What is acute encephalitis an infection of?
The brain parenchyma
What cells would you see in the CSF of a patient with acute bacterial meningitis?
What is the most common cause of viral meningitis?
Enteroviruses such as ECHO
What is the treatment for viral meningitis?
Supportive treatment - generally a self limiting condition
How do you confirm a diagnosis of viral meningitis?
Viral stool culture Throat swab CSF PCR
List some causes of viral encephalitis?
Herpes Simples Varicella zoster CMV HIV Measles West Nile Virus Tick borne encephalitis Rabies
What is the treatment of herpes simplex encephalitis?
High dose IV aciclovir
What is the treatment for varicella zoster viral meningitis?
High dose aciclovir
A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night.
Viral encephalitis due to varicella zoster virus
A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night What investigations would you want?
Lumbar puncture MRI If she has had a seizure then EEG
A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night. There is going to be a four hour wait to get any investigations. What do you do?
A 32 year old women presents to a & e with confusion. She also had a widespread blistering rash. This is the MRI of her brain; describe it and give the most likely diagnosis.
Viral encephalitis due to varicella zoster virus.
MRI shows an inflamed portion of the temporal lobe involving the uncus and parahippocampus (the birght white section)
A patients presents with syptoms suggestive of viral encephalitis. You are concerned that the patient has raised ICP. What investigation is best to perform.
CT scan. In a normal case a lumbar punture should be performed but if there is a concern about raised ICP a CT scan should be given first.
What is the first line investigation for a patient with suspected viral encephalitis (Normal ICP)
What are the three most common causes of bacteria meningitis in neonates?
Group B stre
What is the most common cause of bacterial meningitis in children?
What is the most common cause of bacterial meningitis in people aged 10 - 21?
What are the two most common causes of bacterial meningitis in people over 21?
What are the two most common causes of meningitis in the elderly?
What kind of bacterial meningitis is someone who has had a fracture of the cribriform plate at risk of?
What kind of bacterial meningitis is someone who has had open head trauma or open neurosurgery at risk of?
Gram Negative rods
List 4 things that can be predisposing factors for bacterial meningitis
1. Immunocompromised state
2. Basilar skull fracture
3. Head trauma/Post neurosurgery
4. CSF shunt
List three possible ways in which a bacterial meningitis can start. Explain briefly the pathogenesis of each one.
1. Nasopharyngeal colonization (this can then spread)
2. Direct extension of bacteria (from parameningeal foci such - sinusitis, mastoiditis or brain abscess)
3. From a remote infection site (endocarditis, pneumonia, UTI)
In meningococcal meningitis what actually causes the symptoms?
A gram positive bacilli then causes meningitis in neonates, elderly and immunocompressed patients
What antibiotic would you give in a patient with listeria meningitis?
(NOT Ceftriaxone as listeria is intrinsically resistant to this!)
What is the treatment for tuberculous meningitis?
How many tubes do you send for CSF interpretation? What are they?
1. Haematology - cell count & differential
2. Microbiology - gram staina & culture
3. Biochemistry - glucose & proteins
What antibiotics do you give for a suspected actute bacterial meningitis?
What investigations should someone with suspected meningitis get who also has papilloedema.
Urgent CT or MRI
List 6 groups of people that should undergo a CT scan before an MRI in suspected bacterial meningitis?
2. History of CNS disease eg stroke
3. New onset seizure
5. Abnormal level of consciousness
6. Focal neurological deficit such a dilated non reactive pupil or abnormal eye movements
A patients presents with a stiff neck fever and a non blanching rach into a & e. They are drowsy and confused. What do you do first?
Give antibiotics (Ceftriaxone)
What two antibiotics should prescribes for people over the age of 55 presenting with symtpoms suggestive of meningitis? Why?
Ampicillin (to cover listeria infections)
What other drug could you give with the first dose of antibiotics in bacterial meningitis?
What is the first line treatment for a patient with meningitis who has a severe penicillin allergy
Chloramphenicol IV & Vancomycin
What is the treatment of penicillin resistant meningitis?
Vancomycin +/- Rifampicin
What would you give to a penicillin allergic patient with meningitis caused by listeria?
Co - trimoxazole
Is dexamethasone useful in pneumococcal or meningococcal meningitis?
Give a treatment plan for a patient with bacterial meningitis with low GCS of fluctuating conscious level.
1. Admit to HDU
2. Secure airway and start oxygen
3. IV Cefriaxone (+ ampicillin if over 55)
4. IV corticosteroids
DO NOT wait for CT scan or LP
What prophylactic treatment should be given to close contacts of someone who has meningitis?
What prophylactic treatment is recommended for contacts of someone who has meningitis who is under 12?