Meningitis, Malaria, Pneumonia Flashcards
You’re working in a GP practice. A patient comes in with signs suggestive of meningitis. What should you do?
Call an ambulance
Give Benzyl Penicillin IM or IV
You’re working in a GP practice. A patient comes in with signs suggestive of meningitis. They have a penicillin allergy. What should you do?
Call an ambulance
If they’ve anaphylaxis to penicillin you can give cefuroxime if there is any.
If the allergy is minor give BenPen anyway
A patient is referred from their GP with suspected meningococcal septicaemia.
What should your immediate investigations and treatment be?
BUFALO
Blood cultures Urine output Fluids Antibiotics (a 3rd gen. cephalosporin) Lactate Oxygen
What antibiotics should you give to a patient with suspected meningitis?
3rd gen cephalosporin: cefotaxime
If over 50 or under 3 months also give amoxicillin for listeria cover
What sort of rash would you see in meningococcal septicaemia?
Petechiae
Purpura
Ecchymosis
Non-blanching
Investigations for meningitis?
BUFALO
Bedside
- Obs
- BM
- ABG/VBG
Routine
- Bloods: FBC, U+E, CRP, Clotting, LFTs
- Cultures
- LP
Specialist
- CT head
How do you know if it is safe to do an LP?
If they have signs of raised ICP then you should do a CT head before doing an LP
Papilloedema Reduced GCS Seizures Focal neurology Previous malignancy
What are signs of raised ICP?
Papilloedema Reduced GCS Seizures Focal neurology Previous malignancy
In CSF…
What are glucose and protein levels like in bacterial, viral and TB meningitis?
What leukocytes are present?
What colour is the CSF?
Glucose
- viral = normal
- bacterial = low
- TB = low
Protein
- viral = normal
- bacteria = high
- TB = high
Leukocytes
- viral = lymphocytes
- bacterial = neutrophils
- TB = lymphocytes
Colour
- viral = clear
- bacterial = turbid
- TB = opalescent
Which organisms cause meningitis in:
- neonates
- children
- adults
- elderly
- Group B strep, E. coli, S. pneumoniae, Listeria
- N. meningitidis, S. pneumoniae, H. influenzae
- N. meningitidis, S. pneumoniae
- N. meningitidis, S. pneumoniae, Listeria, H. influenza
Which viruses cause meningitis?
Management?
Enteroviruses
Herpes virus
Mumps
Supportive, usually self resolving
Which bugs cause encephalitis?
Management?
Herpes simplex
EBV
CMV
Varicella zoster
Aciclovir
What are contacts of meningitis patients given as prophylaxis?
Ciprofloxacin
What are the neuro signs of meningitis?
Kernig’s: unable to extend knee with hip flexed
Brudzinski’s: unable to lift head and legs off bed
What are the clinical features of meningitis and meningococcal septicaemia?
Stiff neck Photophobia Malaise Fever N + V Headache Reduced consciousness
Septicaemia:
- low BP
- tachycardia
- purpuric rash
Clinical features of malaria?
Fever, rigors Myalgia Malaise Headache Vomiting + diarrhoea
Investigations for malaria?
BUFALO if they look septic
Bedside:
- obs
- BM
- ABG, VBG
Routine:
- Bloods: FBC, U+E, CRP, Clotting, LFTs, lactate
- Blood film
- CXR
Specialist:
- MRI if concerned about cerebral malaria
What special blood test identifies malaria?
Blood film
Thick and thin
Thick is best to see parasites
Also, antigen assay
What’s the incubation period for malaria?
Depends on type:
- falciparum 9-14 days
Others can be up to a year
List the types of malaria?
What’s the basic difference between them?
Falciparum (main, most severe)
Ovale Vivax Malariae Knowlesi (These all are less severe and don't cause cerebral malaria, they also have a liver stage)
What would make a case of malaria ‘complicated malaria’?
Impaired consciousness, seizures Renal impairment Acidosis Hypoglycaemia Hb < 80 DIC or bleeding Shock Haemoglobinuria Parasite count >2%
Management of falciparum malaria?
UNCOMPLICATED:
1st line: Riamet (PO equivalent of artesunate)
2nd line: malarone, quinine + doxy
COMPLICATED:
1st line: IV artesunate
2nd line: IV quinine + PO doxy
Management of non-falciparum malaria?
Chloroquinine
Riamet
The malaria can go dormant in the liver, so treatment must include ‘eradication of liver stage’ with primaquine
What are the possible complications of malaria?
Splenomegaly
Cerebral malaria
Renal and liver impairment
What are the clinical features of cerebral malaria?
Stroke Oedema Seizures Reducing GCS Coma Death
Which drugs are used as malaria prophylaxis?
Chloroquine
Doxycycline
Proguanil
Investigations of pneumonia?
BUFALO if he looks septic
Bedside:
- obs
- BM
- ABG, VBG
Routine:
- bloods: FBC, UE, CRP, lactate, LFT, clotting
- CXR
- sputum sample
- blood cultures
Specialist
- CT
- MRI
- bronchoscopy + lavage
What are the markers of clinical severity and increased risk of death in pneumonia?
How would you manage based on these?
CURB65
Confusion
Urea > 7 mmol/L
Resp rate > 30
BP < 90/60
0-1 = low risk, manage in community, amoxicillin 2 = moderate risk, admit, amox + clarithromycin 3+ = high risk, consider ITU, co-amox + clari
Management of pneumonia?
Supportive
Oxygen
Antibiotics:
low risk: amoxicillin
moderate risk: amox + clari
high risk: co-amox + clari
If Pen allergic: use macrolide (clari) or tetracycline
What is the most common bug that causes pneumonia?
What others cause it?
Strep pneumoniae
Legionella pnuemophila H. influenzae Mycoplasma pneumonia Klebsiella Pseudomonas
What’s the full name of:
- legionella
- listeria
Legionella pneumophila
Listeria monocytogenes
What would make you consider legionella pneumonia?
How can you test for it?
What antibiotic treats it?
Exposure to poorly maintained air conditioning
No improvement with amoxicillin
Deranged renal and liver function tests
Makes young and fit people very unwell
Urinary antigen
Macrolide (clari)
Complications of pneumonia?
Sepsis Lung abscess AKI Extra-thoracic infection Effusions Multi-organ failure Death
Clinical features of pneumonia?
SOB
Cough + sputum
Fever
Malaise
Low oxygen sats
Crepitations
Dull to percussion
What test do you do to test vocal resonance?
What does it help you with?
Patient says 99 while you auscultate
It should sound muffled
Increased vocal resonance - it sounds clearer: consolidation
Decreased or absent vocal resonance - pleural effusion or collapse
