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3rd Year Infection > Meningitis Self Learning > Flashcards

Meningitis Self Learning Flashcards

1
Q

What is Meningism?

A

Complex of:

  • Headache
  • Photophobia
  • Vomiting
  • Neck stiffness
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2
Q

Meningism is associated with what/

A

Meningitis

SAH

Bacteraemia

Severe influenza

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3
Q

How does neck stiffness present in meningism?

A

Passive flexion stiffness

Lateral/rotational stiffness indicated Cervical spine cause

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4
Q

Outline the pathogenesis of meningitis?

A
  1. Attachment ot mucosal epithelial cells
  2. Transgression of mucosal barrier
  3. Survival in blood
  4. Entry into CSF
  5. Production of overt infection without brain infection
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5
Q

How is meningitis classified?

A

Bacterial, Fungal or Viral

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6
Q

What are the common bacterial pathogens in meningitis?

A
  • Neisseria meningitidis*
  • Streptococcus pneumoniae*
  • Haemophilius influenzae*

Neonates: E. coli, Group B Strep

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7
Q

What are the common viral pathogens in meningitis?

A

Enteroviruses

Herpes simplex virus

Mumps

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8
Q

Meningitis is associated with which surgery?

A

Ventriculo-atrial/peritoneal shunts (10-30%)

Coagulase negative Staphylococci

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9
Q

What are the non-infective causes of meningitis?

A

Tumour cells in CSF - diagnosed by CSF cytology

Drug reactions

Sarcoidosis/SLE

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10
Q

What are the typical causes of meningism?

A

Influenza, head and neck infections, UTI, bacteraemia

Subarachnoid haemorrhage

Migraine

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11
Q

Meningitis should always be considered as a diagnosis in what?

A

Unexplained unconsciousness

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12
Q

What are the risk factors for meningitis?

A

Recent skull trauma

Alcoholism

Diabetes mellitus

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13
Q

What are the typical symptoms of meningitis?

A

Meningism - photophobia, neck stiffness, vomoting, headache

Fever

Clouded consciousness

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14
Q

How should a suspected meningitis case be examined?

A

General - Pyrexia, GCS, Petechiae, rashes

CVS - Pulse rate, BP

Neuro - Focal neurological signs, papilloedema

Kernig’s sign

Chin to chest

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15
Q

What is Kernig’s Sign?

A

Flex hip - can patient straighten leg?

Cannot straighten hamstring due to spasm? Meningism likely

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16
Q

What investigations should be used for suspected meningitis?

A

Bloods before antibiotics

Lumbar puncture unless focal signs, papilloedema

PCR

FBC

U+E

17
Q

What are the contraindications for Lumbar Puncture?

A

Focal Neurological signs

Papilloedema

Space occupying lesion

18
Q

In case of papilloedema or focal neurological signs, what should be performed before a lumbar puncture in suspected meningitis?

A

Head CT to exclude space occupying lesion

19
Q

What should be recorded when testing the CSF?

A

Opening pressure

CSF Microbiology

  • Gram/ZN stain
  • Differential cell count
  • Culture (+ mycobacterial/fungal)
  • PCR

CSF Biochemistry

  • Glucose
  • Protein
20
Q

How CSF factors are assessed in suspected meningitis?

A

Appearance

Cells

Predominant cell type

Glucose

Protein

21
Q

How do CSF factors change in bacterial meningitis?

A

Appearance - Turbid

Cells - Increased

Predominant cell type - Neutrophils

Glucose - Decreased

Protein - Increased

22
Q

How do CSF factors change in bacterial meningitis?

A

Appearance - Clear

Cells - Increased

Predominant cell - Lymphocyte

Glucose - Normal

Protein - Moderate increase

23
Q

Bacterial meningitis due to common bacterial pathogens is typically associated with what?

A

Nasopharyngeal colonisation

24
Q

What is key in antibiotic therapy for menigitis?

A

Ability for agent to penetrate the CSF

25
Q

What antibiotics are used in meningitis?

A

Benzylpenicillin

Ceftriaxone

26
Q

How is meningitis managed?

A

Vaccinations

Antibiotics (ceftriaxone, benzylpenicillin)

Steroids (dexamethasone - prevent complications)

27
Q

How does Fulminant Meningococcal Septicaemia present?

A

Sudden onset:

  • LoC
  • Fever
  • Septicaemic shock
  • Renal failure
  • DIC
28
Q

What conditions are associated with Neisseria meningitidies infections?

A

Meningitis

Fulminant meningococcal septicaemia

Chronic meningococcaemia

29
Q

How is Meningococcal meningitis/sepsis treated?

A

Parenteral penicillin then hospital admission

Notified to health protection

30
Q

What are the most common causes of viral meningitis?

A

Enteroviruses (echovirus, coxsackie virus)

MMR

HSV

Varicella

In HIV - EBV

31
Q

How is Viral meningitis managed?

A

Symptomatic

Immunocompromised: IV Ig

32
Q

Where is fungal meningitis seen?

A

Immunocompromised (HIV, diabetics, lymphoma, immunosuppressant drugs)

33
Q

What are the most common pathogens in fungal meningitis?

A

Cryptococcus neoformans

34
Q

How is Cryptococcal meningitis managed?

A

Amphotericin

Fluconazole

35
Q

How does meninigitis differ in neonates?

A

Poorly localised symptoms/signs

More common pathogens: Group B Strep, E. coli, Enteroviruses

36
Q

How is neonatal meningitis treated?

A

Ampicillin

Gentamicin/cefotaxime

IV Ig in viral

Chemoprophylaxis in childbirth for high-risk mothers

3rd Year Infection (16 decks)

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