Meningitis

Question 1

What is it?

Answer 1

Inflammation of the Meninges surrounding the brain and spinal cord

Question 2

What causes it?

Answer 2

Can be infection by bacteria, viruses, fungi or parasites, and can also have non-infective causes

Question 3

What bacteria cause meningitis? (4)

Answer 3

Strep Pneumoniae, Group B Strep, N Meningitidis, H Influenzae

Question 4

What Viruses cause meningitis? (4)

Answer 4

HSV, Measles, Influenza, Coxsackie

Question 5

What are the non-infective causes? (2)

Answer 5

Malignant cells e.g Leukaemia/lymphoma, Toxins e.g Intrathecal drugs, NSAIDs, Trimethoprim, SLE

Question 6

Is meningitis common?

Answer 6

There are 3200 cases of bacterial Meningitis in the UK each year

Question 7

Who does it affect?

Answer 7

It can affect all age groups but is more common in infants and the elderly

Question 8

What is the most common cause?

Answer 8

Viral Meningitis

Question 9

What prophylaxis is there?

Answer 9

Vaccines are given against bacterial meningitis types: A, C, W, Y, Group B H. Influenza, Pneumococcus

Question 10

Risk Factors (10)

Answer 10

CSF shunts, dural abnormalities, Spinal Procedures, Endocarditis, Diabetes, Alcoholism, Cirrhosis, Splenectomy, Sickle Cell, Crowding e.g University Students

Question 11

Symptoms (5)

Answer 11

Headache, leg pains, stiff neck, photophobia, seizures

Question 12

Signs (12)

Answer 12

Cold peripheries, abnormal skin colour, pain/resistance on passive knee extension, reduced conscious level, Opathotonus (arching of the body), Petechial rash, slow cap refill, Disseminated Intravascular Coagulation, Hypotension, Tachycardia, Pyrexia, Low urine output (signs of sepsis)

Question 13

Differentials (4)

Answer 13

Encephalitis, Subarachnoid Haemorrhage, Sepsis from elsewhere, Tetanus

Question 14

What bloods would you do? (8)

Answer 14

FBC, U&E, ESR, CRP, Coagulation Screen, Blood Cultures, LFTs, Glucose

Question 15

Other investigations (3)

Answer 15

CT, CXR, Lumbar Puncture with CSF Microscopy, culture and sensitivities

Question 16

What would be seen in Pyogenic CSF? i.e caused by bacteria

Answer 16

Turbid, Polymorphs, Glucose <1/2 of plasma, >1.5g/L of protein

Question 17

What would be seen in Viral CSF? i.e caused by viruses

Answer 17

Clear, mononuclear cells, Glucose >1/2 of plasma, <1g/L of protein

Question 18

What values of CSF lactate can determine bacterial or viral?

Answer 18

> 3.5mmol/L is bacterial, <3.5mmol/L is viral

Question 19

What is the treatment for bacterial meningitis? (7)

Answer 19

Immediate IM Benzylpenicillin, Dexamethasone, IV cefotaxime (broad to cover all causes) if below 55, Cefotaxime and Ampicillin if above 55, alter once sensitivities have been confirmed, analagesia, anti-pyretics, get senior help

Question 20

What is the treatment for viral meningitis? (4)

Answer 20

Look for signs of disease causing meningitis e.g cold sore, Aciclovir, analgesia, hydration

Question 21

What should be given to relatives as prophylaxis in bacterial meningitis?

Answer 21

A course of either Rifampicin or Ciprofloxacin

Question 22

Complications (8)

Answer 22

Sepsis, coma, loss of airway, raised ICP, subdural effusions, seizures, deafness, cranial nerve dysfunction

Question 23

Is there a good prognosis? (4)

Answer 23

Bacterial meningitis kills more under 5 year olds than any other infection, prognosis depends on the pathogen age and presentation, Pneumococcus has higher rates of mortality, Viral normally has complete resolution in 10 days