Emergency: Encephalitis And Meningitis

Question 1

What is encephalitis?

Answer 1

Inflammation of the brain

Question 2

What are the most common causes of acute encephalitis in the UK?

Answer 2

Herpes simplex virus 1 and 2
Enteroviruses
Varicella zoster

Question 3

Other than the most common 3 viral causes (herpes simplex, varicella zoster and enteroviruses) what other infective causes are there?

Answer 3

Measles, mumps and rubella 
Rabies 
Parvovirus (slapped cheek syndrome)
TB
Toxoplasmosis 
Malaria 
Lyme disease

Question 4

What are some non infective causes of encephalitis?

Answer 4

Hypoglycaemia 
DKA
Hepatic failure
SAH
Lead or other poisoning 
Malignancy 
Lupus

Question 5

What signs and symptoms are associated with encephalitis?

Answer 5

Early non specific symptoms:
Fever
Headache
Vomiting

Followed by:
Reduced consciousness
Odd behaviour 
Seizures 
Meningism - stiff neck, photophobia, headache

Question 6

How should encephalitis be managed?

Answer 6

High dose aciclovir in all cases to cover herpes simplex until investigation results available

EEG and MRI might show characteristic temporal lobe abnormalities

Seizure control and monitoring for raised ICP

Question 7

What investigations for encephalitis should be done?

Answer 7

CSF MC&S and PCR
Bloods
Stool sample
Urine dipstick and MSU

Question 8

Is viral or bacterial meningitis more common?

Answer 8

Viral

Question 9

Is viral or bacterial meningitis more lethal in nature?

Answer 9

Bacterial

Question 10

A range of bacteria and viruses can cause meningitis. What are some more rarer causes?

Answer 10

TB
Fungal infections
Malignant infiltration

Question 11

What are the most common bacterial causes of acute meningitis?

Answer 11

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilius influenzae type B

Question 12

What are the most common bacterial causes of meningitis during the neonatal period?

Answer 12

Group B streptococci
E.Coli
Listeria monocytogenes

Question 13

What are some common viral causes of meningitis?

Answer 13

Mumps
Enteroviruses
EBV

Question 14

For bacterial meningitis, under what age is the peak age of incidence?

Answer 14

Under 5

80% of all cases occur in children under 16

Question 15

What type of bacterial meningitis accounts for over half of the cases in the UK?

Answer 15

Meningococcal meningitis

Question 16

What is neisseria meningitidis often referred to as?

Answer 16

Meningococcal meningitis

Question 17

What is the most common variety of meningococcal meningitis in uk?

Answer 17

Group B

Question 18

Why in the early stages is it difficult to diagnose meningitis, especially in infants?

Answer 18

Early signs are non specific and may be subtle

Question 19

Where is group B streptococcus usually acquired from?

Answer 19

The mother at birth

Question 20

What are some non specific symptoms and signs in bacterial meningitis?

Answer 20

Irritability
Poor feeding
Vomiting
Lethargy

Question 21

What are the more specific signs associated with bacterial meningitis that develop later?

Answer 21

Bulging fontanelle
Fever
Neck stiffness and photophobia in the older child 
Seizures 
Apnoea 

Meningococcal infection can present with characteristic non-blanching purpuric rash if septicaemia present

Question 22

In bacterial meningitis, what are signs of sepsis?

Answer 22

Fever
Cold hands/feet/limb/joint pain 
Abnormal skin colour
Odd behaviour 
Rash 
DIC
Tachycardia 
Hypotension 
Tachypnoea

Question 23

In bacterial meningitis do septic signs or meningeal signs usually present first?

Answer 23

Septic signs

Question 24

In bacterial meningitis, what are the meningeal signs?

Answer 24

Stiff neck (often absent if less than 18 months old)
Kernig’s sign - resistance to extending knee of hip flexed
Brudzinski’s sign - hips flex on bending head forward
Photophobia
Opisthotonos - spasm occurs muscles causing backward arching of head

Question 25

What investigations should be done if suspecting bacterial meningitis?

Answer 25

``` Bloods: FBC, U&E, CRP, LFTs EDTA bottle for PCR Blood sugar Coagulation studies Blood gases Other microbiology samples (urine MSU, nose swab, stool sample, CSF if appropriate) ``` (In addition to sepsis 6) Give: oxygen, fluids, abx Take: blood culture, lactate, urine output)

Question 26

What signs suggest raised ICP? (And therefore no LP)

Answer 26

``` Focal neurological signs Papilloedema Significant fontanelle bulging DIC Signs of cerebral herniation ```

Question 27

Before admission to hospital, what medication should be given early if suspecting bacterial meningitis?

Answer 27

Parenteral penicillin Early antibiotic treatment significantly reduces fatality rates

Question 28

How should bacterial meningitis be managed (before organism known)

Answer 28

High flow oxygen Fluids IV antibiotics: if less than 3 months give amoxicillin and cefotaxime, if more than 3 months cefotaxime Dexamethasone if child more than 3 months and not meningococcal septicaemia

Question 29

What are some complications of meningitis?

Answer 29

``` Abscesses Subdural effusion Cerebral oedema Epilepsy Ataxia Paralysis Deafness - steroids may prevent this ```

Question 30

Following infection with meningococcus, what should be given to all household contacts?

Answer 30

Rifampicin or ceftriaxone or ciprofloxacin

Question 31

Describe neisseria meningitidis

Answer 31

Gram neg cocci in pairs Often within polymorphs Numerous serogroups -A, B, C, W135 based in the polysaccharide capsule antigen (evades immune response by preventing phagocytosis) Outer membrane acts as an endotoxin

Question 32

What vaccinations are there for bacterial meningitis?

Answer 32

Haemophilius influenza type B | Meningococcus C

Question 33

How is meningococcal meningitis spread?

Answer 33

Aerosols and nasopharyngeal secretions Most people are harmlessly colonised

Question 34

Is meningitis a notifiable disease?

Answer 34

Yes

Question 35

When meningococcal disease is acquired what are the 3 states that can occur?

Answer 35

Clearance Carriage Invasion