Fever and headache

Question 1

viral causes of meningitis

Answer 1

Common, mild, spontaneous improves enteroviruses, influenza

Question 2

bacterial causes of meningitis

Answer 2

common serious medical emergency N. meningitis, streptococcus pneumoniae. Rare: homophilius influenzae, listeria monocytosis, mycobacterium tuberculosis

Question 3

Fungal causes ofmeningitis

Answer 3

rare, AIDs ir cancer

cryptococcus neoformans

Question 4

Protozoa

Answer 4

Rare accidental ingestion of worm eggs of larvae angiostrongylus cantonensis - not in NZ

Question 5

Other causes of meningitis

Answer 5

common, drugs, trauma, neurosurgery, cancer

Question 6

Inflammation of the meninges causes

Answer 6

Headache
photophobia
neck stiffness
drowsiness

Question 7

systemic inflammatory response causes

Answer 7

fever
drowsiness
septic shock
rash (nisseria meningitidis)

Question 8

Pathogenesis of bacterial meningitidis

Answer 8

illness proceeded by nasopharyngeal colonisation
10-20% of young adults colonised with N. meningitidis
Bacteria enter subarachnoid space and propagate

Question 9

Diagnostic techniques

Answer 9

CSF fluid
Blood cultures
Throat swab
Blood to detect bacterial DNA by PCR

Question 10

Other early warning signs

Answer 10

Sore hamstrings
Kernels sign: lift legs slowly and if they say stop because their headache is getting worse. You’re stretching the cauda equina and meninges, most patients with meningitis don’t have it, but if found then worth noting

Question 11

CSF measures with bacterial meningitis

Answer 11

glucose = decreased 
protein = elevated 
WBC = increased, mainly neutrophils 
Gram stain = +/- 
Culture = ++/-

Question 12

CSF measures with viral meningitis

Answer 12

glucose = normal 
protein = increased or normal 
WBC = increased, lymphocytes 
gram stain = - 
Culture = -

Question 13

What if no characteristic rash?

Answer 13

all efforts to find the etiology
especially exclude meningococcal disease
If CSF gram stain negative
- streptococcus pneumoniae antigen test CSF
CSF - PCR meningococcus pneumonococcus,common viral causes
Blood PCR - meningococcus
Throat swab - carriage of meningococcus or pneumonococcus

Question 14

Seasonal?

Answer 14

More common in winter

Question 15

Demographic?

Answer 15

More common in very young maori and pacific children

Question 16

Ways N. meningitidis evades the immune system

Answer 16

• Protein on the outside that binds to factor H, Which down regulates the complement process
• produces “blebs” of lipopoly saccharide in persons blood

Question 17

neutrophil polysaccharide traps

Answer 17

When the lipopolysaccharide load is very high, out neutrophils commit suicide an release their DNA which forms a net across a capillary to trap circulating bacteria, immune cells and immune proteins as they go past. This is why capillaries get clogged in septic shock.

Question 18

What happens in shock?

Answer 18

Reduced BP, tachycardia,reduced perfusion of organs

Question 19

Management of bacterial meningitis

Answer 19

Give IV antibiotics 
resuscitate 
take blood cultures when IV line sited 
transfer to hospital 
investigations 
pain relief, fluid, IV antibiotics 

prophylaxis to contacts - meningococcus

Question 20

management of viral meningitis

Answer 20

reassurance
analgesia
can usually recover at home