Meningitis Flashcards
Meningitis Viral vs Bacterial
- Viral meningitis more common and more benign
- All cases of suspected meningitis should be treated as bacterial meningitis until proven otherwise
- Meningococcal disease is infection caused by N. meningitidis causing meningitis and/or septicaemia
Meningitis RFs
- Young age
- Immune suppression
- Smoking
- CSF shunts or dural defects
- Spinal procedures…
Meningitis Bacterial Aetiology Neonates
- Group B strep
- Listeria monocytogenes
- E. coli
Meningitis Bacterial Aetiology Infants and Young Children
- H. influenza type B (if<4 and unvaccinated)
- N. meningitidis
- S. pneumoniae
Meningitis Bacterial Aetiology Adults and Older Children
- H. influenzae type b
- N. meningitidis
- S. pneumoniae
- Gram-negative bacilli (such as non-type b H. influenzae, Klebsiella, Pseudomonas, Enterobacter)
- Staphylococci, enterococcus species, streptococci and L. monocytogenes.
Meningitis Bacterial Aetiology Elderly and Immunocompromised
- S. pneumoniae
- L. monocytogenes
- Tuberculosis (TB)
- Gram-negative organisms.
Meningitis (Neonatal)
- Neonates at greater risk
- Low birth weight, prematurity, PPROM, foetal hypoxia, maternal infection all increase risk
- Intrapartum prophylactic antibiotics for all mothers with GBS
Meningitis Aseptic
- No bacteria can be cultured
- Viral infection (HSV, enterovirus)
- Fungal infection (immunodeficiency) cryptococcal, Histoplasma, coccidoides
- Parasites
- Atypical TB, syphilis, Lyme disease
- Kawasaki
- Mollaret’s
Meningitis Non-infective
- Malignant cells
- Chemicals
- Medication
- Sarcoidosis
Meningitis Presentation
-Purpuric rash is strongly suggestive of meningococcal sepsis
-Non-specific features, fever, headache, vomiting, lethargy
-Cold hands and feet
-Stiff neck
-Non-blanching rash
-Back rigidity
-Confusion/altered mental state
-Bulging fontanelle
-Photophobia
-Cap refill >2 seconds
In early stages features can be vague and nonspecific
-Early features include; cold hands and feet, abnormal skin colour, leg pain
Meningitis Differentials
- Other causes of pyrexia and severe infection
- Intracranial abscess
- Other causes of altered mental state and coma
- Other causes of petechial/purpuric rashes
Meningitis Ix
- Ixs must not delay treatment
- Immediate LP providing no signs of raised ICP (reduced consciousness, bad headache, fits), focal neurology, severe shock or sepsis
- To find cause
- CSF may be normal in early stages
- FBC, CRP, coag, blood culture, whole blood PCR, glucose, gases
- U/Es, CXR, culture urine nasopharyngeal swabs and stool
- CT scan not advisable before LP as may delay
Meningitis Initial Management
-Supportive and treatment
Viral
-Supportive, no specific treatment
-In primary care; Benzylpenicillin IM if meningococcal septicaemia with non-blanching rash (300mg <1, 600mg 1-9, 1200mg >10)
-In secondary care give ceftriaxone IV (cefatoxime IV if <3months)
-Aciclovir is beneficial in treating herpetic viral infections but only if given early on
-Ganciclovir for CMV, significant renal toxicity, close monitoring required
Meningitis Antimicrobial Management
IV ceftriaxone for
-N. meningitidis (prevention of secondary cases with ciprofloxacin or rifampicin)
-S. pneumoniae
-H. influenzae type b
For GBS: cefatoxime IV
For listeriosis meningitis: amoxicillin IV and gentamicin
Meningitis Complications
-30-50% have neurological sequelae
