Meningitis

Question 1

Causative agents of meningitis

Answer 1

Menigococcal/ Pneumococcal

Less common
- H. influenzae
- Listeria
- CMV
- Immunocompromised: HIV

Question 2

Features of meningitis
- Early
- Later

Answer 2

Early
- Headache
- Cold hands and feet
- Abnormal skin colour

Later
- Meningism: neck stiffness, photophobia
- Kernig’s sign= pain and resistance on passive knee extension with hip fully flexed

• Seizure
• Non- blanching petechial rash

Question 3

Management

Answer 3

Antibiotics
- <55= cefotaxime
- >55= add ampicillin

Dexamethasone if mainly meniningitic

Viral= Aciclovir

Question 4

Investigations

Answer 4

Normal bloods

Blood culture

Throat swab: viral and bacterial

CT

Lumbar puncture- if no signs of raised ICP
- Culture/ microscopy/ PCR (if aseptic) of CSF

CXR to rule out TB

Question 5

Contraindications for lumbar puncture

Answer 5

Signs of raised ICP

Respiratory insufficiency

Local infection at LP site

Coagulopathy/ anticoagulation

Focal neurological signs

Question 6

LP findings for TB meningitis
- Opening pressure
- Appearance
- White cells
- Proteins
- Glucose

Answer 6

Opening pressure= normal/ raised

Appearance
- cloudfy, “Fibrin web”

White cells
- Lymphocytes, <500

Proteins
- Raised

Glucose
- Reduced

Question 7

LP findings for TB meningitis
- Opening pressure
- Appearance
- White cells
- Proteins
- Glucose

Answer 7

Opening pressure
- Very high

Appearance
- Cloudy

White cells
- Raised neutrophils

Proteins
- Normal

Glucose
- Low