IV CEFTRIAXONE (or CEFOTAXIME) for 10d

 Listeria: IV AMOXICILLIN for 10d and GENTAMICIN for at least 1st 7d

18
Q

Management of viral meningitis [3]

A

Diagnosis of exclusion
If enterovirus, resolves within 72h
IV acyclovir for HSV

19
Q

Mx fungal [2]

A
  • IV Amphothericin B and fluconazole

- Long term fluconazole as secondary prophylaxis

20
Q

Public health aspect in meningitis mx [3]

A
  • Close contacts of meningococcal within last 7d
  • get one off prophylactic dose CIPROFLOXACIN
    + meningococcal vaccine (if suitable serotype

Infection (20 decks)

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