Meningitis

Question 1

What should be done if you suspect meningitis in primary care?

Answer 1

Arrange urgent transfer to secondary care

Question 2

What should be done if you suspect meningitis in primary care and there is a non-blancing rash?

Answer 2

Give benzylpenicillin 1.2mg IM/IV before admitting

Question 3

What are the differentials for meninigitis?

Answer 3

• Malaria
• Encephalitis
• Septicaemia
• Subarachnoid haemorrhage
• Dengue
• Tetanus

Question 4

What are the early features of meningitis?

Answer 4

• Headache
• Fever
• Leg pains
• Cold hands and feet
• Abnormal skin colour

Question 5

What are the later signs of meningitis?

Answer 5

• Meningism
• Decreased GCS or coma
• Seizures
• Petechial rash
• Shock

Question 6

What signs of meningism may be present in meningitis?

Answer 6

• Neck stiffness
• Photophobia
• Kernigs sign

Question 7

What is Kernigs sign?

Answer 7

Pain and resistance on passive knee extension with hip fully flexed

Question 8

What is the first step in managing meningitis?

Answer 8

ABCDE assessment, fluid resuscitation, blood glucose correction

Question 9

What is the first question to ask yourself when managing meningitis?

Answer 9

Shocked or not?

Question 10

What are the signs of shock in meningitis?

Answer 10

• Prolonged CRT
• Cold hands and feet
• Low BP
• Evolving rash

Question 11

What should be done if a patient with meningitis is shocked?

Answer 11

• Get ICU help
• Blood cultures
• IV antibiotics
• Airway support
• Fluid resus/inotropes/vasopressors
• Delay LP until stable

Question 12

What question should be asked if a patient with meningitis is not shocked?

Answer 12

Do they have signs of raised ICP?

Question 13

What are the signs of raised ICP in meningitis?

Answer 13

• Papilloedema
• Uncontrolled seizures
• Focal neurology

Question 14

What should be done if a patient with meningitis has signs of raised ICP?

Answer 14

• Get ICU help
• IV antibodies (after cultures)
• Dexamethasone 10mg IV
• Airway support
• Fluid resus
• Delay LP until stable
• Nurse at 30 degrees

Question 15

What should be done if a patient with meningitis doesn’t have signs of raised ICP?

Answer 15

• LP within 1 hour
• IV antibodies (before LP if LP is delayed >1 hour)
• Dexamethasone 10mg IV

Question 16

What should be done after the acute management of meningitis?

Answer 16

• Discuss abx with micro and adjust based on organism
• Maintain normovolaemia
• Isolate for 24 hours
• Inform PHE

Question 17

What empirical antibiotics are used for meningitis?

Answer 17

Ceftriaxone 2g/12 hours

Question 18

What may be added to empirical antibiotics for meningitis?

Answer 18

Amoxicillin 2g/4 hours

Question 19

When should amoxicillin be added to empirical antibiotics for meningitis?

Answer 19

If >60 years of age or immunocompromised

Question 20

Who needs meningitis prophylaxis?

Answer 20

• Household contacts in droplet range

- Those who have kissed patient

Question 21

What is used for meningitis prophylaxis?

Answer 21

Ciprofloxacin

Question 22

How does CSF fluid appear in bacterial, TB, and viral meningitis?

Answer 22

Bacterial = often turbid
TB = often fibrin web
Viral = often clear

Question 23

What is the predominant cell in the CSF in bacterial, TB, and viral meningitis?

Answer 23

Bacterial = polymorphs
TB = mononuclear
Viral = mononuclear

Question 24

What is the CSF cell count in bacterial, TB, and viral meningitis?

Answer 24

Bacterial = 90-1000
TB = 10-1000
Viral = 50-1000

Question 25

What is the CSF glucose in bacterial, TB, and viral meningitis?

Answer 25

Bacterial = <1/2 plasma
TB = <1/2 plasma
Viral = >1/2 plasma

Question 26

What is the CSF protein in bacterial, TB, and viral meningitis?

Answer 26

Bacterial = >1.5
TB = 1-5
Viral = <1