Meningitis Flashcards
What is Meningism?
A symptoms complex that can occur in meningitis, subarachnoid haemorrhage, bacteraemia & viral infections including:
- Headache
- Photophobia
- Vomiting
- Stiff neck (on flexion, lateral is more likely a joint problem)
What are the most common causes of bacterial meningitis?
Meningococcus (most common in kids)
Pneumococcus (most common in adults)
Haemophilus Influenzae B
In neonates:
- E. Coli
- Group B Strep
What’s the most common causes of viral meningitis?
Mumps HSV Enteroviruses - Echovirus - Coxsackie A & B - Parechoviruses
What organisms do meningitis in people with ventricular shunts?
Most often Coagulase -ve Staph e.g. Staph Epidermidis
What can cause non-infective meningitis? aka Aseptic Meningitis
Tumour cells
Drugs
Sarcoid
SLE
What are the common symptoms of meningitis?
Vomiting Headache Stiff Neck Fever Photophobia Lethargy Clouded Consciousness Rashes
Tachy/bradycardic
Shock
DIC
Renal Failure
Sometimes Cranial nerve palsies
How does the timeline indicate a specific cause?
Acute (<24hrs) rapidly progressive is most likely meningococcal
Subacute (onsets over 1-7days) may be viral, bacterial or fungal
Risk factors for meningitis?
Recent Skull Trauma
Alcoholism
DM
Exposure
What physical signs do we test for in meningitis?
- Neck stiffness by passively flexing chin to chest
- Kernig’s sign (can’t straighten leg due to hamstring spasm)
What tests to do if you suspect meningitis?
- Blood culture
- LP
FBC
- Neutrophylic leucocytosis in bacterial
- Leucopenia in advanced infection
- Thrombocytopenia in DIC
- Abnormal clotting & increased FDPs
U&Es
LFTs
What tests are run on CSF from an LP?
- GLucose (vs serum level)
- Protein
- Gram stain
(ZN maybe) - Diff cell count
- Antigen detection
- Culture
- PCR
Describe the appearance of Bacterial CSF?
- Turbid
- Greatly increased cells
- Neutrophil dominant
- Low Glc
- Greatly increased protein
Describe viral CSF?
Clear or turbid Moderately high cells Lymphocyte dominant Normal Glc Moderately high protein
Describe Fungal CSF?
Clear to Turbid Moderately high cells Lymphocyte/mixed dominant Low Glc Greatly increased protein
Describe normal CSF?
Clear
Low cell no.
Lymphocyte dominant
60% of blood glc
Where does bacterial meningitis usually start?
The Nasopharynx
What therapy is used for Bacterial Meningitis?
IV Benzylpenicillin or Ceftriaxone
Dexamethasone
Supportive Therapy
In adults give ciprofloxacin or Rifampicin on discharge to eradicate from nasopharynx
What are the bad prognostic factors in bacterial meningitis?
- Delay in Abx
- Extremes of age
- Purpuric lesions
- Shock
- Hyperpyrexia
- DIC
- Acidosis
- No leucocytosis
What do we do prophylactically with meningococcus?
Rifampicin or ciprofloxacin in close contacts
What sets pneumococcal presentation apart from other bacteria?
Takes 1-2 days versus rapid onset of meningococcus
more likely to have focal neuro signs and alt consciousness
Often comes with skull fractures or sinus/ear infection
Who is at highest risk of TB meningitis?
In the uk elderly men or alcoholics
How do we spot TB meningitis?
Meningism, low fever and other TB
Subacute/slower onset
How is a viral meningitis likely to present?
Non-specific prodrome
Then rapid development of meningism
What else should we test for in viral meningitisis?
HIV
How do we treat viral meningitis?
Supportive
IF crhonic –> IV immunoglobulin
If HSV –> IV Aciclovir
Who gets Cryptococcal Meningitis?
Mostly HIV sufferers
but sometimes DM, lymphoma and immunosuppressed patients
IT comes from pigeon droppings
How do you diagnose fungal meningitis?
- Gram staining & India Ink
CSF & Serum Cryptococcal Polysaccharide Antigen
Culture
How does fungal meningitis present?
Subacute onset of non-specific symptoms incl fever, headache, nausea, lethargy, confusion & abdo pain
Meningism is less common
How do we treat and prevent cryptococcal meningitis?
IV Amphotericin +/- flucytosine
Long term Fluconazole for HIV patients after an episode as 2* prophylaxis
Predisopising factors in a neonate?
- LBW
- Prolonged rupture of membranes
- Maternal DM
How does neonatal meningitis present?
Type 1 - Early onset
- Within 3 days birth
- Resp distress, bacteraemia & meningitis
- From mum’s genital tract
- 50% mortality
Late Onset:
- > 1wk after
- Bacteraemia & meningitis without resp involvement
- got by cross infection
- 10-20% mortality
How do you treat a baby with meningitis?
IV Ampicillin = group B strep & Listeria
IV Gentamicin or cefotaxime = gram negative bacilli (E.coli)
IVIG for enteroviruses or parechoviruses
How do you prevent meninigitis in neonates?
High risk mum’s get amoxicillin or co-amoxiclav during labour:
- Pre-term
- Prolonged labour
- H/o
- Intrapartum fever
In enterovirus or parechovirus meningitis we cohort, use hygiene and ~ IVIG for close contacts
Potential side effects of meningitis include?
Deafness
Orchitis & testicular atrophy in mumps
Death
Cranial nerve deficits
Hydrocephalus
Seizures
Hemiparesis
