Wk 27: Meningitis Flashcards
What is meningitis?
- Inflammation of membranes covering brain + spinal cord
- Inc risk: head trauma + ventriculo-peritoneal shunts
What is the main cause of bacterial meningitis?
Neisseria meningitidis
- 13 types: A, B, C, Y + W-135
What other bacterial pathogens cause bacterial meningitis?
- S pneumoniae: gram +ve cocci
- H influenzae type B: gram -ve rods
What is viral causes of meningitis?
- Less severe
- Virus that live in intestines: enteroviruses, mumps, measles + herpes
- Poor hygiene inc transmission
What is fungal causes of meningitis?
- Life threatening
- Slow progression
- Cryptococcus, candida
How is meningitis transmitted?
- Neisseria meningitidis: droplets
- Other: infection of skin, urinary tract, GI tract
What are the risk factors of meningitis?
- Infants + young children + elder
- Community settings
- Asplenia
- Compromised immune system
- Exposed to active/passive tobacco smoke
- Pregnant + working w/ animals
What are classic symptoms of meningitis?
- Fever
- Headache
- Photophobia
- Neck stiffness
- Petechial rash
What are the presentations in young children?
- Muscle + joint aches
- Cold extremities
What is a petechial rash?
- Present in septicaemia
- Early disease: blanching + maculopapular
- Rapidly evolving petechial rash = severe
- Non-blanching = med emergency
What is kernig’s sign in meningitis?
Severe stiffness of hamstring = inability to straighten leg when hip is flexed to 90 degrees
What is brudzinski’s sign in meningitis?
Severe neck stiffness causing hips + knees to flex when neck flexed
How is meningitis diagnosed?
- History + examination
- FBCs
- Microbiology testing of CSF sample = golden standard
- Nasopharyngeal swab through mouth
What is the CSF sample?
- Lumbar puncture drains cerebrospinal fluid from back below termination of spinal cord
- In meningitis: sample turbid
- Bacteria not cultured if antibiotics administered
When should a CFS sample not be perfomred?
- Raised intracranial pressure
- Hemodynamically unstable
- Clotting abnormalities/thrombocytopenia
What is the treatment for meningitis?
- Parenteral antibiotics asap: benzylpenicillin/cefotaxime
- W/hold benzylpenicillin in allergy if anaphylactic
What is first line for children over 3 months?
Ceftriaxone OR cefotaxime
What is first line for infants <3 months?
Cefotaxime plus ampicillin/amoxicillin (active against listeria)
What are supportive therapies for meningitis?
- Corticosteroids
- IV fluids
- Enteral nutrition
- Management of septicaemia + shock
What are the management of septicaemia + shock?
- Respiratory support
- Correct metabolic disturbance
- IV fluids
- Vasoactive therapies
- Renal replacement therapies
What are long term complications of meningitis?
- Hearing loss
- Orthopaedic complications
- Skin complications
- Psychosocial problems
- Neurological + developmental problems
- Renal failure
When is chemoprophylaxis indicated?
- 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
Which medications are used for chemoprophylaxis?
- Ciprofloxacin: for pregnancy
- Rifampicin: BD for 2 days
- Ceftriaxone: injection
Which vaccinations are available?
- 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
Who must you report to if meningitis is suspected?
Local health protection unit of health protection agency
