meningitis

Question 1

meningism

Answer 1

symptom complex:

• headache
• neck stiffness (on passive flexion)
• photophobia
• vomiting

Question 2

pathogenesis of meningitis 5 steps

Answer 2

1. attachment to mucosal epithelium
2. transgression of mucosal barrier
3. survival in blood stream
4. entry into CSF
5. production of infection in meninges

Question 3

common bacterial causes of meningitis in children

Answer 3

Neisseria meningitidis
(meningococcal infection) - MUCH MORE SEVERE
case fatality 5-15%

Streptococcus pneumoniae
(pneumococcal infection )

enter via nasopharynx epithelium

Question 4

bacterial causes in neonates

Answer 4

E. coli

Group B streptococci

Question 5

viral causes

Answer 5

• Echoviruses
• Coxsackie A and
  B viruses

if suspected - PCR CSF

Question 6

shunt associated meningitis

Answer 6

ventriculo-atrial / peritonial shunts develop ventriculitis and meningitis - coagulase (-) staphylococci

remove shunt

Question 7

aseptic meningitis

Answer 7

neoplasm
reaction to drugs

high WBC but nothing cultured in CSF

Question 8

non infective causes of meningism

Answer 8

SAH

migraine

Question 9

RFs for meningitis

Answer 9

DM
recent head trauma
Alcoholism

Question 10

kernig’s sign

Answer 10

hip flexed - can’t straight leg due to hamstring spasm

Question 11

Tests

Answer 11

Blood cultures
LP: if any ICP then don’t
FBC

Question 12

CSF results if bacterial meningitis

Answer 12

turbid, increased cells, neutrophils, reduced glc

Question 13

CSF results if viral meningitis

Answer 13

lymphocytes, normal plc

Question 14

treating acute bacterial meningitis

Answer 14

1. early clinical recognition
2. rapid detection of pathogen
3. rapid initiation of appt A/Bs
4. early recognition of sequelae of septicaemia: DIC, hypoxia, acidosis
5. a/b prophylaxis for contacts

Question 15

Meningococcal Meningitis

Neisseria meningitidis

Answer 15

(meningococcal infection) - commonest cause, presents rapid/acute - due to initial nasopharynx infection

common in children/young adults

MUCH HIGHER MORTALITY RATE THAN pneumococcal disease (strep pneumoniae)

Question 16

indian, SSA, Middle East

Meningococcal Meningitis
Neisseria meningitidis

Answer 16

group A meningococcal

Question 17

vaccine for infants

vaccine for adolescent booster

Answer 17

Men B

Men ACWY

Question 18

fulminant meningococcal septicaemia

Answer 18

startling sudden onset of symptoms:

• rapid loss of consciousness
• DIC
• Fever
• Septicaemia shock
• PURPURIC RASH

commonly die <24hrs

GP =a/bs –> hosp

Question 19

tx of meningococcal meningitis or sepsis at GP

Answer 19

parenteral penicillin

Question 20

poor prognostic markers for Meningococcal Meningitis

Neisseria meningitidis

Answer 20

delay in a/bs, extremes of age, purpuric lesions, shock, hyperpyrexia

presence of DIC

Question 21

on discharge and to contacts tx
for Meningococcal Meningitis
(Neisseria meningitidis)

Answer 21

rifampicin eradicate from nasopharynx

Question 22

Pneumococcal Meningitis (streptococcus pneumonia)

epidemiology

Answer 22

most frequent cause in adults - predisposing factors: pneumonia, sinusitis, IE, head trauma

Question 23

Pneumococcal Meningitis tx

Answer 23

high dose ceftriaxone

Question 24

PC of Pneumococcal Meningitis

Answer 24

altered conscious level, focal neurological signs with concurrent infections - sinuses etc

Question 25

pneumococcal vaccine for?

Answer 25

over 65yrs | or high risk: DM, CKD, HIV

Question 26

pneumococcal conjugate vaccine

Answer 26

children

Question 27

fungal meningitis more important cause in what sub group of people

Answer 27

Cryptococcus neoformans (yeast form) - in HIV pts found in bird droppings

Question 28

fungal meningitis tx

Answer 28

high dose fluconazole

Question 29

neonatal meningitis | PC

Answer 29

vague symptoms

Question 30

neonatal meningitis | RFs:

Answer 30

low birth weight prolonged rupture of membranes maternal DM

Question 31

neonatal meningitis tx

Answer 31

cefotaxime

Question 32

Primary symptom of paed sepsis

Answer 32

commonly hypothermic the younger the child the higher the risk of sepsis - neonates > children - greater risk than adults

Question 33

child gender risk of sepsis

Answer 33

boys > girls

Question 34

symptoms of paed sepsis

Answer 34

- Fever, hypothermia - Cold hands, feet - Prolonged cap refill - Chills / rigors - Limb pain can be first symptom of sepsis - Vomiting / diarrhoea – inflammatory mediator release - M weakness - M joint aches - Skin rash - Diminish urine output

Question 35

PC of meningitis in neonates

Answer 35

- irritability - lethargy - NAPPY PAIN (stretching meninges) - bulging fontanelles

Question 36

Severe PC of meningitis in neonates

Answer 36

seizures | focal neurological abnormalities

Question 37

tx for meningitis +/- sepsis in paeds

Answer 37

- supportive: ABC DEFG | - a/bs with good penetration - cephalosporin

Question 38

back up option for culturing if blood cultures weren't taken prior to a/bs

Answer 38

skin lesion biopsy

Question 39

paediatric sepsis

Answer 39

SIRS + proven/infection SIRS: fever/hypothermia, tachycardia, tachypnoea, leucocytosis/leucocytopenia

Question 40

Pneumococcal meningitis complications | children

Answer 40

morbidities: - brain damage - hearing loss (always test hearing post infection) - hydrocephalus

Question 41

paeds meningococcal meningitis complications

Answer 41

- amputation | - cognitive impairment/epilepsy

Question 42

paeds meningococcal disease steps --> meningitis

Answer 42

meningococcus in bloodstream <12 hrs: septic shock (common period for mortality) < 18-36 hrs sign of meningitis