Meningitis Flashcards
Define Meningitis?
Inflammation of the leptomeningeal (pia and arachnoid mater) coverings of the brain, most commonly due to infection
What are the bacterial causes of meningitis in Neonates?
Group B streptococci
Escherichia Coli
Listeria Monocytogenes
What are the bacterial causes of meningitis in Children?
Haemophilus Influenzae
Neisseria Meningitidis
Streptococcus Pneumoniae
What are the bacterial causes of meningitis in Adults?
Neisseria Meningitidis
Streptococcus Pneumoniae
TB
What are the bacterial causes of meningitis Elderely?
Streptococcus Pneumoniae
Listeria Monocytogenes
What are the viral causes of Meningitis?
Enteroviruses Mumps HSV VZV HIV
What are the other causes of Meningitis?
Fungal (Cryptococcus which is a common cause of Meningitis in HIV patients)
Aseptic Meningitis (not due to microbes)
Mollaret’s Meningitis (recurrent benign lymphocytic meningitis)
What are the risk factors for Meningitis?
Close communities (e.g. college halls) o Basal skull fractures o Mastoiditis o Sinusitis o Inner ear infections o Alcoholism o Immunodeficiency o Splenectomy o Sickle cell anaemia o CSF shunts o Intracranial surgery
What is the epidemiology of meningitis in the UK?
2500 notifications/yr
What are the presenting symptoms of meningitis?
- Severe headache
- Photophobia
- Neck or backache
- Irritability
- Drowsiness
- Vomiting
- High-pitched crying or fits (common in children)
- Reduced consciousness
- Fever
What’s important to remember when taking a history for meningitis?
Remember to take a good travel history and exposure history and make sure they’re not exposed to any of the exposure factors
What are the exposure factors in Meningitis?
Rodents (lymphocytic choriomeningitis virus)
Ticks (Lyme borrelia, Rocky Mountain spotted fever)
Mosquitoes (West Nile Virus)
Sexual Activity (HSV-2, HIV, Syphillis)
Travel
What are the signs of Meningism on physical examination?
Photophobia
Neck Stiffness
Kernig’s Sign
Brudzinski’s sign
What is Kernig’s sign?
With the hips flexed, there is pain/resistance on passive knee extension
What is Brudzinski’s sign?
Flexion of the hips when the neck is flexed
What are the signs of Infection on physical examination?
Fever Tachycardia Hypotension Skin Rash Altered Mental State
What bloods would you do for meningitis?
Two sets of blood cultures
What Imaging would you do for Meningitis?
CT scan- exclude mass lesion or raised ICP before LP
What can we used a Lumbar Puncture for in Meningitis?
MC&S
Microscopy, Culture & Sensitivity
What would we see in Bacterial Meningitis in Lumbar Puncture?
Cloudy CSF
High neutrophils
High protein
Low glucose
What would we see in Viral Meningitis in Lumbar Puncture?
High Lymphocytes
High Protein
Normal Glucose
What would we see in TB meningitis in Lumbar Puncture?
Fibrinous CSF
High Lymphocytes
High Protein
Low Glucose
What is the management plan for Meningitis?
Immediate IV antibiotics (before LP)
Dexamethasone IV
Resuscitation
What antibiotics do we usually give in meningitis?
First choice: 3rd generation cephalosporin (e.g. cefotaxime or ceftriaxone)
Benzylpenicillin may be used as an initial blind therapy
What is the usage of Dexamethasone in the treatment of meningitis?
Given shortly before or with the first dose of antibiotics
Associated with a reduced risk of complications
What is the usage of Resuscitation in the treatment of meningitis?
Manage in ITU
Notify public health cervices
What are the possible complications of meningitis?
Septicaemia • Shock • DIC • Renal failure • Seizures • Peripheral gangrene • Cerebral oedema • Cranial nerve lesions • Cerebral venous thrombosis • Hydrocephalus • Waterhouse-Friderichsen Syndrome
What is Waterhouse-Friderichsen Syndrome?
Bilateral adrenal haemorrhage caused by severe meningococcal infection
What is the prognosis for patients with meningitis?
Mortality rate from bacterial meningitis: 10-40% with meningococcal sepsis
Viral meningitis is self-limiting
