meningitis and TB

Question 1

what causes meningitis?

Answer 1

Bacterial infection

• meningococcus or pneumococcus
• streptococcus pneumoniae
• neisseria meningitis

Viral infection
- HSV, VZV, HIV

fungal infection
- cryptococcosis, aspergilloma

Question 2

what are the early signs of meningitis?

Answer 2

headache 
fever 
leg pains 
cold hands and feet 
absnormal skin colour

Question 3

what are the late signs of meningitis?

Answer 3

neck stiffness

photophobia

+ve Kernigs and Brudzinskis (Kernig’s = knee, Brudzinski’s = back of head)

reduced GCS or coma

seizures and focal CNS signs

petechial rash

shock

Question 4

what investigations are performed in meningitis?

Answer 4

blood culture 
serum pneumococcal and meningococcal PCR 
viral gargle and culture 
lumbar puncture 
FBC 
neuroimaging

Question 5

what would FBC show in meningitis?

Answer 5

leucocytosis, anaemia and thrombocytopenia
hypocalcaemia or hypokalaemia
hyponatraemia
hypo or hyperglycaemia

Question 6

what would LP show in BM?

Answer 6

turbid CSF appearance 
raised cell count 
neutrophils and lympocytes 
Glucose <1/2 plasma value 
Increased protein

Question 7

What would LP show in VM?

Answer 7

clear appearance
increased cell count 
lymphocyte predominate 
normal glucose 
increased protein (less than BM)

Question 8

when is an LP contraindicated in meningitis?

Answer 8

Brain shift 
Rapid GCS decline 
Resp/cardiac compromise 
severe sepsis 
coagulopathy

Question 9

how is BM treated?

Answer 9

Supportive care

IV dexamethasone 10mg 6hourly for 4 days
IV ceftriaxone
- chloramphenicol if B-lactam allergic

Question 10

how is VM treated?

Answer 10

supportive care

IV aciclovir

Question 11

how is fungal meningitis treated?

Answer 11

amphotericin B + fluconazole

Question 12

what are the complications of meningitis?

Answer 12

HACTIVE

• hydrocephalus
• abscess
• cerebritis/cranial nerve lesion,
• thrombosis
• infarct
• ventriculitis/vasculopathy
• extra-axial collection

Shock, seizures, sepsis

Cognitive, academic or behavioural issues

Question 13

what bacterium causes TB?

Answer 13

mycobacterium tuberculosis

Question 14

what are the systemic features of TB?

Answer 14

low grade fever
anorexia 
weight loss 
fatigue 
night sweats 
clubbing 
erythema nodosum

Question 15

what are the pulmonary symptoms of TB?

Answer 15

cough 
pleurisy 
haemoptysis 
pleural effusion 
SOB

Question 16

what are the LN, GI, spinal and CNS symptoms of TB?

Answer 16

painless cervical lymphadenopathy

ileocaecal disease with colicky abdo pain and vomiting
bowel obstruction due to thickening

Chronic back and bony tenderness. Neuro symptoms. Potts vertebrae

headache, meningism, confusion, seizures, focal neuro deficit

Question 17

what is Pott’s vertebrae?

Answer 17

Spinal tuberculosis (TB) or Pott’s spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities

Question 18

what InV are done in TB?

Answer 18

CXR

• fibronodular opacities in upper lobes
• hilar lymphadenopathy
• Ghon lesion
• Pleural effusion

Sputum acid fast bacilli smear
- Ziehl Neelson stain positive for TB

sputum culture

FBC
- leucocytosis and anaemia

Mantoux test

Question 19

what is the treatment of TB?

Answer 19

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

(RIPE)

R&I for 4 months, P&E for 2

Question 20

what are the SE’s of rifampicin?

Answer 20

red body secretions and LFT derrangement

Question 21

what are the SE’s of Isoniazid? what drug must be given alongside?

Answer 21

peripheral neuropathy (secondary to B6 depletion) 
- pyridoxine given alongside 

hepatitis

Question 22

what are the SE’s of pyrazinamide?

Answer 22

hepatotoxic

Question 23

what are the SEs of ethambutol?

Answer 23

colour blindness
decreased visual acuity
optic neuritis

Question 24

what are the complications of TB ?

Answer 24

ARDS 
PTX 
Meningitis 
Empyema 
bronchiectasis 
Neuro deficit