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Infection > meningitis > Flashcards

meningitis Flashcards

1
Q

meningism

A

symptom complex:

  • headache
  • neck stiffness (on passive flexion)
  • photophobia
  • vomiting
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2
Q

pathogenesis of meningitis 5 steps

A
  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
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3
Q

common bacterial causes of meningitis in children

A

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

Streptococcus pneumoniae
(pneumococcal infection )

enter via nasopharynx epithelium

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4
Q

bacterial causes in neonates

A

E. coli

Group B streptococci

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5
Q

viral causes

A
  • Echoviruses
  • Coxsackie A and
    B viruses

if suspected - PCR CSF

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6
Q

shunt associated meningitis

A

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

remove shunt

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7
Q

aseptic meningitis

A

neoplasm
reaction to drugs

high WBC but nothing cultured in CSF

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8
Q

non infective causes of meningism

A

SAH

migraine

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9
Q

RFs for meningitis

A

DM
recent head trauma
Alcoholism

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10
Q

kernig’s sign

A

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

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11
Q

Tests

A

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

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12
Q

CSF results if bacterial meningitis

A

turbid, increased cells, neutrophils, reduced glc

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13
Q

CSF results if viral meningitis

A

lymphocytes, normal plc

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14
Q

treating acute bacterial meningitis

A
  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
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15
Q

Meningococcal Meningitis

Neisseria meningitidis

A

(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)

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16
Q

indian, SSA, Middle East

Meningococcal Meningitis
Neisseria meningitidis

A

group A meningococcal

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17
Q

vaccine for infants

vaccine for adolescent booster

A

Men B

Men ACWY

18
Q

fulminant meningococcal septicaemia

A

startling sudden onset of symptoms:

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

commonly die <24hrs

GP =a/bs –> hosp

19
Q

tx of meningococcal meningitis or sepsis at GP

A

parenteral penicillin

20
Q

poor prognostic markers for Meningococcal Meningitis

Neisseria meningitidis

A

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

presence of DIC

21
Q

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

A

rifampicin eradicate from nasopharynx

22
Q

Pneumococcal Meningitis (streptococcus pneumonia)

epidemiology

A

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

23
Q

Pneumococcal Meningitis tx

A

high dose ceftriaxone

24
Q

PC of Pneumococcal Meningitis

A

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

25
Q

pneumococcal vaccine for?

A

over 65yrs

or high risk: DM, CKD, HIV

26
Q

pneumococcal conjugate vaccine

A

children

27
Q

fungal meningitis more important cause in what sub group of people

A

Cryptococcus neoformans (yeast form) - in HIV pts

found in bird droppings

28
Q

fungal meningitis tx

A

high dose fluconazole

29
Q

neonatal meningitis

PC

A

vague symptoms

30
Q

neonatal meningitis

RFs:

A

low birth weight
prolonged rupture of membranes
maternal DM

31
Q

neonatal meningitis tx

A

cefotaxime

32
Q

Primary symptom of paed sepsis

A

commonly hypothermic

the younger the child the higher the risk of sepsis

  • neonates > children
  • greater risk than adults
33
Q

child gender risk of sepsis

A

boys > girls

34
Q

symptoms of paed sepsis

A
  • 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
35
Q

PC of meningitis in neonates

A
  • irritability
  • lethargy
  • NAPPY PAIN (stretching meninges)
  • bulging fontanelles
36
Q

Severe PC of meningitis in neonates

A

seizures

focal neurological abnormalities

37
Q

tx for meningitis +/- sepsis in paeds

A
  • supportive: ABC DEFG

- a/bs with good penetration - cephalosporin

38
Q

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

A

skin lesion biopsy

39
Q

paediatric sepsis

A

SIRS + proven/infection

SIRS: fever/hypothermia, tachycardia, tachypnoea, leucocytosis/leucocytopenia

40
Q

Pneumococcal meningitis complications

children

A

morbidities:

  • brain damage
  • hearing loss (always test hearing post infection)
  • hydrocephalus
41
Q

paeds meningococcal meningitis complications

A
  • amputation

- cognitive impairment/epilepsy

42
Q

paeds meningococcal disease steps –> meningitis

A

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

Infection (11 decks)

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