Meningitis

Question 1

What are the most common causative pathogens?

Answer 1

Meningococcus, pneumococcus

Question 2

How does meningitis present?

Answer 2

Meningism, fever, headache, vomiting, nausea, lethargy, irritability, muscle pain, chills/shivering, sore throat, non-blanching rash, raised ICP

Question 3

What are signs of meningism?

Answer 3

Neck stiffness, photophobia, Kernig’s sign

Question 4

What are signs of shock?

Answer 4

Prolonged capillary refill time, DIC

Question 5

What main tests would you do?

Answer 5

Blood cultures, LP, Throat swabs, ABG

Question 6

What might a LP look like in bacterial meningitis?

Answer 6

Turbid, very high WBC, glucose <1/2 of plasma, high protein

Question 7

What might a LP look like in viral meningitis?

Answer 7

Clear, lymphocytic predominance, glucose >1/2 of plasma, normal protein

Question 8

What are some differential diagnoses?

Answer 8

Malaria, encephalitis, septicaemia, dengue, typhoid

Question 9

When should you start antibiotics?

Answer 9

As early as possible

Question 10

Who should you give prophylaxis to?

Answer 10

Household contacts in droplet range

Question 11

What are some potential complications?

Answer 11

Shock, elevated ICP

Question 12

Is acute meningitis a notifiable disease?

Answer 12

Yes

Question 13

What can cause bacterial meningitis?

Answer 13

E.coli, listeria, HIB, S. pneumoniae, Klebsiella, TB

Question 14

What can cause viral meningitis?

Answer 14

Mumps, herpes zoster, HIV, influenza, measles, enteroviruses

Question 15

What are risk factors for meningitis?

Answer 15

Immunosuppression, smoking, CSF shunts, DM, IVDU, adrenal insufficiency, malignancy, SCD, crowding

Question 16

How does raised ICP present?

Answer 16

Decreased GCS, seizure, focal deficits

Question 17

What antibiotic do you give if there’s a rash?

Answer 17

Benzylpenicillin IV

Question 18

What antibiotic do you give if there’s no rash?

Answer 18

Cefotaxime IV

Question 19

When would you add vancomycin?

Answer 19

If S. pneumoniae suspected

Question 20

When would you add ampicillin?

Answer 20

If listeria suspected

Question 21

How would you manage viral meningitis?

Answer 21

Analgesia, antipyretics, hydration

Question 22

Which organism are pregnant people at high risk for?

Answer 22

Listeria monocytogenes

Question 23

What organism indicates a worse prognosis?

Answer 23

Neisseria meningitis

Question 24

What organism causes meningitis in neonates?

Answer 24

Streptococcus agalactiae

Question 25

What organism is the most common cause of meningitis?

Answer 25

Streptococcus pneumoniae