Viral and Bacterial Meningitis Flashcards
Meningitis is inflammation of the meninges of the brain, notifiable to…
PHE
Name some viral causes of meningitis
Enteroviruses eg coxsackie
HSV-2 (herpes simplex virus)
VZV (varicella zoster virus)
Are viral or bacterial causes of meningitis more common?
Viral
Name some bacterial causes of meningitis
Strep. pneumoniae
Neisseria meningitidis
True or false:
Bacterial meningitis is more severe than viral meningitis
True
What are risk factors for meningitis?
Extremes of age
Immunocompromised
Non-vaccinated
Crowded environment
What bacteria commonly causes meningitis in neonates (1-3 months)
Group B alpha haem-strep
(Strep. agalactiae)
Also:
listeria, E. coli, S pneumoniae
Describe features of Neisseria Meningitidis
Gram negative
Diplococcus
What is a sign of Neisseria Meningitidis?
Non blanching purpuric rash
(meningococcal septicaemia causes DIC so very easily bleeds)
Describe the features of strep. pneumoniae
Gram positive
In pairs (diplococcus) or in short chains
What vaccine protects against strep pneumoniae?
PCV vaccine
How come group B strep is the most common cause of neonatal meningitis?
Group B strep colonises the maternal vagina
True or false: Group B strep is gram positive coccus in chains
True
What food is listeria monocytogenes found in?
Cheese
What group is affected most by listeria?
Extremes of age and pregnant ladies
What are symptoms of meningitis?
Headache
Neck stiffness
Fever
Photophobia
Rash
Altered consciousness
Seizures
What are signs of meningitis?
Kernig (can’t extend knee when hip is flexed without pain)
Brudzinski (when neck flexed, knees and hips automatically flex
Pyrexia (fever)
How do you diagnose meningitis?
Lumbar puncture and CSF analysis
Should you lumbar puncture with raised intracranial pressure?
No, increased risk of herniation
Where is a lumbar puncture taken?
L3-L4
What colour will the CSF be from bacterial meningitis?
Cloudy yellow
True or false:
The CSF from viral meningitis will be cloudy yellow
False
Will be clear and look normal
What is the opening pressure in lumbar puncture of patient with bacterial meningitis?
High
What is the opening pressure in lumbar puncture of patient with viral meningitis?
Normal
True or false: there is more than 1g of protein per litre in lumbar puncture of bacterial and fungal meningitis
True (viruses may release a small amount of protein, they don’t use glucose)
What happens to the white cell count in CSF of bacterial meningitis patient?
Neutrophilia
Describe the CSF collected from bacterial meningitis
Cloudy, low glucose, high protein, neutrophilia
(Bacteria release proteins and use up glucose. Immune system releases neutrophils in response to bacteria)
Describe the CSF collected from viral meningitis
Clear, normal glucose, mildly raised protein, high lymphocytes
(Viruses don’t use up glucose but may release small amount of protein. Immune system releases lymphocytes in response to viruses)
What happens to the white cell count in CSF of viral meningitis patient?
lymphocytosis
(same as fungal or TB meningitis)
How do you treat bacterial meningitis?
Ceftriaxone or Cefotaxime
with Dexamethasone (steroid)
What antibiotic covers listeria?
Amoxicillin
How do you treat meningitis caused by an enterovirus?
No treatment
What antibiotic is used for meningitis caused by HSV or VZV?
Aciclovir
What is given for prophylaxis for those who have been contact traced as having 7+ days of prolonged contact preceding a meningitis patient’s symptoms starting?
One off dose of ciprofloxacin
If a patient present in the GP with a non-blanching rash and meningococcal septicaemia is suspected, what do they do?
Give IM benzylpenicillin and immediate hospital referral
What is a complication of meningitis?
DIC due to meningococcal septicaemia
What is Waterhouse Friedrichsen Syndrome?
Adrenal insufficiency caused by intra-adrenal haemorrhage as a result of meningococcal DIC
