Meningitits Flashcards
What is meningitis?
Inflammation of the meninges
What are the risk factors for meningitis?
- Extremities of age
- Living in close proximity
- Absence of vaccination Hx
- Immunosuppression
- Patients having spinal procedures
What are the important factors in a history?
- Classic triad of symptoms
- Onset
More rapid = more likely bacterial - Patient’s travel Hx
Some countries have high rates of pneumococcal penicillin resistance - Neurological state
What are the symptoms of bacterial meningitis?
- Triad:
Photophobia
Meningism (neck stiffness)
Headache
- Not-blanching petechial rash (non always present)
- Altered mental state
- Fever/vomiting
- Very sleepy/difficult to wake
- SeizuresWhat are the symptoms of meningococcal septicaemia?
Non-blanching rash plus:
- Fever
- Vomiting/nausea
- lethargy
- Muscle ache/joint pain
- Cold hands/feet
- Leg pain
- Pale/mottled skin
- Rapid breathing/dyspnoea
- Confusion
- Very sleepy/vacant/difficult to wake.
What is meningococcal disease?
Meningitis and/or septicaemia caused by Neisseria meningitidis
Is bacterial or viral meningitis more fatal?
Bacterial
Is bacterial or viral meningitis more common?
Viral
What are the most common bacteria that cause bacterial meningitis?
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
What is the most common viruses that cause viral meningitis?
- Herpes Simplex Virus (HSV)
- Enterovirus
- Varicella zoster virus (VZV)
How is herpes simplex virus treated?
Aciclovir
What would you look for on examination for meningitis?
- Glass test
Purpuric non-blanching rash
- Sepsis
- GCS
- Neck stiffness
- Kernig's sign
- Brudzinki's test
- Fundoscopy
- Neurological examWhat is Kernig’s sign?
- Thigh is flexed at the hip and knee at 90-degree angles
- Subsequent extension in the knee is painful
What is Brudzinki’s test?
- Lie patient flat on back, gently use your hands to lift their head and neck off the bed and flex their chin to their chest.
- +ve test = involuntary flexion of hips and knees
What investigations would you order for a patient with meningitis who is NOT suspected to have sepsis?
Bloods
- FBC
- U&E
- Creatinine
- LFTs
- Clotting screen
- Blood cultures
- Procalcitonin (or CRP if unavailable)
- Meningococcal and Pneumococcal PCR
- Serology sample
Throat swab
- Bacterial culture
CSF
- Opening pressure
- Microscopy, culture and sensitivity
- Meningococcal and pneumnococcal PCR
- Protein
- Glucose
- Lactate
Further tests
- PCR
What investigations would you order for a patient with meningitis who is suspected to have sepsis?
Bloods
- FBC
- U&E
- Creatinine
- LFTs
- Clotting screen
- Blood cultures
- Procalcitonin (or CRP if unavailable)
- Meningococcal and Pneumococcal PCR
- Serology sample
Throat swab
- Bacterial culture
When would you delay lumbar puncture?
- Signs of severe sepsis or rapidly evolving rash
- Respiratory or cardiac compromise
- Anticoagulant therapy/known thrombocytopenia
- Infection at the site of LP
- Focal neurological signs (raised ICP)
- Papilledema
- Continuous or uncontrolled seizures
- GCS ≤12
Where would you insert the needle for lumbar puncture and why?
- L3-4
- Spinal cord ends at L1-2
What would bacterial meningitis look like on a lumbar puncture sample?
- Appearance = Turbid/cloudy
- WCC count = 500-10,000 polymorphs (high)
- Glucose = very low
- Protein = High
Bacteria swimming in the CSF will release proteins and use up glucose
Immune system releases neutrophils in response to bacteria
What would viral meningitis look like on a lumbar puncture sample?
- Appearance = Clear
- WCC count = <1000 lymphocytes
- Glucose = Normal
- Protein = Raised
Viruses don’t use glucose but may release a small amount of protein
Immune system releases lymphocytes in response to viruses
What is the ‘blind’ treatment for bacterial meningitis in a GP setting or the treatment of a non-blanching rash?
IM or IV benzylpenicillin
• <1 year – 300mg
• 1-9 years = 600mg
• > 10 years – 1200mg
DO NOT GIVE IF ALLERGIC TO PENICILLINS
What is the treatment for bacterial meningitis in a hospital setting?
< 3 months
- Cefotaxime + amoxicillin/ampicillin
> 3 months
- Cefotaxime
ADDITIONAL
- Vancomycin rifampicin
If risk of penicillin resistant pneumococcal infection
- Dexamethasone
What would you give for bacterial meningitis if the patient has a penicillin allergy?
Chloramphenicol and dexamethasone
What are differentials for meningitis?
- Encephalitis
- Non-infectious causes
Blood
Trauma
Drugs - Subdural empyema
What is bacterial meningitis?
Bacteria infect the lining of the meninges and the spinal cord
What is meningococcal septicaemia?
Bacteria in the blood multiply uncontrollably
