Flashcards in Meningitis Deck (16)
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1
Causes of bacterial meningitis
Neisseria meningitidis: classic petechial rash, occurs in small epidemics
Streptococcus pneumoniae: more common if skull fractures, ear disease, congenital CNS lesions
Remainder (30%): Listeria monocytogenes (elderly/immunosuppressed), Haemophilus influenzae, Staph. aureus, TB
2
Viral causes of meningitis
Enteroviruses: coxsakievirus A/B, echoviruses
HSV
VZV
3
Clinical presentation of bacterial meningitis
Meningitic syndrome: headache, neck stiffness, fever
High fever + rigors
Photophobia
Malaise
Vomiting
Confusion & seizures
Kernig's sign +ve
Brudzinski sign +ve
Signs of raised ICP / cranial nerve palsies
4
Meningitis complications
Venous sinus thrombosis
Severe cerebral oedema
Hydrocephalus
5
Meningococcal meningitis presentation & causes
Petechial rash: erythematous, non-blanching purpura
Carried in nasopharynx
Most caused by meningitis C/B
Meningitis ACWY jab at 14y
6
Viral meningitis presentation
Almost always a benign, self-limiting condition
4-10d
Headache following for months
7
TB meningitis presentation
Insidious illness with fever, weight loss, progressive confusion/cerebral irritation --> coma
May present as per bacterial meningitis
8
Meningitis investigations
Bloods: FBC, U&Es, LFTs, clotting, glucose, lactate
Serum PCR: pneumococcal & meningococcal antigens
Blood cultures: prior to abx
Lumbar puncture: if clinical suspicion of a mass lesion: send for MCS protein, glucose, PCR
CT prior to lumbar puncture: if suspected raised ICP
2x throat swabs: virology + bacteriology
9
CSF stains demonstrating organisms
Gram +ve intracellular diplococci: Pneumococcus
Gram -ve cocci: Meningococcus
Ziehl-Neesen stain for acid-fast bacilli: TB
Indian stain: fungi
10
CSF findings for bacterial/TB/viral meningitis/encephalitis
Bacteria: tubid fluid, high polymorphs
Virus: clear fluid, high lymphocytes, normal glucose
TB: raised lymphocytes, raised polymorphs
11
What is meningitis the inflammation of?
Leptomeninges, pia mater and arachnoid mater
12
What indicates meningitis?
>5 wbc in CSF
13
What causes chronic meningitis?
Fungi
14
What is Kernig's sign?
Raise knee over 90, if pain is felt in back +
15
What is Brudzinki's sign?
When they hold their neck up if they automatically pull their knees up
16
