Meningitis? Flashcards
define meningitis?
inflammation of the leptomeningeal (pia and arachnoid mater) coverings of the brain, most commonly due to infection
most common causative agent of meningitis?
Streptococcus pneumoniae
bacteria causing meningitis in 0-3 months?
- Group B streptococci
- Escherichia coli -
- Listeria monocytogenes
bacteria causing meningitis in 3 MONTHS – 6 YEARS ?
- Haemophilus influenzae -
- Neisseria meningitidis -
- Streptococcus pneumoniae +
bacteria causing meningitis in 6- 60 years?
- Neisseria meningitidis -UNIVERSITY STUDENTS
- Streptococcus pneumoniae +
- Tuberculosis
bacteria causing meningitis in >60 years?
- Streptococcus pneumoniae +
* Listeria monocytogenes
bacteria causing meningitis in immunosuppressed?
• Listeria monocytogenes
most common viral cause of meningitis?
o Enteroviruses
most common fungal cause of meningitis?
o Cryptococcus
risk factors of meningitis?
o 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
presenting complaints of meningitis?
- Severe headache
- Photophobia
- Neck stiffness
- Irritability
- Drowsiness
- Vomiting
- High-pitched crying or fits (common in children)
- Reduced consciousness
- Fever
signs of meningism?
o Photophobia
o Neck stiffness
o Kernig’s Sign - with the hips flexed, there is pain/resistance on passive knee extension
o Brudzinski’s Sign - flexion of the hips when the neck is flexed
signs of infection?
o NON BLANCHING rash o Fever o Tachycardia o Hypotension o Altered mental state
first line investigation?
Bloods o Two sets of blood cultures o FBC o CRP o Coagulation screen o Blood glucose o Blood gas
gold standard investigation?
Lumbar Puncture
what might a bacterial CSF show? Appearance Glucose Protein White cells
Cloudy
Low (< 1/2 plasma)
High (> 1 g/l)
10 - 5,000 polymorphs/mm³
what might a viral CSF show? Appearance Glucose Protein White cells
Clear/cloudy
60-80% of plasma glucose*
Normal/raised
15 - 1,000 lymphocytes/mm³
what might a TB CSF show? Appearance Glucose Protein White cells
Slight cloudy, fibrin web
Low (< 1/2 plasma)
High (> 1 g/l)
30 - 300 lymphocytes/mm³
what might a fungal CSF show? Appearance Glucose Protein White cells
Cloudy
Low
High
20 - 200 lymphocytes/mm³
immediate management plan for meningitis in GP setting?
o IM Benzylpenicillin may be used straight away in a GP setting
immediate management plan for meningitis in hospital?
IV Antibiotics (before LP) o First choice: IV cefotaxime
what should be given along side antibiotics?
• Dexamethasone IV
what Prophylaxis should be given?
o Oral ciprofloxacin or rifampicin
complications of meningitis?
- Septicaemia - LOW BP
- Sensorineural hearing loss – most common complication
- Shock
- DIC
- Renal failure
- Seizures
- Peripheral gangrene
- Cerebral oedema
- Cranial nerve lesions
- Cerebral venous thrombosis
- Hydrocephalus
prognosis of bacterial meningitis?
worse with sepsis
prognosis of viral meningitis?
self limiting - will recover with no medication
