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Infection > Y4 - Meningitis > Flashcards

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
Q

What is the most common cause of meningitis in those post-head injury?

A

Strep pneumonia most common if CSF leak

Others: pseudomonas, staph aureus

26
Q

What is the most common cause of meningitis?

A

Strep pneumoniae

27
Q

What other feature (apart from meningitis) can pneumococcal meningitis cause?

A

Cerebral oedema

28
Q

What are the risk factors for pneumococcal meningitis?

A

Alcoholic
Rough living
Immunosupressed

29
Q

How does pneumococcus protect against phagocytosis?

A

It has a polysaccharide capsule

30
Q

In which group is meningococcal meningitis most common?

A

Children

31
Q

What are the most common serotypes of meningococcus?

A

A most common

C next most common

32
Q

How do you manage meningococcal meningitis?

A

Preadmission penicillin

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!11

33
Q

What is the pathogenesis of meningococcal meningitis?

A

Contact between bacteria and patient –> nasopharyngeal colonisation

Protease/viral infection leads to cellular penetration

34
Q

Delete as appropriate:

Meningococcal rashes are blanching/non-blanching

A

Non-blanching

35
Q

Who should get prophylaxis for meningitis?

A

Close contacts of meningococcal meningitis patients (family, flatmates, kissing contacts)

36
Q

What prophylaxis do close contacts of meningococcal infection get?

A

Single dose ciprofloxacin
48h Rifampicin
Single dose ceftriaxone

Vaccine if serotype C

37
Q

How can meningococcal disease present?

A

Sepsis (endotoxins trigger sepsis syndrome) or meningitis or both
Also assoc with DIC

38
Q

How is the mortality of meningococcal disease significantly reduced?

A

Early recognition and administration of IM penicillin

39
Q

How do we prevent bacterial meningitis?

A

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
Q

What encephalopathic features may be present in H. influenzae meningitis?

A

Cerebral oedema

Subdural effusions

41
Q

How do you manage meningitis?

A

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
Q

What does antibiotic choice for meningitis depend on?

A

Causative parhogen
Resistance of local pathogens
Penetration of CSF
If listeria possible cause (e.g. neonate, immunosuppressed, elderly) add amoxicillin

43
Q

What are the possible complications of meningitis?

A 
Circulatory collapse
Focal neurological abnormalities 
Hydrocephalus
Brain abscess
Seizures
44
Q

What is the mortality of bacterial meningitis?

A

Less than 10%

45
Q

What is the morbidity of bacterial meningitis?

A 
15%
Hearing
Seizures
Learning problems
Lower IQ when compared with sibs
46
Q

What can cause lymphocytic meningitis?

A

Viruses (eneteroviruses, e.g. coxsackie, ECHO, mumps, measles)
Bacterial - partially treated, TB, Lyme disease, syphilis, encephalitis, SLE

47
Q

What is the most common cause of meningitis?

A

Viral then pneumococcal

48
Q

What are the two main causes of encephalitis?

A

HSV

Everything else

49
Q

What are the clinical features of encephalitis?

A

Seizures, impaired consciousness behavioural changes, cognitive impairment, hallucinations, focal signs

50
Q

What underlying diseases may present with encephalitis?

A

Measles, mumps, HIV, cancer, autoimmune dx

51
Q

What are the CSF changes in encephalitis?

A

Numerous lymphocytes, raised protein (IgG), organisms (culture, PCR (Herpes), immunoassay)

52
Q

What changes will you see on T2 CT scan of someone with HSV encephalitis?

A

Hyperintensity of the temporal lobes

Virus has affinity for the temporal lobes

53
Q

How do you treat encephalitis?

A

HSV - acyclovir high dose parenterally

Bacterial - Rx as appropriate

Infection (22 decks)

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