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Acute Care & Trauma > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Define Meningitis?

A

Inflammation of the leptomeningeal (pia and arachnoid mater) coverings of the brain, most commonly due to infection

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2
Q

What are the bacterial causes of meningitis in Neonates?

A

Group B streptococci
Escherichia Coli
Listeria Monocytogenes

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3
Q

What are the bacterial causes of meningitis in Children?

A

Haemophilus Influenzae
Neisseria Meningitidis
Streptococcus Pneumoniae

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4
Q

What are the bacterial causes of meningitis in Adults?

A

Neisseria Meningitidis
Streptococcus Pneumoniae
TB

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5
Q

What are the bacterial causes of meningitis Elderely?

A

Streptococcus Pneumoniae

Listeria Monocytogenes

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6
Q

What are the viral causes of Meningitis?

A 
Enteroviruses
Mumps
HSV
VZV 
HIV
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7
Q

What are the other causes of Meningitis?

A

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)

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8
Q

What are the risk factors for Meningitis?

A 
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
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9
Q

What is the epidemiology of meningitis in the UK?

A

2500 notifications/yr

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10
Q

What are the presenting symptoms of meningitis?

A
  • Severe headache
  • Photophobia
  • Neck or backache
  • Irritability
  • Drowsiness
  • Vomiting
  • High-pitched crying or fits (common in children)
  • Reduced consciousness
  • Fever
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11
Q

What’s important to remember when taking a history for meningitis?

A

Remember to take a good travel history and exposure history and make sure they’re not exposed to any of the exposure factors

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12
Q

What are the exposure factors in Meningitis?

A

Rodents (lymphocytic choriomeningitis virus)
Ticks (Lyme borrelia, Rocky Mountain spotted fever)
Mosquitoes (West Nile Virus)
Sexual Activity (HSV-2, HIV, Syphillis)
Travel

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13
Q

What are the signs of Meningism on physical examination?

A

Photophobia
Neck Stiffness
Kernig’s Sign
Brudzinski’s sign

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14
Q

What is Kernig’s sign?

A

With the hips flexed, there is pain/resistance on passive knee extension

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15
Q

What is Brudzinski’s sign?

A

Flexion of the hips when the neck is flexed

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16
Q

What are the signs of Infection on physical examination?

A 
Fever 
Tachycardia
Hypotension
Skin Rash
Altered Mental State
17
Q

What bloods would you do for meningitis?

A

Two sets of blood cultures

18
Q

What Imaging would you do for Meningitis?

A

CT scan- exclude mass lesion or raised ICP before LP

19
Q

What can we used a Lumbar Puncture for in Meningitis?

A

MC&S

Microscopy, Culture & Sensitivity

20
Q

What would we see in Bacterial Meningitis in Lumbar Puncture?

A

Cloudy CSF
High neutrophils
High protein
Low glucose

21
Q

What would we see in Viral Meningitis in Lumbar Puncture?

A

High Lymphocytes
High Protein
Normal Glucose

22
Q

What would we see in TB meningitis in Lumbar Puncture?

A

Fibrinous CSF
High Lymphocytes
High Protein
Low Glucose

23
Q

What is the management plan for Meningitis?

A

Immediate IV antibiotics (before LP)
Dexamethasone IV
Resuscitation

24
Q

What antibiotics do we usually give in meningitis?

A

First choice: 3rd generation cephalosporin (e.g. cefotaxime or ceftriaxone)
Benzylpenicillin may be used as an initial blind therapy

25
Q

What is the usage of Dexamethasone in the treatment of meningitis?

A

Given shortly before or with the first dose of antibiotics

Associated with a reduced risk of complications

26
Q

What is the usage of Resuscitation in the treatment of meningitis?

A

Manage in ITU

Notify public health cervices

27
Q

What are the possible complications of meningitis?

A 
Septicaemia	
• Shock	
• DIC	
• Renal failure	
• Seizures
• Peripheral gangrene	
• Cerebral oedema	
• Cranial	nerve lesions
• Cerebral venous	thrombosis	
• Hydrocephalus	
• Waterhouse-Friderichsen	Syndrome
28
Q

What is Waterhouse-Friderichsen Syndrome?

A

Bilateral adrenal haemorrhage caused by severe meningococcal infection

29
Q

What is the prognosis for patients with meningitis?

A

Mortality rate from bacterial meningitis: 10-40% with meningococcal sepsis
Viral meningitis is self-limiting

Acute Care & Trauma (25 decks)

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