Clinical Care- Meningitis

Question 1

Why is meningitis painful?

Answer 1

Unlike the brain the meninges have nociceptors

Question 2

what are common bacterial etiologies of meningitis

Answer 2

(1) Streptococcus pneumonia
(2) Neisseria meningitides
(3) Listeria monocytogenes

Question 3

what are common viral etiologies of meningitis

Answer 3

(1) Enterovirus
(2) Herpes simplex virus
(a) Between 13-36% of patients presenting with primary genital herpes may have findings consistent with meningeal involvement.
(3) West Nile Virus

Question 4

Signs and symptoms of meningitis

Answer 4

(1) Classic triad of acute bacterial meningitis
(a) Fever
(b) Nuchal rigidity
(c) Change in mental status
(2) Nuchal rigidity due to meningeal irritation
(3) Other symptoms
(a) Headache
(b) Photophobia
(c) Rash (associated with Neisseria meningitides)

Question 5

difference between Meningitis and encephalitis

Answer 5

(a) Important distinguishing feature is degree of brain function disturbance
(b) In meningitis cerebral function usually remains normal
(c) Encephalitis brain function is more abnormal leading to altered mental status, motor and sensory deficits, altered behavior, speech or movement disorders, speech changes

Question 6

Diagnosis of meningitis

Answer 6

Test meningeal irritation (Brudzinski sign, Kernig sign)

Lab testing

Lumbar puncture to evaluate CSF (should be delayed if there are signs of increased intracranial pressure: Papilledema, abnormal LOC, Focal neurological deficit)

Initiation of treatment should not be delayed if there is high clinical suspicion of meningitis.

Question 7

acute management and treatment of meningitis

Answer 7

Empiric treatment covers most common bacterial etiologies and focuses on decreasing acute inflammation. need antibiotics that cross blood brain barrier

Question 8

meds for treating meningitis

Answer 8

Ceftriaxone (Rocephin), dose: 2g IV Q12Hr

If patient has a penicillin allergy consult the MO prior to administration due to cephalosporin and penicillin cross reactivity.

Vancomycin (not in AMAL)

Dexamethasone, dose: 0.15mg/kg IV Q6Hr
Decreases acute inflammation in CNS. Studies demonstrate that there are less neurological long term complications

Question 9

if aseptic meningitis due to HSV is suspected (e.g. concomitant genital lesions) what drug therapy is recommended

Answer 9

acyclovir IV is recommended

Question 10

prophylaxis of meningitis

Answer 10

Exposed crew – Ciprofloxacin (Cipro) - is a Fluoroquinolone antibiotic. 500 mg PO x1

Mask patient and medical personnel in close proximity

Ensure vaccinations are current
a) Meningiococcal, S. penumoniae, and H. influenza vaccinations