Meningitis

Question 1

Causes of bacterial meningitis

Answer 1

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

Question 2

Viral causes of meningitis

Answer 2

Enteroviruses: coxsakievirus A/B, echoviruses
HSV
VZV

Question 3

Clinical presentation of bacterial meningitis

Answer 3

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

Question 4

Meningitis complications

Answer 4

Venous sinus thrombosis
Severe cerebral oedema
Hydrocephalus

Question 5

Meningococcal meningitis presentation & causes

Answer 5

Petechial rash: erythematous, non-blanching purpura
Carried in nasopharynx
Most caused by meningitis C/B
Meningitis ACWY jab at 14y

Question 6

Viral meningitis presentation

Answer 6

Almost always a benign, self-limiting condition
4-10d
Headache following for months

Question 7

TB meningitis presentation

Answer 7

Insidious illness with fever, weight loss, progressive confusion/cerebral irritation –> coma
May present as per bacterial meningitis

Question 8

Meningitis investigations

Answer 8

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

Question 9

CSF stains demonstrating organisms

Answer 9

Gram +ve intracellular diplococci: Pneumococcus
Gram -ve cocci: Meningococcus
Ziehl-Neesen stain for acid-fast bacilli: TB
Indian stain: fungi

Question 10

CSF findings for bacterial/TB/viral meningitis/encephalitis

Answer 10

Bacteria: tubid fluid, high polymorphs
Virus: clear fluid, high lymphocytes, normal glucose
TB: raised lymphocytes, raised polymorphs

Question 11

What is meningitis the inflammation of?

Answer 11

Leptomeninges, pia mater and arachnoid mater

Question 12

What indicates meningitis?

Answer 12

> 5 wbc in CSF

Question 13

What causes chronic meningitis?

Answer 13

Fungi

Question 14

What is Kernig’s sign?

Answer 14

Raise knee over 90, if pain is felt in back +

Question 15

What is Brudzinki’s sign?

Answer 15

When they hold their neck up if they automatically pull their knees up

Question 16

What are the complications of meningitis?

Answer 16

Hearing loss
Epilepsy
Problems with memory and concentration 
Co-ordination, movement and balance problems 
Vision loss
Loss of limbs (infection spread)
Arthritis 
Kidney problems