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Y4 - Meningitis Flashcards

1
Q

What are the most common causes of meningitis in new borns?

A

GBS
E. coli
Listeria monocytogenes

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2
Q

What are the most common causes of meningitis in infants and children?

A

Strep pneumoniae
Neisseria meningitidis
Hib

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3
Q

What are the most common causes of meningitis in adolescents and young adults?

A

Neisseria meningitidis

Strep pneumoniae

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4
Q

What are the most common causes of meningitis in older adults?

A

Strep pneumoniae
Neisseria meningitidis
Listeria monocytogenes

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5
Q

Define meningism

A

Irritation of the meninges leading to the classic triad of fever, headache, photophobia

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6
Q

Define meningitis

A

Inflammation of the meninges

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7
Q

Define encephalitis

A

Brain parenchymal inflammation

LEADS to focal neurological signs

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8
Q

Define myelitis

A

Inflammation of the spinal cord

LEADS to referred symptoms along dermatomes

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9
Q

Define bacteraemia

A

Organism in the bloodstream

Leads to minimal symptoms

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10
Q

Define septicaemia

A

Bacteraemia with a high sepsis score (fever, tachycardia, shock, coagulopathy, organ failure)

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11
Q

Define pyaemia

A

Metastatic foci

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12
Q

What are the clinical findings of meningitis?

A

Meningism (headache, fever, photophobia)
Fits, consciousness affected
Contacts, travel, immunisation status?
Rash
Kernig’s and brudzinski’s sign
Focal signs
Septic signs (e.g. hypotension, tachycardia)

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13
Q

What is kernig’s sign?

A

Extension of knee painful

Or limited knee extension

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14
Q

What is brudzinski’s sign?

A

Passive flexion of neck leads to hip and knee flexion

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15
Q

What is a non-blanching rash in meningitis indicative of?

A

A viral infection

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16
Q

What is a blanching rash in meningitis indicative of?

A

A bacterial infection

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17
Q

What investigations should you order in suspected meningitis?

A

Bloods - culture, WBC, U&Es
Radiology - CT before LP (to check for collections/cerebral oedema)
LP

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18
Q

What tests do you want to do on the CSF collected from LP in suspected meningitis?

A

Red cells, polymorphs, lymphocytes, glucose, protein, Ig, culture, immunoassay, PCR

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19
Q

When must you do an LP?

A

When know its safe - i.e. after scan and BEFORE antibiotics

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20
Q

What would be the basic CSF findings in someone with a bacterial meningitis?

A

Polymorphs most common cell, raised protein count, low glucose

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21
Q

What would be the basic CSF findings in someone with a viral meningitis?

A

Lymphocytes most common cell, raised protein count, normal glucose

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22
Q

What would be the basic CSF findings in someone with a tuberculous meningitis?

A

Lymphocytes most common cell, raised protein count, low glucose

23
Q

What bacteria is screened for in pregnancy and if not treated may lead to neonatal meningitis?

A

GBS

Also the most common cause of neonatal meningitis

24
Q

What is the most common cause of meningitis in those with a VP shunt?

A

Staph. epidermis and staph aureus (remember these are skin flora)
Coliforms (VP ends in peritoneum)

25
What is the most common cause of meningitis in those post-head injury?
Strep pneumonia most common if CSF leak Others: pseudomonas, staph aureus
26
What is the most common cause of meningitis?
Strep pneumoniae
27
What other feature (apart from meningitis) can pneumococcal meningitis cause?
Cerebral oedema
28
What are the risk factors for pneumococcal meningitis?
Alcoholic Rough living Immunosupressed
29
How does pneumococcus protect against phagocytosis?
It has a polysaccharide capsule
30
In which group is meningococcal meningitis most common?
Children
31
What are the most common serotypes of meningococcus?
A most common | C next most common
32
How do you manage meningococcal meningitis?
Preadmission penicillin | !!!!!!!!!!!!!!!!!!!!!!!!!!!!!11
33
What is the pathogenesis of meningococcal meningitis?
Contact between bacteria and patient --> nasopharyngeal colonisation Protease/viral infection leads to cellular penetration
34
Delete as appropriate: | Meningococcal rashes are blanching/non-blanching
Non-blanching
35
Who should get prophylaxis for meningitis?
Close contacts of meningococcal meningitis patients (family, flatmates, kissing contacts)
36
What prophylaxis do close contacts of meningococcal infection get?
Single dose ciprofloxacin 48h Rifampicin Single dose ceftriaxone Vaccine if serotype C
37
How can meningococcal disease present?
Sepsis (endotoxins trigger sepsis syndrome) or meningitis or both Also assoc with DIC
38
How is the mortality of meningococcal disease significantly reduced?
Early recognition and administration of IM penicillin
39
How do we prevent bacterial meningitis?
Vaccination (Men A, B, C, H. influenzae, pneumococcal vaccine) Perinatal screening (group B strep & antepartum penicillin) Chemoprophylaxis for close contacts of those with meningococcus/H. influenzae
40
What encephalopathic features may be present in H. influenzae meningitis?
Cerebral oedema | Subdural effusions
41
How do you manage meningitis?
ABCD Antibiotics - penicillin/cefotaxime nb - haemophilus meningitis not responsive to penicillin Steroids (dexamethasone for cerebral oedema if seen on CT/focal neurological signs) Screen for sepsis Analgesia
42
What does antibiotic choice for meningitis depend on?
Causative parhogen Resistance of local pathogens Penetration of CSF If listeria possible cause (e.g. neonate, immunosuppressed, elderly) add amoxicillin
43
What are the possible complications of meningitis?
``` Circulatory collapse Focal neurological abnormalities Hydrocephalus Brain abscess Seizures ```
44
What is the mortality of bacterial meningitis?
Less than 10%
45
What is the morbidity of bacterial meningitis?
``` 15% Hearing Seizures Learning problems Lower IQ when compared with sibs ```
46
What can cause lymphocytic meningitis?
Viruses (eneteroviruses, e.g. coxsackie, ECHO, mumps, measles) Bacterial - partially treated, TB, Lyme disease, syphilis, encephalitis, SLE
47
What is the most common cause of meningitis?
Viral then pneumococcal
48
What are the two main causes of encephalitis?
HSV | Everything else
49
What are the clinical features of encephalitis?
Seizures, impaired consciousness behavioural changes, cognitive impairment, hallucinations, focal signs
50
What underlying diseases may present with encephalitis?
Measles, mumps, HIV, cancer, autoimmune dx
51
What are the CSF changes in encephalitis?
Numerous lymphocytes, raised protein (IgG), organisms (culture, PCR (Herpes), immunoassay)
52
What changes will you see on T2 CT scan of someone with HSV encephalitis?
Hyperintensity of the temporal lobes | Virus has affinity for the temporal lobes
53
How do you treat encephalitis?
HSV - acyclovir high dose parenterally | Bacterial - Rx as appropriate

Infection (22 decks)

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