4. Meningitis

Question 1

what is meningitis

Answer 1

inflammation of the meninges
the meninges are the lining of the brain and spinal cord
cord. Usually due to a bacterial or a viral infection

Question 2

what is meningococcal septicaemia

Answer 2

hen the meningococcus bacterial infection is in the bloodstream. Meningococcal refers to the bacteria and septicaemia refers to infection in the blood stream.

Question 3

what classical symptom does meningococcal septicaemia cause

Answer 3

non-blanching rash

Question 4

what is meningococcal meningitis

Answer 4

Meningococcal meningitis is when the bacteria is infecting the meninges and the cerebrospinal fluid around the brain and spinal cord.

Question 5

name the two most common causes of bacterial meningitis

Answer 5

Neisseria meningitidis(meningococcus) 
Streptococcus pneumoniae (pneumococcus).

Question 6

In neonates what is the most common cause of bacterial meningitis

Answer 6

Group B Streptococcus (GBS). GBS is usually contracted during birth from the GBS bacteria that can often live harmlessly in the mothers vagina.

Question 7

What is the typical symptoms of meningitis, start with the triad of symptoms first

Answer 7

headache, neck stiffness and photophobia

also present with vomiting, fever, altered consciousness and seizures
(non-blanching rash also in meningococcal septicaemia)

Question 8

What 2 special test can be used to look for meningeal irritation upon physical examination

Answer 8

Kernig’s test and Brundzinskis test

Question 9

what is kernig’s test

Answer 9

lying patient on back, flex one hip and knee to 90 degrees and then slowly straighten the knee whilst keeping the hip flexed

creates a slight stretch ini the meninges and where there is meningitis it will produce spinal pain or resistance to this movement

Question 10

what is Brudzinski test

Answer 10

lying patient on back and using your hand to lift their head ad neck off the bed and flex their chin to their chest

positive test is when this causes the patient to involuntarily flex their hips and knees

Question 11

in the community if you see a child with suspected meningitis and a non-blanching rash what medication should they receive

Answer 11

urgent stat dose (IM or IV) of benzylpenicillin prior to transfer to the hospital
• < 1 year – 300mg
• 1-9 years – 600mg
• > 10 years and adults – 1200mg

Question 12

what investigations would you carry out if you suspect meningitis

Answer 12

lumber puncture
blood cultures
meningococcal PCR

Question 13

what are the typical antibiotics used too treat meningitis

Answer 13

• < 3 months – cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy from the mother)
• > 3 months – ceftriaxone

Question 14

what medication should be added to cefotaxime if there is a risk of penicillin resistant pneumococcal infection (ie if the patient has recently travelled to a high risk country)

Answer 14

add Vancomycin

Question 15

Id the lumbar puncture suggests bacterial meningitis what steroid should be given

Answer 15

dexamethasone 4 times daily for 4 days in children over 3 months

Question 16

True or false
Bacteria meningitis and meningococcal infection are notifiable diseases so public healthneed to be informed of all cases.

Answer 16

true

Question 17

what post exposure prophylaxis should be given if someone has come into contact with a patient with meningococcal infections

Answer 17

ciprofloxacin ideally given within 24 hours of the initial diagnosis

Question 18

what are the most common causes of viral meningitis

Answer 18

herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV)

Question 19

where is the needle usually inserted in a lumbar puncture and why

Answer 19

spinal cord ends at L1/2

so needle is inserted L3-4

Question 20

What colour does CSF look like in the following scenarios;

1. Normal CSF
2. Bacterial infection of CSF
3. Viral infection of CSF

Answer 20

1. clear
2. cloudy
3. clear

Question 21

what are the protein levels of the CSF look like in the following scenarios;

1. Normal CSF
2. Bacterial infection of CSF
3. Viral infection of CSF

Answer 21

1. 0.2-0.4 g/L
2. 1.5 g/L
3. mildly raised or normal

Question 22

what are the glucose levels of the CSF look like in the following scenarios;

1. Normal CSF
2. Bacterial infection of CSF
3. Viral infection of CSF

Answer 22

1. 0.6-0.8
2. less than 0.5
3. 0.6-0.8

Question 23

what does the white cell count look like in the CSF in the following scenarios

1. normal
2. bacterial
3. viral

Answer 23

1. less than 5
2. more than 1000 and neutrophils
3. more than 1000 and lymphocytes

Question 24

what are the complications of meningitis

Answer 24

• Hearing loss is a key complication
• Seizures and epilepsy
• Cognitive impairment and learning disability
• Memory loss
• Focal neurological deficits such as limb weakness or spasticity

Question 25

what does the immune system release in response to a bacteria

Answer 25

neutrophils

Question 26

what does the immune system release in response to a virus

Answer 26

lymphocytes