Week 221 - Meningitis Flashcards
Week 221 - Meningitis: What are the risk factors for developing meningitis?
- Age 60
- DM
- Renal or adrenal insufficiency
- Immunosupression
- Sickle cell disease
- Alcoholism and cirrhosis
- Recent exposure to meningitis
- Contiguous infection
- Dural defect
- IV drug abuse
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates (<1month)?
- E.Coli
- Pneumococcal meningitis
- Listeria monocytogenes
- Nisseria meningitides
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children older than 2 months?
- Pneumococcocal
- N. Menigitides
- H. Influenza
Week 221 - Meningitis: What are the two main mechanisms by which bacteria enter the subarachnoid space?
- Haematogenous spread from respiratory tract.
* Direct spread from a contiguous infection (sinusitis, mastoiditis) or from an injury.
Week 221 - Meningitis: What are the symptoms of meningism?
- Photophobia
- Headache
- Stiff neck
Week 221 - Meningitis: You may not see meningism in babies, what are the symptoms that you may see that would suggest meningitis?
- Hyper/hypothermia
- change in sleeping or eating habits.
- irritability or lethargy.
- high pitched cry
- bulging fontenelle
Week 221 - Meningitis: What is Kernig’s sign?
Patient is in supine position, hip and knee is flexed to 90º, patient feels pain when leg is extended.
Week 221 - Meningitis: What is Brudzinski sign?
When supine, passively flex neck, this causes the lower extremities (hips and knees) to flex.
Week 221 - Meningitis: The non-blanching petechial rash is a sign of what?
Sepsis.
Week 221 - Meningitis: What are the signs of encephalitis?
Fever, headache and decreased neurological function.
Week 221 - Meningitis: Which investigations should be performed for suspected meningitis?
- FBC, Coagulation studies, serum glucose.
- ABG
- Throat swab
- H1N1
- PCR
- Lumbar puncture (if not contraindicated)
Week 221 - Meningitis: A CT is indicated before a lumbar puncture in which patients?
> 60 y.o., immunocompromised, known CNS lesions, seizure within 1 week of presentation, suspicion of elevated ICP (Papilloedema, high BP but low HR).
Week 221 - Meningitis: What are the absolute contraindications for a lumbar puncture?
- Infected skin at site.
- Raised ICP
- Shock
- Focal neurological signs
- Unequal pressures between supratentorial and infratentorial compartments (from CT)
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in viral meningitis?
- Opening pressure - Normal or High
- Colour - Clear
- Cells/mm - 5-1000
- Predominant cell - Lymphocytes
- CSF:plasma glucose - Normal
- Protein - Normal
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in bacterial meningitis?
- Opening pressure - High
- Colour - Cloudy
- Cells/mm - 100-50000
- Predominant cell - Neutrophil
- CSF:plasma glucose - Low
- Protein - Elevated
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in tuberculous meningitis?
- Opening pressure - High
- Colour - Cloudy/yellow
- Cells/mm - 25-500
- Predominant cell - Lymphocyte
- CSF:plasma glucose - Low/very low
- Protein - elevated
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in fungal meningitis?
- Opening pressure - High/Very high
- Colour - Clear/cloudy
- Cells/mm - 0-1000
- Predominant cell - Lymphocyte
- CSF:Plasma glucose - Normal/low
- Protein - Normal
Week 221 - Meningitis: Which antibiotic should be used in neonates for listeria and Group b strep?
- Listeria - Ampicillin and Aminoglycoside/Cefotaxime
* Group B strep - Benzylpenicillin and cefotaxime
Week 221 - Meningitis: Which class of antibiotics is used to treat meningitis (not neonates)?
Cephalosporin
Week 221 - Meningitis: Which antibiotic is used for the prophylaxis of meningitis?
Ciprofloxacin
Week 221 - Meningitis: Which organisms that cause meningitis are routinely vaccinated against?
- H influenze
- Menningococcal C
- Strep Pneumoniae
- MMR
Week 221 - Meningitis: What are the complications of meningitis?
- Focal neurological sequelae
- Hemiparesis, Facial palsy
- Visual field defects, hearing loss, blindness,
- Syndrome of inappropriate ADH secretion.
- Cranial nerve palsies
Week 221 - Meningitis: What are the measures in place to prevent transmission across the blood brain barrier?
- Capillaries have tight junctions that do not exist in normal circulation.
- There is also a thick basement membrane.
- There is active transport for certain metabolites whilst small molecules like 02,CO2 and hormones are able to diffuse across.
Week 221 - Meningitis: What are the names of the cells that line the choroid plexus and ventricles?
Ependymal cells.
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates?
- E. Coli
- Streptococci
- Listeria
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children?
- H. influenza
- Pneumococcal
- Meningococcal
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in young adults?
- Pneumococcal
* Meningococcal
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in older adults?
- Pneumococcal
- Listeria
- Gram -ve organisms
Week 221 - Meningitis: Lyme disease is caused by which organism? What are the symptoms?
Borelia Burgdorferi
• Rash, arthritis, aseptic meningitis, focal nerve palsy, mild encephalopathy.
Week 221 - Meningitis: What are the features of viral meningitis?
- Acute onset of meningism, fever, irritability.
- Usually self-limiting with complete recovery.
- Often have systemic features.
Week 221 - Meningitis: Which organisms cause viral meningitis?
Echo, coxsackie, mumps, HIV.
Week 221 - Meningitis: Which organisms cause viral encephalitis?
- Herpes simplex 1
- Herpes simplex 2
- CMV
- Herpes zoster
- Arboviruses
- HIV
- Rubella/Toxoplasmosis
Week 221 - Meningitis: What are the features of viral encephalitis caused by Herpes simplex type 1?
- Mostly children and young adults.
- Affects temporal and inferior frontal lobes.
- Oedema, necrosis, haemorrhage, specific viral inclusion bodies.
- 40-70% mortality if left untreated.
Week 221 - Meningitis: How much fluid should be given to a child experiencing shock due to meningitis?
• 20ml/kg (25% of circulating volume)
Week 221 - Meningitis: What family of viruses most commonly causes viral meningitis?
Enteroviruses (echo, coxsachie, polio)
Week 221 - Meningitis: Which bacteria is the most common cause of bacterial meningitis in the UK?
Neisseria meningitides - (Meningococcal)
Week 221 - Meningitis: What are the two sites where the blood brain barrier is most commonly crossed? What conditions commonly occur when pathogens cross at these sites?
- Brain microvascular endothelial cells - Causes encephalitis or brain abscess.
- Choroid plexus - Causes meningitis.
Week 221 - Meningitis: Why is the choroid plexus a weak spot for the crossing of the blood-brain barrier?
Endothelium is fenestrated, tight junctions are weaker and epithelium has fast rate of endocytosis.
