(!) Meningitis Flashcards
Leading organism for meningitis
Bacterial- NHS
adults- Neiserissa, Hib and Strep Pneumoniae
0-3m- GBS, ecoli, Listeria
3m-6y- N. Men, Hib
6-60y- S.Pneumo, N. Men
>60-S.Pneumo, N.Men, Listeria
Immunosuppresed- Listeria, Fungal
TUBERCULOSIS
viral- young/teens–many, not specific- cocksackie, but complications of Mumps, varicella, Herpes, other
Sx of Meningitis
Neck stiffness, photophobia, headache, Fever
altered mental status
Focal neuro, and seizures- encephelitis/meninioencephelitis
(+any signs of ICP rise- papilloedema, confusion, focal neuro, eye movement changes etc)
Kernings sign- Pain in back/thigh when bend HIP
up
Brudinskis sign- forced flex of neck causes flex of hips
Bacterial- pt tends to be worse all around
Worse photophobia
Rash- non-blanching petichial or purpuric red rash- meningococcal
TB- slower progressing- indolent sx like TB (FLAWS) + reccurent headaches
Fungal- Immunocompromised
Ix and Mx of Meningitis
A-E approach- pts are very very unwell
ABG- obtain Glucose (ddx), Lactate
+ Normal bloods
+ BLOOD CULTURE BEFORE ABX
diagnostic- need a LP, but care if any signs of ICP raise, severe sepsis, other worrying signs
so for pt safety can give abx first (but reduce the usefulness of CSF cultures)
(LP results in other card)
Culture CSF+ PCR, Zhiels Nielssen stain (TB)/auramine stain can throat swab too
GIVE –
Abx-at least 2 w- empirical often used- Ceftriaxone +/- amoxicillin depending (CHILDREN GET IM BENPEN AT GP)
IV steroids often used(NOT IN BABY)
Contact ITU
COnsider adding Aciclovir if doubts of encephelitis
EMPIRICAL CONTACT TREATMENT-give Abx to contacts-ciproflaxin
(ABX indications in other card)
LP results for different meningitides
Viral-
Clear fluid, normal OP, Protein normal/up, glucose normal, LYMPHOCYTE++ (1000)
Bacterial
Cloudy, high OP, Protein UP, glucose DOWN (less than half plasma gluc), LEUKOCYTE ++
Tuberculosis-Cloudy, fibrin web, Protein high, Gluc less than half plasma gluc, LYMPHOCYTE + (300)
Fungal-cloudy, prot high, gluc low, Lympho +
Abx for meningitis management
Empiricals given before cultures are back–
0-3m- mainly GBS- Cefotaxime+amox (listeria cover)
Any child-give IM BENPEN AT GP IF SUSPECTED THERE
6y-60y- Ceftriaxone alone
Over 60- Give CEF+ AMox again
pretty much- Cefotaxime/Ceftriaxone- N.Men, HiB and S.Pneum cover
Amox- Listeria cover
for contacts- Ciproflaxin
Do you give IM benpen to a kid with bacterial meningitis if theyre allergic to penicillin
do it
except if previous anaphylaxis reactions
signs of raised icp making you not want to LP
signs suggesting raised intracranial pressure
reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)
relative bradycardia and hypertension
focal neurological signs
abnormal posture or posturing
unequal, dilated or poorly responsive pupils
papilloedema
abnormal ‘doll’s eye’ movements
extensive or spreading purpura
after convulsions until stabilised
Meningitis complications
Most common- sensorineural hearing loss
then
seizures
focal neuro
infectious-absess, sepsis
pressure- herniation
