Meningitis

Question 1

Meningitis can be classified by etiology into:

Answer 1

1. Bacterial meningitis
2. Viral meningitis (aseptic)
3. Fungal meningitis

Question 2

Most common cause of meningitis is […]

Answer 2

Viral

Question 3

What viral organism may cause meningitis ?

Answer 3

Enteroviruses (coxsackie)
HSV-2
HIV, West Nile, VZV

Question 4

What bacterial organisms may cause meningitis ?

Answer 4

• S. Pneumoniae
• N. Meningitidis
• H. Influenzae (non vaccinated)
• GBS (neonates)
• Listeria (extreme age, pregnant, immunocompromised)

Question 5

What is the most common bacterial organism in meningitis ?

Answer 5

S. Pneumonea

Question 6

Most common agent:
Meningitis in HIV patient

Answer 6

CD4 <50: Cryptococcus

Question 7

Most common agent:
Meningitis with history of swimming in river

Answer 7

Naegleria fowleri

Question 8

Most common agent:
Meningitis with petechial rash

Answer 8

Neisseria Meningitidis

Question 9

What are the symptoms of meningitis

Answer 9

Fever
Headache
Photophobia
Nuchal regidity

Question 10

Presentation of :

Fever
Headache
confused / altered sensation

Answer 10

Encephalitis

Question 11

Presentation of :

Fever
Headache
focal neurological deficit

Answer 11

Brain abscess

Question 12

What are the positive signs of meningitis on examination ?

Answer 12

Kernig’s (hip flexion)
Brudzinski’s (neck flexion)

Question 13

Meningitis spread by […]

Answer 13

Droplet

Question 14

Patient with meningitis need to be isolated for […] of antibiotics

Answer 14

24 hours

Question 15

[…] is needed for diagnosis of meningitis

Answer 15

LP
with gram stain & culture

Question 16

What are contraindications for LP in patient with meningitis ?

Answer 16

signs of 🔺ICP
- papilledema
- focal neurological deficit
- altered mental status
- new onset seizure
CNS lesion
immunocompromised

Question 17

What are the CSF findings in viral meningitis ?

Answer 17

Cell type : Lø
Protein: N/🔺
Glucose: 🟢

Question 18

What are the CSF findings in bacterial meningitis ?

Answer 18

Cell type : PMNs
Protein: 🔺
Glucose: 🔻

Question 19

What are the CSF findings in fungal meningitis ?

Answer 19

Cell type : Lø
Protein: 🔺
Glucose: 🔻

Question 20

What are the CSF findings in TB meningitis ?

Answer 20

Cell type : Lø
Protein: 🔺🔺🔺
Glucose: 🔻

Question 21

Normal CSF cell count […]

Answer 21

<5

Question 22

Meningitis with low attenuation over tempo-parietal area
Most common causative agent […]

Answer 22

HSV

Question 23

Most common late complication of meningitis […]

Answer 23

Hearing loss

Question 24

Viral Meningitis treatment

Answer 24

Supportive

Question 25

Viral encephalitis treatment

Answer 25

Acyclovir (IV)

Question 26

Bacterial meningitis empiric treatment

Answer 26

Vancomycin + Ceftriaxone + Dexamethasone
+ Ampicillin ( extreme age for Listeria )

Question 27

What is the cephalosporin choice in meningitis in neonates

Answer 27

Cefotaxime

Question 28

What is the cephalosporin choice in meningitis in immunocompromised / Neurosurgical patient

Answer 28

4th generation (cefepime /ceftazidime)
Or meropenem to cover pseudomonas

Question 29

What antibiotics used for meningitis caused by Listeria

Answer 29

Ampicillin
(Alternative: TMP-SMX)

Question 30

Prophylaxis to contacted people of meningitis :

Answer 30

Ciprofloxacin
- pediatrics: 2 doses Rifampicin
- pregnant: Ceftriaxone

Question 31

Meningitis culture positive for MRSA
The antibiotic of choice is :

Answer 31

Vancomycin

Question 32

What is the role of dexamethasone in meningitis

Answer 32

Decrease mortality
Prevent sequela from autoimmune reaction against lysed bacteria (S. Pneumo)
(Deafness, Vision loss, focal neurological deficit)
Give for 4 days if culture positive

Question 33

CSF analysis:
Bacterial
Viral
TB
Cryptococcal
SAH
MS

Answer 33

Bacterial: 🔻Glc 🔺Nø
Viral: 🟢Glc 🔺Lø <300
TB/fungal: 🔻Glc 🔺Lø <500
Cryptococcal: india ink
SAH: xanthochromia (RBC)
MS: oligoclonal bands