Meningitis Flashcards
What should be done if you suspect meningitis in primary care?
Arrange urgent transfer to secondary care
What should be done if you suspect meningitis in primary care and there is a non-blancing rash?
Give benzylpenicillin 1.2mg IM/IV before admitting
What are the differentials for meninigitis?
- Malaria
- Encephalitis
- Septicaemia
- Subarachnoid haemorrhage
- Dengue
- Tetanus
What are the early features of meningitis?
- Headache
- Fever
- Leg pains
- Cold hands and feet
- Abnormal skin colour
What are the later signs of meningitis?
- Meningism
- Decreased GCS or coma
- Seizures
- Petechial rash
- Shock
What signs of meningism may be present in meningitis?
- Neck stiffness
- Photophobia
- Kernigs sign
What is Kernigs sign?
Pain and resistance on passive knee extension with hip fully flexed
What is the first step in managing meningitis?
ABCDE assessment, fluid resuscitation, blood glucose correction
What is the first question to ask yourself when managing meningitis?
Shocked or not?
What are the signs of shock in meningitis?
- Prolonged CRT
- Cold hands and feet
- Low BP
- Evolving rash
What should be done if a patient with meningitis is shocked?
- Get ICU help
- Blood cultures
- IV antibiotics
- Airway support
- Fluid resus/inotropes/vasopressors
- Delay LP until stable
What question should be asked if a patient with meningitis is not shocked?
Do they have signs of raised ICP?
What are the signs of raised ICP in meningitis?
- Papilloedema
- Uncontrolled seizures
- Focal neurology
What should be done if a patient with meningitis has signs of raised ICP?
- Get ICU help
- IV antibodies (after cultures)
- Dexamethasone 10mg IV
- Airway support
- Fluid resus
- Delay LP until stable
- Nurse at 30 degrees
What should be done if a patient with meningitis doesn’t have signs of raised ICP?
- LP within 1 hour
- IV antibodies (before LP if LP is delayed >1 hour)
- Dexamethasone 10mg IV
What should be done after the acute management of meningitis?
- Discuss abx with micro and adjust based on organism
- Maintain normovolaemia
- Isolate for 24 hours
- Inform PHE
What empirical antibiotics are used for meningitis?
Ceftriaxone 2g/12 hours
What may be added to empirical antibiotics for meningitis?
Amoxicillin 2g/4 hours
When should amoxicillin be added to empirical antibiotics for meningitis?
If >60 years of age or immunocompromised
Who needs meningitis prophylaxis?
- Household contacts in droplet range
- Those who have kissed patient
What is used for meningitis prophylaxis?
Ciprofloxacin
How does CSF fluid appear in bacterial, TB, and viral meningitis?
Bacterial = often turbid TB = often fibrin web Viral = often clear
What is the predominant cell in the CSF in bacterial, TB, and viral meningitis?
Bacterial = polymorphs TB = mononuclear Viral = mononuclear
What is the CSF cell count in bacterial, TB, and viral meningitis?
Bacterial = 90-1000 TB = 10-1000 Viral = 50-1000
What is the CSF glucose in bacterial, TB, and viral meningitis?
Bacterial = <1/2 plasma TB = <1/2 plasma Viral = >1/2 plasma
What is the CSF protein in bacterial, TB, and viral meningitis?
Bacterial = >1.5 TB = 1-5 Viral = <1
