Meningitis Flashcards
Epidemiology of meningococcal meningitis
Children and young adults
<10% are >5 years
Epidemiology of meningococcal meningitis
Children and young adults
<10% are >5 years
What must you do in cases of meningococcal meningitis
Notify local health protection consultant
Clinical features of meningococcal meningitis
Sepsis Sudden onset Purpuric rash Unconsciousness Fever Sterile CSF Waterhouse-Freidrichsen syndrome Renal failure Disseminated intravascular coagulation
Treatment of meningococcal meningitis
1st line is parenteral penicillin
2nd line high dose ceftriaxone then benzylpenicillin
Complications of meningococcal meningitis
50% die within first 24 hours and if it becomes chronic it is known as fulminant
Prognosis of meningococcal meningitis
Over 50% mortality, if they survive, sent home with rifampicin or ciprofloxacin
Prevention and prophylaxis of meningococcal meningitis
Men C and Men B vaccine
Rifampicin to r ciprofloxacin for all those who have been in contact with the sick
Pneumococcal meningitis epidemiology
Most frequent bacterial cause in adults
Clinical features of pneumococcal meningitis
Predisposing pneumonia Sinusitis Endocarditis Head trauma Alcoholism Splenectomy Altered consciousness Petechiae - uncommon
Treatment of pneumococcal meningitis
Early, high dose ceftriaxone
If uncomplicated then dexamethasone
Complications of pneumococcal meningitis
Death Hearing loss Cranial nerve defects Hemiparesis Hydrocephalus Siezures
Mortality of pneumococcal meningitis
30-50%
Prevention of pneumococcal meningitis
Pneumococcal vaccine (pneumovax or prevnar)
Epidemiology of Heamophilus influenzae type B meningitis
Young children
Often preceded by URTI with otitis media
Clinical features ofHeamophilus influenzae type B meningitis
Fever Lethargy Drowsiness Rarely petechiae No nuchal rigidity
Treatment of Heamophilus influenzae type B meningitis
Cefotaxime
Dexamethasone if very serious
Prevention/prophylaxis of Heamophilus influenzae type B meningitis
Rifampicin for all those who have had close contact
Vaccinato
Listeria monocytogenes meningitis epidemiology
Neonates
Older people
Immunosuppressed
Listeria monocytogenes meningitis clinical features
Typical meningism
Listeria monocytogenes meningitis treatment
IV ampicillin
Mycobacterium tuberculosis meningitis epidemiology
Elderly men
Alcoholics
Post miliary tb
Mycobacterium tuberculosis meningitis clinical features
Often post miliary in children
Extrameningeal TB in 3/4 of adult
Subacutely presents with lethargy, chronic headache, mentation change, unconsciousness and meningitis
Mycobacterium tuberculosis meningitis investigations
CSF studies
CXR
PCR
CT head
Mycobacterium tuberculosis meningitis complications
Neurological
Lung scarring
Mycobacterium tuberculosis meningitis prognosis
Poor in extremes of age, neurological deficits or resistant organisms
Leptospirosis and Lyme disease meningitis clinical features
"Aseptic meningitis" Septicaemia with rigors Myalgia Vomiting Conjunctival effusion Meningism followed by rash
Leptospirosis and Lyme disease meningitis treatment
IV cephalosporins or penicillin for 2-3 weeks
Leptospirosis and Lyme disease meningitis complications
Hepato-renal damage
Cranial beiropathies
Leptospirosis and Lyme disease meningitis prognosis
Good with early treatment
Leptospirosis and Lyme disease meningitis prevention
Avoid tick bites
Early treatment of tick bites
Viral meningitis causative viruses
Enteroviruses (echovirus, cocksackievirus) Mumps HSV VSV Epstein Barr
Clinical features of viral meningitis
Non specific prodromal illness Rapid headache onset Photophobia Low grade fever Stiff neck Lucid Alert Only later on so we get lethargy, confusion, siezures and focal neurological deficits
Viral meningitis investigations
PCR of CSF
Throat swab
HIV testing
Treatment of viral meningitis
If not recovered after 72 hours or very severe:
IV immunoglobulins
IV acyclovir for HSV
Viral meningitis complications
Neurological disorders
Orchitis
Testicular atrophy
Prognosis of viral meningitis
Most make a complete recovery
Prevention of viral meningitis
MMR and good hand hygiene
Cryptococcal neoformans meningitis epidemiology
Main cause of meningitis in HIV patients
Sometimes affects diabetics, lymphoma patients and immunosuppressed
Cryptococcal neoformans meningitis investigations
Gram stain shows yeast cells
Serum cryptococcal antigen
Cryptococcal neoformans meningitis presentation
Subacute onset with low grade fever, headache, nausea, photophobia, lethargy, confusion, abdo pain and meningism
Treatment of Cryptococcal neoformans meningitis
Parenteral amphotericin
Add flucytosine if severe or replace entirely with high dose fluconazole
Cryptococcal neoformans meningitis presentation
Long term fluconazole for at risk patients
Neonatal meningitis causative organisms
Group B strep E.coli Listeria monocytogenes Enteroviruses Parechoviruses
Neonatal meningitis mortality
Early onset = 50%
Late onset = 10-20%
Neonatal meningitis presentation
Non specific/ poorly localised symptoms
Low birth weight
Maternal diabetes mellitus
Neonatal meningitis treatment
Group B strep = benzylpenicillin and amoxicillin
E.coli = cefotaxime
Listeria monocytogenes= ampicillin and gentamicin
Neonatal meningitis complications
Neuro and development complications in 33%
Prevention of neonatal meningitis
Mother’s with increased risk are given amoxicillin or co-amoxiclav during labour
CSF findings in bacterial meningitis
Turbid Greatly increased cell count Predominant cells are neutrophils Glucose is reduced Protein is greatly increased
CSF findings in viral meningitis
Clear to turbid Moderate increase in cell count Predominant cells are lymphocytes Normal glucose Moderate increase in protein
CSF findings in TB meningitis
Clear to turbid Moderate increase in cells Main cells are lymphocytes or a mix of cells Reduced glucose Greatly increased protein
Ventricular atrial shunt meningitis main cause
Staph epidermis
What is Kernigs sign?
Hamstring spasm preventing leg straightening
CSF investigations
Gram stain Differential cell count Antigen detection test Bacterial culture Mycobacteria or fungal culture PCR for viruses PCR for bacteria Glucose Protein
