Meningitis

Question 1

What are the classical symptoms/triad of meningitis?

Answer 1

Headache, neck stiffness and photophobia

Question 2

What causes meningitis?

Answer 2

Due to inflammation of meninges

Arise from any irritation of the meninges including infection, blood or trauma

Question 3

What are other common differential diagnosis?

Answer 3

Encephalitis - most common cause is HSV (herpes simplex virus)
- Is inflammation of the brain and unlike meningitis, it causes confusion or disorientation, drowsiness, seizures and changes in personality and behaviour, such as feeling very agitated

Non-infectious causes (blood, trauma, drugs) or meningeal irritation
Subdural empyema (collection of pus in subdural space)

Question 4

What are risk factors for meningitis?

Answer 4

Extremes of age
Living in close proximity 
Vaccination history (absence of)
Immune suppression/deficiency 
Travel history

Question 5

What may be seen on examination in meningitis?

Answer 5

Important signs:

• Purpuric (non-blanching) rash - do ‘glass test’ if it does not disappear indicates septicaemia
• Signs of sepsis and shock

Assess neck stiffness - ask patient to touch chest with chin
- Kernig’s sign - A test for meningeal irritation: when leg is raised and straightened there is resistance in the medial hamstrings

Fundoscopy - check of papilloedema (may be difficult in photophobic patients)

Question 6

What investigations may be done?

Answer 6

Most important - COLLECT CSF (from L2-S2 LP)
Blood cultures
Serology
Throat swab
Urine pneumococcal antigen

Question 7

How is meningitis treated?

Answer 7

For clinical suspicion of bacterial meningitis give empirical antibiotic
IV 3rd gen cephalosporin e.g. ceftriaxone given ASAP
In GP give IM Benzylpenicillin as 1st line treatment
- If listeria is suspected ampicillin should be added