Meningitis

Question 1

What life altering changes maybe seen after surviving a bout of meningitis?

Answer 1

25% of survivors live with:

• limb loss
• blindness
• cerebral palsy
• quadriplegia
• severe mental development

Question 2

Causes of meningitis post a basilar skull fracture?

Answer 2

• Strep. pneumoniae
• H.influenzae
• Gr.A Beta-hemolytic streptococci

Question 3

Cause of meingitis in immunocompromised?

Answer 3

• Listeria
• Strep. Pneumonaie
• Neisseria Meningitidis
• GNR

Question 4

In a lumbar puncture conducted for suspected Bacterial meningitis, 4 tubes of CSF are collected? Why>

Answer 4

1. one tube to hematology (CELL count and differential)
2. Microbio (gram stain/ cultures)
3. Chemistry (glucose and protein)

Question 5

How does H. influenzae appear with gram stain?

Answer 5

small, pleomorphic gran-NEGATIVE rods/ coccobacili

Question 6

Why may bacterial meningitis come across as culture negative?

Answer 6

• oral antibiotics administration PRE-LP may lower the GRAM positivity by 20% and culture positivity by 30%

Question 7

If listeria is suspected, and the patient has penicillin allergy, what shoul dbe administered to the pt?

Answer 7

• Co-trimazole, alone is successful

Question 8

If there is a CLEAR hx of anaphylaxis to Beta-lactams?

Answer 8

• IV CHloramphenicol (25mg/kg) QDS
• IV vancomycin (500mg 6hrly)

with DEXAMETHASONE 10mg QDS

Question 9

The effectiveness of steroids administration to bacterial meningitis?

Answer 9

• GIVEN with/ 10-20min before 1st Ab dose (IV 10mg)
• —-mortality reduces from 15% to 7%

—–BESt benefit seen in pneumococcal meningitis (less likely to have IMPAIRED consciousness, seizures and cardio-respiratory failure)

Question 10

When are steroids contraindicated in a pt?

Answer 10

If pt is said to be:

• immunocompromised
• allergic to steroids
• in septic/ meningococcal shock
• having post-surgical meningitis

Question 11

What is done to prevent secondary cases of meningitis?

Answer 11

1. Report Public health/ Health Protection of all clinically suspected cases ASAP after admission
2. close contacts to be located and chemoprophylaxis and vaccination to be be implemented
3. ALERT docs of an incr. risk persists for 6 months- with GP records of ALL close contacts

Question 12

What vaccines are available?

Answer 12

• N. Meningitidis (Serogroups A and C; travel vaccination and Gr. C)
• H.Influenzae (HiB vaccine)
• Strep. Pneumoniae