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infection > Meningitits - Learning Package > Flashcards

Meningitits - Learning Package Flashcards

1
Q

What is meningism?

A

Meningism = symptom complex characterised by headache, photophobia and vomiting with muscle spasms leading to neck rigidity

  • Caused by meningitis or sub-arachnoid haemorrhage or infection
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2
Q

What is meningitis?

A

Meningitis, due to infection or meninges, leads to inflammation and signs of meningeal irritation

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3
Q

Describe the pathophysiology of meningitis due to anatomy?

A

Anatomy:

  • Under surface of brain rests within cranial fossae, which abuts on structures from which infection may spread
    • Such as from frontal and ethmoid sinuses to produce abscess/empyema in frontal lobe
    • Middle ear extend to temporal lobe
    • Fractures of skull or neurosurgery may be complicated by opportunistic bacterial meningitis

Blood brain barrier has implications for transport of antibiotics from blood to brain

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4
Q

Describe the pathogenesis of meningitis?

A
  • Inflammation of meninges
  • 1 Attachment to mucosal epithelial cells
  • 2 Transgression of the mucosal barrier
  • 3 Survival in blood stream
  • 4 Entry into CSF
  • 5 Production of overt infection in the meninges with or without brain infection (encephalitis)
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5
Q

How is meningitis classified?

A

Classified by cause as bacterial, viral or fungal:

  • Bacterial
    • Neisseria meningitides (meningococcus)
    • Streptococcus pneumoniae (pneumococcus)
    • In neonates
      • E-coli
      • Group B streptococci
  • Viral
    • Enteroviruses
      • Echoviruses
      • Parechoviruses
      • Coxsackie A and B
      • Poliovirus
      • Mumps
      • Herpes simplex virus
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6
Q

What are some common organisms for bacterial meningitis?

A
  • Neisseria meningitides (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • In neonates
    • E-coli
    • Group B streptococci
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7
Q

What are some common organisms for viral meningitis?

A
  • Enteroviruses
    • Echoviruses
    • Parechoviruses
    • Coxsackie A and B
    • Poliovirus
    • Mumps
    • Herpes simplex virus
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8
Q

What are some non-infective causes of meningitis?

A
  • Tumour cells in CSF can produce an aseptic meningitis
  • Reactions to certain drugs or chemicals
  • By some diseases of unknown aetiology such as sarcoidosis or SLE
  • Subarachnoid haemorrhage
  • Migraine
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9
Q

What are some common conditions that present with meningism?

A
  • Influenza
  • Tonsillitis
  • Pneumonia
  • Sinusitis
  • UTI
  • Any severe bacteraemic illness
  • Non-infective causes
    • Subarachnoid haemorrhage
    • Migraine
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10
Q

What are the different forms of meningitis presentation?

A
  • Acute
    • Symptoms and signs for less than 24 hours, quickly progresses
    • Commonest cause meningococcal infection
  • Subacute
    • Signs and symptoms for 1-7 days
    • Number of aetiologies possible, almost all viral and 75% bacterial meningitides present subacutely
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11
Q

Describe the general presentation of meningitis?

A
  • “Meningeal symptoms”
    • Vomiting
    • Headache
    • Stiff neck
    • Lethargy
    • Clouding of consciousness
    • Photophobia
  • Signs
    • Neurological signs usually absent although cranial nerve palsies (VI, VII or VIII usually) may occur
    • Pyrexia
    • Reduced consciousness
    • Skin and conjunctival petechiae
    • Rashes
    • Hypotension due to septic shock
    • Kernig’s sign
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12
Q

What are “meningeal symptoms”?

A
  • Meningeal symptoms”
    • Vomiting
    • Headache
    • Stiff neck
    • Lethargy
    • Clouding of consciousness
    • Photophobia
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13
Q

What are some risk factors for meningitis?

A
  • Risk factors include recent skull trauma, alcoholism and diabetes mellitus
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14
Q

What investigations should be done for meningitis?

A
  • Blood culture
  • FBC
  • U&E
  • LFT
  • Lumbar puncture
    • Definitive diagnosis by allowing examination of CSF
  • CSF microbiology
    • Gram stain
    • Differential cell count
    • Antigen detection test
    • Bacterial culture
    • Mycobacterial or fungul culture
    • PCR for viruses
    • PCR for bacteria
  • CSF biochemistry
    • Glucose
    • Protein
  • CT scan
    • If focal neurological signs or papilloedema to exclude space occupying lesion
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15
Q

CSF findings, appearance for:

  • Normal
  • Bacterial meningitis
  • Viral meningitis
  • TB meningitis
A
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16
Q

CSF findings, cells for:

  • Normal
  • Bacterial meningitis
  • Viral meningitis
  • TB meningitis
A
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17
Q

CSF findings, predominant cell type for:

  • Normal
  • Bacterial meningitis
  • Viral meningitis
  • TB meningitis
A
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18
Q

CSF findings, glucose for:

  • Normal
  • Bacterial meningitis
  • Viral meningitis
  • TB meningitis
A
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19
Q

CSF findings, protein for:

  • Normal
  • Bacterial meningitis
  • Viral meningitis
  • TB meningitis
A
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20
Q

Describe the aetiology of bacterial meningitis?

A
  • Usually streptococcus pneumoniae, Neisseria meningitides or haemophilus influenza
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21
Q

What are the principles of bacterial meningitis treatment?

A
  • Early recognition
  • Rapid detection of pathogen
  • Rapid initiation of appropriate bactericidal antimicrobial therapy
  • Early recognition and treatment of sequelae of septicaemia
    • Eg DIC with shock, hypoxia, acidosis and adrenal insufficiency
  • Antibiotic prophylaxis of close contacts
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22
Q

Describe the general pharmaceutical management of bacterial meningitis?

A
  • Antibiotic therapy
    • Benzylpenicillin reaches CSF in sufficient quantities only if meninges are inflamed and given 4 hourly high doses
    • Ceftriaxone penetrates poorly into normal CSF, but effective concentrations obtained in bacterial meningitis
  • Steroids (dexamethasone)
    • Prevention of long term neurological sequelae
23
Q

What organism causes meningococcal meningitis?

A
  • Neisseria meningitides
24
Q

Describe the aetiology of meningococcal meningitis?

(age)

A
  • Most common in children and young adults
  • Groups A, B and C
25
Q

Describe the presentation of meningococcal meningitis?

A
  • Meningitis +/- septicaemia (commonest)
    • Fulminant meningococcal septicaemia characterised by suddenness of symptoms causing deterioration in consciousness, fever, septicaemia shock with renal failure and disseminated intravascular coagulation (DIC)
26
Q

Describe the treatment of meningococcal meningitis?

A
  • Early recognition
    • Antibiotics given by GP before hospitalisation
    • Parenteral penicillin (3-4MU)
  • On arrival to hospital if acutely unwell administer high dose ceftriaxone prior to LP
  • Treatment modified after culture
    • Benzylpenicillin or ceftriaxone
  • At time of discharge rifampicin or ciprofloxacin
  • Notification and prophylaxis
    • Reported to local consultant in health protection
    • Close family given chemoprophylaxis with rifampicin or ciprofloxacin
27
Q

Describe the prognosis of meningococcal meningitis?

A
  • Bad prognostic markers includes
    • Delay in instigation of antibiotic therapy
    • Extremes of age
    • Shock with absence of signs of meningitis
    • Presence of DIC, metabolic acidosis and absence of polymorph leucocytosis
28
Q

What organism is responsible for pneumoccal meningitis?

A
  • Streptococcus pneumonia
29
Q

Describe the aetiology of pneumococcal meningitis?

(age)

A
  • Most frequent case of bacterial meningitis in adults
30
Q

Describe the clinical presentation of pneumococcal meningitis?

A
  • Onset acute
  • More likely to have altered consciousness or focal neurological signs that haemophilus or meningococcal meningitis
31
Q

Describe the treatment of pneumococcal meningitis?

A
  • Early administration of high dose ceftriaxone
32
Q

What are some possible complications of pneumococcal meningitis?

A
  • Death (30-50%)
  • Loss of hearing
  • Cranial nerve deficits
  • Hemiparesis
  • Hydrocephalus
  • Seizures
33
Q

How can pneumoccal meningitis be prevented?

A
  • Pneumococcal vaccine
    • For those over 65 in Scotland
34
Q

How can meningococcal meningitis be prevented?

A
  • Group C vaccination part of immunisation schedule in UK
  • A and B exists but not part of
35
Q

What are some less common bacterial meningitis?

A
  • Haemophilus influenza (type B) meningitis
  • Listeria monocytogenes meningitis
  • Tuberculous meningitis
  • Leptospirosis and lyme disease
36
Q

What organisms usually cause viral meningitis?

A
  • Enteroviruses, especially echovirus and coxsackie, are most common in UK
37
Q

Describe the clinical presentation of viral meningitis?

A
  • Non-specific prodromal illness followed by rapid onset of headache, photophobia, low grade fever and a stiff neck
  • Patients usually lucid and alert
  • If encephalitis also present
    • Lethargy, confusion, seizures and focal neurological signs
  • With enteroviral meningitis
    • Rash
38
Q

What investigations are done for viral meningitis?

A
  • PCR of CSF for enteroviruses, herpes simplex, mumps and other viruses
  • Enteroviruses can be detected in throat swabs and from faeces
  • Testing for HIV
39
Q

Describe the treatment for viral meningitis?

A
  • Enteroviruses and parechoviruses
    • Symptomatic and usually recovery within 72 hours
  • If chronic infection occurs (eg in immunocompromised)
    • IV immunoglobulin
  • Herpes simplex virus
    • Aciclovir, initially IV
40
Q

Describe the prognosis of viral meningitis?

A
  • Most people make complete recovery
41
Q

How is viral meningitis prevented?

A
  • MMR immunisation in immunisation schedule
  • Good hand hygiene
42
Q

Describe the aetiology of fungal meningitis?

A
  • The yeast Cryptococcus neoformans (most common cause) of patients with HIV infection, or rarely in patients with diabetes, lymphoma or taking immunosuppressive drugs
43
Q

What is the most common form of fungal meningitis?

A

Cryptococcal meningitis

44
Q

Describe the clinical presentation of cryptococcal menignitis?

A
  • Subacute onset of symptoms with low grade fever, headache, nausea, lethargy, confusion and abdominal pain
  • Meningism less common
45
Q

Describe the treatment for cryptococcal meningitis?

A
  • Parenteral amphotericin, sometimes in combination with flucytosine
46
Q

How is cryptococcal meningitis prevented?

A
  • Long term chemoprophylaxis with fluconazole for patients with HIV prevention
47
Q

What are the 2 fundamental ways that neonatal meningitis differs from adults?

A
  • Symptoms and signs usually non-specific or not well localised
  • Bacteria commonly involved are group B streptococci, E-coli and L. Monocytogenes as well as enteroviruses and parachoviruses
48
Q

What are risk factors for neonatal meningitis?

A
  • Low birth weight
  • Prolonged rupture of membranes
  • Maternal diabetes mellitus
49
Q

Descibe the epidemiology of neonatal meningitis?

(incidence, time of year)

A
  • Incidence 1/2500 births
  • Seasonal as with adults
50
Q

Describe the clinical presentation of neonatal meningitis?

A
  • 2 syndromes occur in neonatal meningitis
    • Early onset
    • Marked respiratory distress, bacteraemia and high mortality
    • Organism usually acquired at birth from mothers GI tract
  • Late onset
    • More than 1 week after birth
    • Infection is typified by bacteraemia and meningitis but pulmonary involvement rare
    • Organism spread by cross infection with other mothers, babies or healthcare workers
51
Q

Describe the diagnosis of neonatal meningitis?

A
  • Bacterial
    • Neonatal CSF and blood cultures
    • Maternal blood cultures
  • Viral
    • Neonatal CSF, EDTA blood, faeces and nasopharyngeal secretions
52
Q

Describe the treatment of neonatal meningitis?

A
  • Parenteral ampicillin (group B strep and Listeria) and gentamicin or cefotaxime (to cover gram negative bacilli) until causative organism identified
  • IVIG for enteroviruses or parechoviruses
53
Q

Describe the prognosis of neonatal meningitis?

A
  • High mortality up to 50%
  • Neurological sequelae about 33%
54
Q

How is neonatal meningitis prevented?

A
  • Chemoprophylaxis to prevent neonatal group B strep infection to high risk mothers duriung labour
    • Usually amoxicillin or co-amoxiclav
  • Source isolation of neonates with enterovirus or parechovirus, and strict attention to hand hygiene

infection (15 decks)

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