Meningitis Flashcards
What is Meningitis?
inflammation of the leptomeningeal (pia + arachnoid mater) coverings of the brain
What is meningitis usually due to?
Infection
Give 3 epidemiological facts about meningitis
1.5/ 100,000/ year
Viral most common
Infants most at risk
Describe the aetiology of meningitis
Viral
Bacterial
Aseptic
Non-infective
List 5 symptoms of meningitis
Severe headache N+V Irritability Lethargy Leg pain
List 6 signs of meningitis
Photophobia
Neck stiffness
Non-blanching rash
Fever
Kernig’s Sign: hips flexed, pain/ resistance on passive knee extension
Brudzinski’s Sign: flexion of the hips when the neck is flexed
List 7 risk factors for meningitis
Young age Immune suppression. Smoking. CSF shunts or dural defects Spinal procedures (eg, spinal anaesthetics) IV drug abuse Crowding (college students) .
List 10 conditions that increase risk of meningitis
Bacterial endocarditis Alcoholism Diabetes mellitus Renal/ adrenal insufficiency Hypoparathyroidism CF Malignancy Splenectomy Thalassaemia major Sickle cell disease
What 5 signs of infection may be seen in a patient with meningitis?
Fever Tachycardia Hypotension Skin rash Altered mental state
What would a lumbar puncture of bacterial meningitis show?
Cloudy CSF
High neutrophils
High protein
Low glucose
What would a lumbar puncture of viral meningitis show?
High lymphocytes
High protein
Normal glucose
What would a lumbar puncture of TB meningitis show?
Fibrinous CSF
High lymphocytes
High protein
Low glucose
What 7 bloods are tested in suspected meningitis?
FBC. CRP. Coagulation screen. (DIC) Whole-blood PCR for N. meningitidis. Blood glucose. (Hypo or Hyper) Blood gases (High lactate in shock) U+Es
Why perform a CXR in suspected meningitis?
Exclude lung abscess
What samples may be cultured in suspected meningitis? Why?
Blood Urine Nasopharyngeal swabs Stool For virology
What are the general principles of management for all viral meningitis?
Analgesia
Antipyretics
Nutritional support
Hydration
What are the general principles of management in primary care for bacterial meningitis?
Urgent hospital transfer + IV Abx:
3rd gen. cephalosporin e.g. Ceftriaxone
or
Benzylpenicillin
What are 5 immediate complications of meningitis?
Septicaemia Shock DIC Coma Cerebral oedema
What are 5 delayed complications of meningitis?
Hydrocephalus Waterhouse-Friderichsen Syndrome (adrenal failure by N. Meningitidis) Seizures Peripheral gangrene SIADH
Give 3 prognostic facts about meningitis
Significant risk of death in bacterial meningitis
Mortality risk very low for other causes.
Viral meningitis is self-limiting
