Meningitits

Question 1

Meningitis

Answer 1

Bacterial, viral
Also rarely TB, fungal or malignant
Viral mild, self-limiting
Bacterial rapidly fatal (focus on this)

Question 2

Bacterial meningitis

Answer 2

Meningococcal meningitis more than half (in UK, B most common)
Pneumococcal uncommon, affects younger children, higher fatality
Hib and men c now rare due to vaccination
Pathogens carried in nasal passages and invade meninges via bloodstream

Question 3

Clinical features

Answer 3

Peak age <5years
Early signs and symptoms non-specific
Irritability, poor feeding, vomiting, fever, drowsiness
Bulging fontanelle
Neck stiffness, photophobia in older child
Seizures
Non-blanching rash - meningococcal septicaemia

Question 4

Diagnosis

Answer 4

High index of suspicion in young children with non-specific symptoms
LP and examination of CSF - treatment not delayed for LP
Blood cultures

Question 5

Contraindications to LP

Answer 5

Signs of raised ICP (depressed consciousness, papilloedema, focal neurological signs - note CT does not rule out)
Coagulopathy
Septic shock

Question 6

Treatment

Answer 6

Broad-spectrum intravenous IV antibiotics
Third generation cephalosporin eg ceftriaxone (cefotaxime and amoxicillin 3months) used to moderate inflammatory response => reduce incidence of some neurological sequelae
Rifampicin, ciprofloxacin or cephtriaxone should be given to all household contacts
Report to HPA

Question 7

Complications

Answer 7

Acute: cerebral oedema; seizures; syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Sensorineural deafness