meningitis

Question 1

23 y.o. student presents with 3 day hx of headache, neck stiffness, myalgia, fever, photophobia and vomiting.

never been unwell before, no recent travel, takes no regular medication, NKDA

lives w 3 other students in a rented flat, non-smoker, 20 units of alcohol a week, never taken recreational drugs

CT scanner out of service

(a) give 4 clinical contraindications to immediate lumbar puncture

Answer 1

1. raised ICP / papilloedema
2. coagulopathy
3. focal neurological signs
4. suspected SOL

• ^{major impairment of consciousness}
• ^{immunocompromised}
• ^seizures

Question 2

(b) pt undergoes non-traumatic LP.

give 5 laboratory ix that you would expect to be performed on the CSF, together with the result you would expect if pt has meningococcal meningitis

Answer 2

appearance - cloudy and turbid (if severe)

1. protein - raised
2. glucose - <50% of plasma level
3. WCC - high
4. gram stain + microscopy - gram -ve N. meningitidis
5. culture - Neiserria meningitidis
6. white cell differential - high neutrophils

Question 3

(c) state the abx and route you would give to treat menigococcal meningitis

Answer 3

IV cefotaxime or ceftriaxone initially

BUT

benzylpenicillin for N. meningitidis

Question 4

(d) what 2 public health measures should be undertaken if meningococcal meningitis was diagnosed in this case?

Answer 4

1. notify consultant for communicable disease control
2. contact tracing - abx prophylaxis (rifampicin or ciprofloxacin) for flatmates and other close contacts