Meningitis

Question 1

What does pyogenic meningitis look like under a microscope?

Answer 1

Neutrophils in the sub arachnoid space.

Question 2

What is the commonest cause of viral meningitis?

Answer 2

Enteroviruses (e.g. ECHO)

Question 3

Investigations for viral meningitis.

Answer 3

Viral stool culture
Throat swab
CSF PCR

Question 4

Commonest causes of bacterial meningitis in neonates.

Answer 4

Listeria, group B strep, E.coli

Question 5

Commonest causes of bacterial meningitis in children

Answer 5

Haemophilus influenzae

Question 6

Commonest causes of bacterial meningitis in ages 10-21

Answer 6

Neisseria meningitidis

Question 7

Commonest causes of bacterial meningitis in over 21s

Answer 7

Strep pneumoniae more than neisseria meningitidis

Question 8

Commonest causes of bacterial meningitis in over 65

Answer 8

More strep pneumo than listeria

Question 9

What meningitis does neurosurgery or head trauma put you at risk of?

Answer 9

Staphylococcus, gram negative bacilli

Question 10

What meningitis does fracture of the cribiform plate put you at risk of?

Answer 10

Strep pneumoniae

Question 11

Complications of meningitis

Answer 11

Purulence
Invasion
Cerebral oedema
Ventriculitis/hydrocephalus

Question 12

What is the gram stain appearance of meningococcus?

Answer 12

Gram negative diplococci

Question 13

Is listeria gram positive or gram negative?

Answer 13

Gram positive

Question 14

What antibiotics for tuberculous meningitis?

Answer 14

Isoniazid, rifampicin, pyrazinamide and ethambutol.

Question 15

What can cause meningitis in HIV and how do you treat it?

Answer 15

Cryptococcus (fungal)

Fluconazole

Question 16

When should you not do a LP in meningitis?

Answer 16

If increased ICP possible

Delirium

Question 17

Give examples of non-infectious causes of aseptic meningitis.

Answer 17

Carcinomatous
Sarcoidosis
Vasculitis
Dural venous sinus thrombosis
Migraine
Drug (co-trim, IVIG, NSAIDs)

Question 18

What investigation and management should be given on admission for bacterial meningitis?

Answer 18

Blood culture and coag screen
Antibiotics and steroids as per guidance
Throat swab
Swab or aspirate purpuric lesions

Question 19

When should patients have CT prior to having a lumbar puncture for meningitis?

Answer 19

Immunocompromised
History of CNS disease
New onset seizure
Papilloedema
Abnormal level of consciousness
Focal neurological deficit

Question 20

Should you give antibiotics before or after a lumbar puncture?

Answer 20

If LP will be delayed for more than 30 mins give it before

Question 21

What is the contact prophylaxis regimen for meningitis?

Answer 21

4 hourly doses of rifampicin orally
OR
1 dose of ciprofloxacin orally
OR 
IM ceftriaxone