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Yr 3 NEURO > Condition- Meningitis > Flashcards

Condition- Meningitis Flashcards

1
Q

What is Meningitis?

A

Inflammation of the meninges

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2
Q

List two common causes of meningitis in neonates

A
  1. E. Coli
  2. Group B step
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3
Q

State the main cause of bacterial meningitis in children

A

H. Influenza

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4
Q

List two of the main pathogens causing bacterial meningitis in adults and teens

A

Neisserie Meningitis

Strep Pneumonia

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5
Q

List two main pathogens causing meningitis in the elderly

A
  • Strep pneumonia- patients go home after pneumonia and come back with meningitis infection
  • Listeria
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6
Q

What is the two most common bacteria causing bacterial meningitis?

A
  1. Pneumococcus (Streptococcus pneumoniae)
  2. Meningococcus (Neisseria meningitidis)
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7
Q

Which subgroup of the population is more at risk of Meningitis caused by Listeria?

A

Patients on immunosuppressive therapy

Elderly

Alcohol Abusers

Diabetics

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8
Q
  1. List some viral causes of meningitis…
  2. List a fungal cause
A

VIRAL:

  • Enterovirus
  • Mumps
  • HSV-2 (HSV-1 more common in encephalitis)
  • VZV
  • HIV

FUNGAL:

  • Cryptococcus
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9
Q

List some risk factors for developing meningitis…

A
  • Close communities (college halls)
  • Exposure to pathogens

Then think about immunocompromised portion of the population:

  • For bacterial <5 yrs and >60yrs
  • Immunosupressed
  • Non-immunised infants
  • HIV/AIDs
  • Asplenic/ hyposplenic
  • Cranial anatomic defects
  • Recent infection: sinusitis, inner ear infection, mastoiditis (spreads to meninges)
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10
Q

Describe some of the symptoms of Meningitis…

A
  • Headaches: severe, acute
  • Meningismus (triad): Neck stiffness, photophobia, Kernig’s sign
  • Fever
  • Vomiting
  • Photophobia/ phonophobia
  • Non-blanching purpuric rash
  • Altered mental state
  • Seizures
  • Reduced consciousness
  • INFANTS: irritabilty, not feeding, apnoea
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11
Q

When taking a history of a patient with meningitis it is important you record their travel history and exposure to the following….

A
  • Rodents
  • Ticks (lyme borrelia, rocky mountain spotted fever)
  • Mosquitoes (west nile virus)
  • Sexual Activity (HSV-2, HIV, syphilis)
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12
Q

List some of the signs of Meningitis on physical examination…

A

Signs of MENINGISMUS

  • Photophobia
  • Neck stiffness
  • Kernig’s test positive
  • Brudzinski’s sign positive

General signs of INFECTION:

  • Pyrexia
  • Tachycardia
  • Hypotension
  • Pupurea rash
  • Altered mental state => decreased GCS and MMSA
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13
Q

Describe what Kernig’s sign and Brudzinksi’s signs are…

A

KERNIG’S: Hips flexed, there is pain/resistance on passive knee extension

BRUDZINSKI’S: Flexion of hips when neck is flexed

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14
Q

Which investigations would you order for a patient with suspected Meningitis?

A
  1. Bedside: Temperature, BP, HR
  2. Bloods:
    • Routine: FBC (WCC), U+Es, CRP, LFT, glucose, coagulation screens (because you get DIC)
    • Special: blood cultures + throat swabs + stool sample
  3. Imaging: CT before LP if mass lesion or raised ICP suspected (e.g. decreased GCS) or focal neuro deficit
  4. Lumbar Puncture: serum, WCC, Gram-stain, antigen detection, Culture
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15
Q

List some contraindication for doing an LP/ when would you do a CT scan before doing an LP?

A
  • Raised ICP suspected
  • Lowered GCS
  • Focal neuro deficit
  • Papilloedema
  • Inner Ear problems=> loss of balance/ hearing
  • Trauma
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16
Q

Descirbe the appearance and composition of a sample of CSF from a patient with bacterial meningitis…

Talk about appearance, WCC, protein and glucose

A
  • Appearance: cloudy CSF
  • WCC: high neutrophils
  • Protein: high
  • Glucose: low
17
Q

Descirbe the appearance and composition of a sample of CSF from a patient with viral meningitis…

Talk about appearance, WCC, protein and glucose

A
  • Appearance: clear
  • WCC: high lymphocytes
  • Glucose: Normal
  • Protein: low
18
Q

Descirbe the appearance and composition of a sample of CSF from a patient with TB meningitis…

Talk about appearance, WCC, protein and glucose

A
  • Appearance: fibrinous
  • WCC: High lymphocytes
  • Protein: high
  • Glucose: low
19
Q

How would you manage a person with suspected meningitis? From GP=> Hospital

A
  1. GP: Give IM benzylpenicillin/ ceftriaxone if allergic
    • Refer to hospital immediately
  2. A+E: Broad spectrum abx
    • IM benzylpenicillin
    • IV ceftriaxone
    • Ampicillin if >65yrs and Listeria suspected
  3. Targetted abx therapy
  4. IV dexamethasone if cerberal oedema
20
Q

List some of the complications of meningitis…

A
  • Shock
  • Hydrocephalus
  • Seizures
  • Septicaemia
  • DIC
21
Q

Describe the mortality rate from bacterial and viral meningitis…

A

Bacterial: 10-40%

Viral: Self- limiting

22
Q

What should you give to a pt who presents to a GP practise with suspected Meningitis

A

IM benzylpenicillin and urgent referral to hospital

Yr 3 NEURO (26 decks)

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