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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

What are the complications of meningitis?

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