lecture 7 - meningitis

Question 1

What is meningitis?

Answer 1

A disease that results in swelling of the meninges and increased inter cranial pressure

Question 2

Which types of pathogens can cause meningitis?

Answer 2

bacteria, viruses, fungi

Question 3

What is the time frame of a chronic CNS infection?

Answer 3

> 4 weeks

Question 4

What is encephalitis?

Answer 4

Inflammation of the brain due to an infection or allergic reaction

Question 5

What are the key causes of non-infectious meningitis?

Answer 5

Lymphoma/leukaemia, subarachnoid haemorrhage, drug reactions, autoimmunity

Question 6

What is meningoencephalitis?

Answer 6

Inflammation of the brain and meninges

Question 7

What is the most common route of infection for infectious meningitis?

Answer 7

Haematogenous - via the bloodstream

Question 8

What is the most common route of infection in meningitis?

Answer 8

haematogenous

Question 9

What is the term for the presence of bacteria in the blood?

Answer 9

Bacteraemia

Question 10

What is the term for the presence of viruses in the blood?

Answer 10

viraemia

Question 11

What is the term for the presence of fungi in the blood?

Answer 11

fungaemia

Question 12

What are the 4 possible routes of infection in the development of infectious meningitis?

Answer 12

Haematogenous spread, direct innoculation, contiguous spread, PNS->CNS

Question 13

How does direct inoculation cause infectious meningitis?

Answer 13

Trauma, surgery, procedures can all allow pathogens to enter the brain

Question 14

How does contiguous spread of infection cause meningitis?

Answer 14

Local infections, usually in the head, can spread to the meninges/brain

Question 15

What type of pathogen typically causes infections spread via nerves from the PNS to CNS?

Answer 15

viruses

Question 16

Are the meninges sterile or unsterile in health?

Answer 16

Sterile

Question 17

What are the 3 layers of the meninges (outer to inner)?

Answer 17

Dura mater, arachnoid mater, pia mater

Question 18

Which layer of the meninges contains CSF?

Answer 18

Arachnoid mater - central layer

Question 19

What are the 3 classifications of infectious meningitis?

Answer 19

Acute, aseptic, chronic

Question 20

What type of meningitis is pyogenic?

Answer 20

Acute bacterial meningitis

Question 21

What immune cell can be found in large quantities in the CSF in acute bacterial meningitis?

Answer 21

neutrophils

Question 22

What is the key characteristic of bacterial culture in aseptic meningits?

Answer 22

Negative for bacteria - indicating a viral aetiology

Question 23

What cell type is found in large amounts in the CSF in cases of aseptic/viral meningitis?

Answer 23

Large numbers of lymphocytes

Question 24

What types of bacteria typically cause chronic meningitis?

Answer 24

Tuberculosis, syphilis

Question 25

What cell type is found in large amounts in the CSF in cases of chronic meningitis?

Answer 25

Lymphocytes

Question 26

Which pathogen cause of meningitis has the lowest morbidity/mortality and is typically self-limiting?

Answer 26

Viruses (aseptic meningitis)

Question 27

What are the key respiratory commensal bacteria that cause meningitis?

Answer 27

neisseria meningitidis, strep. pneumoniae, haemophilus influenzae

Question 28

Which types of virus are associated with aseptic meningitis?

Answer 28

Enteroviruses, herpes, mumps, measles, influenza

Question 29

What disease is associated with increased risk of cryptococcus fungal meningitis?

Answer 29

HIV/AIDS (immunodeficiency increases susceptibility)

Question 30

Why are neonates vulnerable to meningitis?

Answer 30

They have an immature immune system

Question 31

What is the most common cause of bacterial meningitis in NZ?

Answer 31

Neisseria meningitidis

Question 32

What are the signs/symptoms of acute bacterial meningitis?

Answer 32

Fever, neck stiffness, photophobia, lethargy, myalgia, arthralgia, headache, seizures, mottles skin, rash, cold extremities

Question 33

What is the “classic triad” in meningitis?

Answer 33

A trio of common symptoms: fever, neck stiffness, headache

Question 34

What is the most common symptom of meningitis?

Answer 34

Fever

Question 35

What are the symptoms of acute bacterial meningitis in infants?

Answer 35

Lethargy, irritability, poor feeding, high pitched cry, bulging fontanelle

Question 36

What can bulging fontanelle be a sign of in infants?

Answer 36

Bacterial meningitis

Question 37

What is the process that causes the rash characteristic of bacterial meningitis?

Answer 37

The haemorrhage of capillaries under the skin leading to spots of redness/bruising

Question 38

Which bacteria typically causes a hemorrhagic rash in cases of meningitis?

Answer 38

N. meningitidis

Question 39

What is the name for the rash spots in early stage meningitis?

Answer 39

Petechiae

Question 40

What is the type of rash found in late stage meningitis?

Answer 40

Purpuric

Question 41

What is the key clinical sign of a meningitis rash?

Answer 41

Non-blanching (in cup test)

Question 42

What test is commonly used to identify meningitis rashes?

Answer 42

Cup/tumbler test - check for non-blanching rash

Question 43

What 2 signs are commonly used to assess lower limb presentations of meningitis?

Answer 43

Kernig’s sign, Brudzinski’s sign

Question 44

What is Kernig’s sign in meningitis?

Answer 44

Knee cannot be fully extended when hip flexed 90 degrees

Question 45

What is Brudzinski’s sign in meningitis?

Answer 45

Passive flexion of the neck causes flexion of both legs and thighs

Question 46

What are the prodromal symptoms of meningitis?

Answer 46

nausea, vomiting, fatigue, malaise, lethargy, cough, pharyngitis, headache, myalgia

Question 47

What are the complications of meningitis?

Answer 47

Death, amputation, hearing loss, blindness, epilepsy, cerebral palsy, cognitive issues

Question 48

What are the at risk groups for meningitis?

Answer 48

infants, elderly, students, immunosuppressed, trauma, surgery, asplenia, bacteraemia

Question 49

Is Neisseria meningitidis gram positive or negative?

Answer 49

negative

Question 50

How is Neisseria meningitidis transmitted?

Answer 50

Respiratory aerosol

Question 51

How is meningitis diagnosed?

Answer 51

Lumbar puncture for CSF then gram stain/culture/PCR to determine pathogen

Question 52

What is the normal appearance of CSF in lumbar puncture?

Answer 52

Clear, colourless

Question 53

What is the typical appearance of CSF from lumbar puncture in cases of meningitis?

Answer 53

turbid, yellow/orange/green from blood, green from pus

Question 54

What are the characteristic WBC, glucose and protein levels in CSF in bacterial meningitis?

Answer 54

High neutrophils, low glucose, high protein

Question 55

What are the characteristic WBC, glucose and protein levels in CSF in viral/aseptic meningitis?

Answer 55

High lymphocytes, normal glucose, high protein

Question 56

What technique can be used to identify meningitis causing viruses in CSF?

Answer 56

PCR

Question 57

What is the empiric antibiotic given for suspected/unclassified meningitis?

Answer 57

Ceftriaxone

Question 58

What is the role of steroids in meningitis treatment?

Answer 58

Reduce inflammation to decrease risk of complications

Question 59

What vaccine is part of the vaccine schedule for infants (Child vax programme) and at risk groups?

Answer 59

Meningococcal B