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PHAM02 - term 2 > Wk 27: Meningitis > Flashcards

Wk 27: Meningitis Flashcards

1
Q

What is meningitis?

A
  • Inflammation of membranes covering brain + spinal cord
  • Inc risk: head trauma + ventriculo-peritoneal shunts
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2
Q

What is the main cause of bacterial meningitis?

A

Neisseria meningitidis

  • 13 types: A, B, C, Y + W-135
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3
Q

What other bacterial pathogens cause bacterial meningitis?

A
  • S pneumoniae: gram +ve cocci
  • H influenzae type B: gram -ve rods
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4
Q

What is viral causes of meningitis?

A
  • Less severe
  • Virus that live in intestines: enteroviruses, mumps, measles + herpes
  • Poor hygiene inc transmission
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5
Q

What is fungal causes of meningitis?

A
  • Life threatening
  • Slow progression
  • Cryptococcus, candida
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6
Q

How is meningitis transmitted?

A
  • Neisseria meningitidis: droplets
  • Other: infection of skin, urinary tract, GI tract
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7
Q

What are the risk factors of meningitis?

A
  • Infants + young children + elder
  • Community settings
  • Asplenia
  • Compromised immune system
  • Exposed to active/passive tobacco smoke
  • Pregnant + working w/ animals
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8
Q

What are classic symptoms of meningitis?

A
  • Fever
  • Headache
  • Photophobia
  • Neck stiffness
  • Petechial rash
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9
Q

What are the presentations in young children?

A
  • Muscle + joint aches
  • Cold extremities
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10
Q

What is a petechial rash?

A
  • Present in septicaemia
  • Early disease: blanching + maculopapular
  • Rapidly evolving petechial rash = severe
  • Non-blanching = med emergency
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11
Q

What is kernig’s sign in meningitis?

A

Severe stiffness of hamstring = inability to straighten leg when hip is flexed to 90 degrees

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12
Q

What is brudzinski’s sign in meningitis?

A

Severe neck stiffness causing hips + knees to flex when neck flexed

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13
Q

How is meningitis diagnosed?

A
  • History + examination
  • FBCs
  • Microbiology testing of CSF sample = golden standard
  • Nasopharyngeal swab through mouth
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14
Q

What is the CSF sample?

A
  • Lumbar puncture drains cerebrospinal fluid from back below termination of spinal cord
  • In meningitis: sample turbid
  • Bacteria not cultured if antibiotics administered
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15
Q

When should a CFS sample not be perfomred?

A
  • Raised intracranial pressure
  • Hemodynamically unstable
  • Clotting abnormalities/thrombocytopenia
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16
Q

What is the treatment for meningitis?

A
  • Parenteral antibiotics asap: benzylpenicillin/cefotaxime
  • W/hold benzylpenicillin in allergy if anaphylactic
17
Q

What is first line for children over 3 months?

A

Ceftriaxone OR cefotaxime

18
Q

What is first line for infants <3 months?

A

Cefotaxime plus ampicillin/amoxicillin (active against listeria)

19
Q

What are supportive therapies for meningitis?

A
  • Corticosteroids
  • IV fluids
  • Enteral nutrition
  • Management of septicaemia + shock
20
Q

What are the management of septicaemia + shock?

A
  • Respiratory support
  • Correct metabolic disturbance
  • IV fluids
  • Vasoactive therapies
  • Renal replacement therapies
21
Q

What are long term complications of meningitis?

A
  • Hearing loss
  • Orthopaedic complications
  • Skin complications
  • Psychosocial problems
  • Neurological + developmental problems
  • Renal failure
22
Q

When is chemoprophylaxis indicated?

A
  • Prolonged close contact: same hh during 7 days prior to presentation
  • Transient close contacts: directly exposed to large particle droplets
  • Patient: given asap unless treated ceftriaxone
23
Q

Which medications are used for chemoprophylaxis?

A
  • Ciprofloxacin: for pregnancy
  • Rifampicin: BD for 2 days
  • Ceftriaxone: injection
24
Q

Which vaccinations are available?

A
  • hib/Men C: 1 yr
  • Quadrivalent vaccine
  • Men B: 2, 4 + 12 months
  • 5 in 1: 8, 12 + 16 wks
  • Pneumococcal: 8, 16 wks + 1 yr
25
Q

Who must you report to if meningitis is suspected?

A

Local health protection unit of health protection agency

PHAM02 - term 2 (21 decks)

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