Meningitis Flashcards
What is meningitis?
Inflammation of the meninges and or cerebrum due to infection
What are the bacterial causes of meningitis and who ges them?
Meningococcus: everyone
Pneumococcus: everyone
HI: kids
Listeria monocytogenes: older and immunosuppressed
Strep B: neonates
What are the viral causes of meningitis?
HSV
VZV
Enterovirus
HIV
What are risk factors for meningitis?
Older age
immunocompromised
Head injury or neurosurgery (pneumococcal)
PWID
Hearing device (pneumococcal)
Cirrhosis (pneumococcal)
What are Sx of meningitis?
Headache
Reduced GCS
Fever
Meningism: neck stiffness, photophobia, Kernig’s sign
Rash is meningococcal
Signs of raised ICP e.g. focal neurological defects, CN palsy, papilloedema
What signs indicate pneumococcal meningitis?
Patients usually have an underlying disease
VIII palsy causing hearing loss and balance problems
Seizures and focal signs
May be a CAP or endocarditis as it is usually a multisystem infection causing the disesae
What are poor prognostic signs in meningitis?
Pneumococcal disesase reduced GCS CNS signs older age bleeding CN palsy Shock
What signs indicate meningococcal disesae?
Rash (purpuric or petechial), also bleeding
What are DDx for meningitis?
Malaria encephalitis SAH Headache causes e.g. migraine Hypoglycaemia Viral meningitis
What initial investigations in suspected meningitis?
Blood cultures
Blood glucose (rule out hypoglycaemia and correct blood glucose)
If signs of shock get ICU involved.
Bloods: raised WCC and CPR indicate infection
LUMBAR PUNCTURE: do within 1 hour before giving Abx with CSF culture and PCR
CT after
Also do throat swabs for bacteria and virology
What are contraindications to LP?
Raised ICP e.g. papilloedema, seizures, focal neurology, GCS <12 - can cause brain herniation
Also infection at LP site, coagulopathy, severe sepsis, resp or cardio compromise
What is the use of CT?
Can show other causes e.g. tumour, meningitis related abscess, cerebral oedema
can’t show raised ICP
What are CSF findings in meningitis?
Bacterial: raised protein, low glucose, neutrophils and lymphocytes (if listeria)
Viral: lymphocytes, neutrophils early, raised protein,normal glucose
What is immediate Rx of meningitis?
Immediately give IV dexamethasone if bacterial is suspected e.g. signs of meningism
Pre-hospital Abx: e.g. benzlpenicillin stat at GP
Abx: IV ceftriaxone
Add IV amoxicillin if listeria suspected (>60, immunocompromised, pregnant, alcohol excess, liver disease
What is secondary prevention of meningitis?
Close contacts get prophylaxis e.g. ciprofloxacin or rifampicin
