Meningitis

Question 1

What are the features of meningitis?

Answer 1

Headache
Fever
Neck stiffness
Photophobia
Non-blanching rash - meningococcal septicaemia
Seizures, reduced consciousness and coma on later presentation

Question 2

Why is the presence of a non-blanching rash serious in meningitis?

Answer 2

It indicated disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages

Question 3

What are the common causes of bacterial meningitis?

Answer 3

In children and adults:
Neisseria meningitidis
Streptococcus pneumoniae

In neonates:
Group B streptococcus

Question 4

What are common causes of viral meningitis?

Answer 4

HSV
enterovirus
Varicella zoster virus

Question 5

What is the treatment for meningitis?

Answer 5

Bacterial:
<3 months = cefotaxime + amoxicillin + dexamethasone
>3 months = ceftriaxone + dexamethasone

Viral:
Tends to be milder than bacterial and is supportive treatment
Aciclovir if HSV meningitis

Question 6

What are the lumbar puncture findings in bacterial meningitis?

Answer 6

Cloudy

Low glucose (<50% plasma)

High protein (>1g/L)

10-5,000 neutrophils

Question 7

What are the lumbar puncture findings in viral meningitis?

Answer 7

Clear/cloudy

Normal or 60-80% glucose

Normal/raised protein

15-1,000 lymphocytes

Question 8

What are the lumbar puncture findings in TB meningitis?

Answer 8

Slightly cloud, fibrin web

Low glucose (<50% plasma)

High protein (>1g/L)

30-300 lymphocytes

Question 9

What are the lumbar puncture findings in fungal meningitis?

Answer 9

Cloudy

Low glucose

High protein

20-200 lymphocytes