meningitis

Question 1

most common causes of neonatal meningitis

Answer 1

GBS (predominantly type 3)

E.coli (predominantly those containing the K1 polysaccharide) .

Listeria Monocytogenes .

These 3 categories constitute about 75% of the causes .

The 25 % ( peusomonas ,proteus ,klibsella ….)

Question 2

Neonatal Meningitis (Etiology) :

Answer 2

bacteremia
scalp lesions
direct extension to the CNS from a contagious otic focus (otits media) .

Question 3

most important symptom

Answer 3

poor feeding

Question 4

Neonatal Meningitis (S & S) :

Answer 4

Usually , manifestations are those associated with neonatal sepsis : temperature instability, respiratory distress, jaundice, apnea .
CNS signs : lethargy , seizures (particularly focal) , vomiting and irritability more specifically suggest meningitis .
A bulging or full fontanelle occurs in about 25% and nuchal rigidity in only 15% .
Cranial nerve abnormalities ( especially the 3rd , 6th and 7th ) may also be present .
high bitched cry , staring expression , lethargy

Question 5

normal value in csf

Answer 5

0 - 5 
(Lymphocytes
Protein 20-40
Glucose 50 – 100
½ - 2/3 blood glcous

Question 6

ABM csf value

Answer 6

100 - 10,000 PMNs
protein > 100
glucose > 25

Question 7

in gram stain result you find gram – bacilli

what is the organism ?

Answer 7

E coli

Question 8

in gram stain result you find Gram + bacilli

what is the organism ?

Answer 8

Listeria

Question 9

in gram stain result you find Gram - cocobacilli

what is the organism ?

Answer 9

H.Infulenza

Question 10

in gram stain result you find Gram – diplococi

what is the organism ?

Answer 10

N.Meningitidis

Question 11

in gram stain result you find Gram + coci

what is the organism ?

Answer 11

GBS

Question 12

in gram stain result you find Gram + dipolccoi

what is the organism ?

Answer 12

Strep pneumonia

Question 13

Neonatal Meningitis (Treatment) :

Answer 13

Empiric treatment is begun with :

ampicillin plus cefotaxime

Question 14

Drug should be

Answer 14

Cross BBB .
I V .
Broad spectrum .
Bactericidal

Question 15

Neonatal Meningitis (Treatment duration)

Answer 15

Parenteral therapy for gram-positive meningitis is given for a minimum of 14 days, and for complicated gram-positive or gram-negative meningitis , a minimum of 21 days .

Question 16

Neurological sequelae that can occur with neonatal meningitis

Answer 16

hydrocephalus , hearing loss, mental retardation , cognitive impairment , cp

Question 17

In post-neonatal period , the most common organisms causing meningitis are :

Answer 17

Neisseria meningitidis (meningococci).

Streptococcus pneumoniae (pneumococci).

Hemophilus influenza type b

Question 18

postnatal meningitis s and s

Answer 18

A respiratory illness or sore throat often precedes the more characteristic symptoms of fever, headache, stiff neck and vomiting.

Brudzinski’s and Kernig’s signs are present in ½ of patients

Question 19

Waterhouse-Friderichsen syndrome

Answer 19

septicemia, profound shock, cutaneous purpura and adrenal hemorrhage

Question 20

Post-Neonatal Meningitis (Complications) :

Answer 20

Systemic complications include hyponatremia due to SIADH , DIC and septic shock .
Survivors occasionally have deafness , other cranial nerve deficits , cerebral infarction , recurrent seizures or mental retardation .
and death

Question 21

meningococcal septicemia clinically

Answer 21

rash (glass test) , rapid breathing , abs cramps , diarrhea

Question 22

Post-Neonatal Meningitis (Treatment):

Answer 22

If meningitis is suspected, antibiotics and corticosteroids are given as soon as blood cultures are drawn or even before .

Dexamethasone (0.15 mg/kg IV q 6 hrs.) should be given 15 min before the 1st dose of antibiotics and continued for 4 days .

3 generation cephalosporin
(Cefotaxime or ceftriaxone)

B- vancomycin

Question 23

Post-Neonatal Meningitis (Treatment Duration)

Answer 23

If N .MENINGITIDS : 5 -7 DAYS .
IF H.INFLUENZA : 7- 10 DAYS .
PNEUMPCOCUS : 10 – 14 DAYS .

Question 24

Dexamethasone dose

Answer 24

0.15 mg/kg IV q 6 hrs (4 doses for 4 days = 16 dose)

Question 25

The most common cause of viral meningitis:

Answer 25

Mump & measles viruses
Enteroviruses
herpes virus
HIV

Question 26

Suspected encephalitis treatment

Answer 26

acyclovir