Meningococcal Disease

Question 1

What concentration of white cells in CSF are suggestive of meningitis?

Answer 1

Neonates: 20 cells/microlitre

Children: 5 cells/microlitre

Reference: NICE

Question 2

Practical Clinical Points

Answer 2

1. Ceftriaxone should not be used if administering calcium-containing infusions as the calcium can cause Ceftriaxone to precipitate out. This can form crystals in the gallbladder, resulting in biliary sludge and stones and deranged LFTs. Cefotaxime should be used instead.
2. Ceftriaxone can also cause an immunoallergic response leading to cholestatic hepatitis.

Reference: LiverTox

Question 3

What is the duration of treatment in Meningitis?

Answer 3

This depends upon the age of the patient and the organism isolated:

3 months and older:

• Haemophilus influenzae* > IV Ceftriaxone 10/7
• Streptococcus pneumoniae* > IV Ceftriaxone 14/7

Unconfirmed, uncomplicated > IV Ceftriaxone 10/7

Under 3 months:

• Streptococcus agalactiae* (Group B Strep) > IV Cefotaxime 14/7
• Listeria monocytogenes* > IV Amoxicillin 21/7 + IV Gentamicin 7/7

Gram negative bacilli > IV Cefotaxime 21/7

Unconfirmed > IV Cefotaxime 14/7 + Ampicillin/Amoxicillin 14/7

Question 4

What is the duration of treatment in Meningococcal disease?

Answer 4

IV Ceftriaxone 7/7

Question 5

What is the role of steroids in Bacterial Meningitis?

Answer 5

Steroids should not be administered to patients younger than 3 months with suspected/confirmed bacterial meningitis.

Dexamethasone (0.15mg/kg QDS) should be administered if lumbar puncture demonstrates:

• Frankly purulent CSF
• CSF WCC >1000/microlitre
• Raised CSF WCC with Protein >1g/litre
• Bacteria on Gram stain

Unless tuberculous meningitis is a potential, in which case the Tuberculosis guidelines should be consulted as steroids may cause harm without co-administration of anti-TB treatment.

Reference: NICE

Question 6

What follow-up is required in Meningitis?

Answer 6

• Hearing test within 4 weeks of being fit for test
• If severe or profound deafness, arrange urgent assessment for cochlear implants
• Follow up in 4-6 weeks from discharge to consider:
  
  • Hearing loss
  • Orthopaedic issues (bone/joint damage)
  • Skin issues (e.g. necrosis scars)
  • Psychosocial issues
  • Neurological and Developmental issues
  • Renal impairment