Meningitis

Question 1

empirical therapy for suspected meningitis in child aged 0 -3 months ?

Answer 1

IV cefotaxime + amoxicillin

Question 2

empirical therapy for suspected meningitis in 3 months - 50 yrs ?

Answer 2

IV cefotaxime

Question 3

empirical therapy for suspected meningitis in adults aged > 50yrs ?

Answer 3

IV cefotaxime + amoxicillin

Question 4

treatment for confirmed meningitis caused by neissieria meningitides (meningococcus) ?

Answer 4

IV benzylpenicillin or cefotaxime

Question 5

treatment for confirmed meningitis caused by streptococcus pneumonia (pneumococcus) ?

Answer 5

IV cefotaxime

Question 6

treatment for confirmed meningitis caused by haemophilia influenzae ?

Answer 6

IV cefotaxime

Question 7

causative organisms for meningitis in neonates - 3 months?

Answer 7

group B streptococcus
e.coli
listeria monocytogenes

Question 8

causative organisms for meningitis in children aged 3 months - 6 yrs ?

Answer 8

neissiseria meningitis
streptococcus pnuemoniae
haemophilus influenzae

Question 9

causative organisms for meningitis in children 6 years and older ?

Answer 9

neisseria meningitis

streptococcus pneumonia

Question 10

causative organisms for meningitis in adults ?

Answer 10

neissieria meningitis
streptococcus pneumoniae

listeria monocytogenes (in adults > 60yrs)

Question 11

LP features of bacterial meningitis ?

Answer 11

cloudy appearance
protein (> 1g/l)
glucose < 1/2 plasma
WCC: neutrophils

Question 12

LP features of viral meningitis ?

Answer 12

cloudy/clear appearance
protein normal or raised
glucose 60-80% plasma
WCC: lymphocytes (15-100)

Question 13

LP features of fungal meningitis ?

Answer 13

cloudy appearance
protein high
glucose low
WCC: lymphocytes (20-200)

Question 14

meningitis is a complication of what infection ?

Answer 14

mumps (paramyxovirus)

Question 15

treatment for confirmed meningitis caused by listeria ?

Answer 15

IV amoxicillin + gentamicin

Question 16

describe the managing of contacts when there is a confirmed case of meningitis ?

Answer 16

all household members and close contacts should be offered prophylaxis
all close contacts within 7 days before symptom onset should be offered prophylaxis

prophylaxis = oral ciprofloxacin or rifampicin

vaccinations should be offered to all close contacts and boosters for those who received vaccine in infancy

prophylaxis isn’t required if meningitis caused by streptococcus pneumonia

Question 17

why are patients with meningitis given steroids ?

Answer 17

IV dexamethasone given to prevent neurological sequelae

i.e. sepsis, hydrocephalus, raised ICP, epilepsy, abscess etc

Question 18

what neurological sequel can occur following meningitis ? how is this prevented ?

Answer 18

IV dexamethasone given to all patients to prevent this

sensorineural hearing loss (most common)
sepsis, intracranial abscess
epilepsy, migraine
hydrocephalus, herniation

Question 19

treatment of choice for meningitis if patient is penicillin or cephalosporin allergic ?

Answer 19

chloramphenicol