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Meningitis Flashcards

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1
Q

Epidemiology of meningococcal meningitis

A

Children and young adults

<10% are >5 years

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2
Q

Epidemiology of meningococcal meningitis

A

Children and young adults

<10% are >5 years

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3
Q

What must you do in cases of meningococcal meningitis

A

Notify local health protection consultant

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4
Q

Clinical features of meningococcal meningitis

A 
Sepsis
Sudden onset
Purpuric rash
Unconsciousness
Fever
Sterile CSF
Waterhouse-Freidrichsen syndrome
Renal failure
Disseminated intravascular coagulation
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5
Q

Treatment of meningococcal meningitis

A

1st line is parenteral penicillin

2nd line high dose ceftriaxone then benzylpenicillin

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6
Q

Complications of meningococcal meningitis

A

50% die within first 24 hours and if it becomes chronic it is known as fulminant

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7
Q

Prognosis of meningococcal meningitis

A

Over 50% mortality, if they survive, sent home with rifampicin or ciprofloxacin

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8
Q

Prevention and prophylaxis of meningococcal meningitis

A

Men C and Men B vaccine

Rifampicin to r ciprofloxacin for all those who have been in contact with the sick

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9
Q

Pneumococcal meningitis epidemiology

A

Most frequent bacterial cause in adults

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10
Q

Clinical features of pneumococcal meningitis

A 
Predisposing pneumonia
Sinusitis
Endocarditis
Head trauma
Alcoholism
Splenectomy
Altered consciousness
Petechiae - uncommon
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11
Q

Treatment of pneumococcal meningitis

A

Early, high dose ceftriaxone

If uncomplicated then dexamethasone

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12
Q

Complications of pneumococcal meningitis

A 
Death
Hearing loss
Cranial nerve defects
Hemiparesis
Hydrocephalus
Siezures
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13
Q

Mortality of pneumococcal meningitis

A

30-50%

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14
Q

Prevention of pneumococcal meningitis

A

Pneumococcal vaccine (pneumovax or prevnar)

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15
Q

Epidemiology of Heamophilus influenzae type B meningitis

A

Young children

Often preceded by URTI with otitis media

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16
Q

Clinical features ofHeamophilus influenzae type B meningitis

A 
Fever
Lethargy
Drowsiness
Rarely petechiae
No nuchal rigidity
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17
Q

Treatment of Heamophilus influenzae type B meningitis

A

Cefotaxime

Dexamethasone if very serious

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18
Q

Prevention/prophylaxis of Heamophilus influenzae type B meningitis

A

Rifampicin for all those who have had close contact

Vaccinato

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19
Q

Listeria monocytogenes meningitis epidemiology

A

Neonates
Older people
Immunosuppressed

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20
Q

Listeria monocytogenes meningitis clinical features

A

Typical meningism

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21
Q

Listeria monocytogenes meningitis treatment

A

IV ampicillin

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22
Q

Mycobacterium tuberculosis meningitis epidemiology

A

Elderly men
Alcoholics
Post miliary tb

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23
Q

Mycobacterium tuberculosis meningitis clinical features

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A

Often post miliary in children
Extrameningeal TB in 3/4 of adult
Subacutely presents with lethargy, chronic headache, mentation change, unconsciousness and meningitis

24
Q

Mycobacterium tuberculosis meningitis investigations

Study These Flashcards
A

CSF studies
CXR
PCR
CT head

25
Mycobacterium tuberculosis meningitis complications
Neurological | Lung scarring
26
Mycobacterium tuberculosis meningitis prognosis
Poor in extremes of age, neurological deficits or resistant organisms
27
Leptospirosis and Lyme disease meningitis clinical features
``` "Aseptic meningitis" Septicaemia with rigors Myalgia Vomiting Conjunctival effusion Meningism followed by rash ```
28
Leptospirosis and Lyme disease meningitis treatment
IV cephalosporins or penicillin for 2-3 weeks
29
Leptospirosis and Lyme disease meningitis complications
Hepato-renal damage | Cranial beiropathies
30
Leptospirosis and Lyme disease meningitis prognosis
Good with early treatment
31
Leptospirosis and Lyme disease meningitis prevention
Avoid tick bites | Early treatment of tick bites
32
Viral meningitis causative viruses
``` Enteroviruses (echovirus, cocksackievirus) Mumps HSV VSV Epstein Barr ```
33
Clinical features of viral meningitis
``` Non specific prodromal illness Rapid headache onset Photophobia Low grade fever Stiff neck Lucid Alert Only later on so we get lethargy, confusion, siezures and focal neurological deficits ```
34
Viral meningitis investigations
PCR of CSF Throat swab HIV testing
35
Treatment of viral meningitis
If not recovered after 72 hours or very severe: IV immunoglobulins IV acyclovir for HSV
36
Viral meningitis complications
Neurological disorders Orchitis Testicular atrophy
37
Prognosis of viral meningitis
Most make a complete recovery
38
Prevention of viral meningitis
MMR and good hand hygiene
39
Cryptococcal neoformans meningitis epidemiology
Main cause of meningitis in HIV patients | Sometimes affects diabetics, lymphoma patients and immunosuppressed
40
Cryptococcal neoformans meningitis investigations
Gram stain shows yeast cells | Serum cryptococcal antigen
41
Cryptococcal neoformans meningitis presentation
Subacute onset with low grade fever, headache, nausea, photophobia, lethargy, confusion, abdo pain and meningism
42
Treatment of Cryptococcal neoformans meningitis
Parenteral amphotericin | Add flucytosine if severe or replace entirely with high dose fluconazole
43
Cryptococcal neoformans meningitis presentation
Long term fluconazole for at risk patients
44
Neonatal meningitis causative organisms
``` Group B strep E.coli Listeria monocytogenes Enteroviruses Parechoviruses ```
45
Neonatal meningitis mortality
Early onset = 50% | Late onset = 10-20%
46
Neonatal meningitis presentation
Non specific/ poorly localised symptoms Low birth weight Maternal diabetes mellitus
47
Neonatal meningitis treatment
Group B strep = benzylpenicillin and amoxicillin E.coli = cefotaxime Listeria monocytogenes= ampicillin and gentamicin
48
Neonatal meningitis complications
Neuro and development complications in 33%
49
Prevention of neonatal meningitis
Mother's with increased risk are given amoxicillin or co-amoxiclav during labour
50
CSF findings in bacterial meningitis
``` Turbid Greatly increased cell count Predominant cells are neutrophils Glucose is reduced Protein is greatly increased ```
51
CSF findings in viral meningitis
``` Clear to turbid Moderate increase in cell count Predominant cells are lymphocytes Normal glucose Moderate increase in protein ```
52
CSF findings in TB meningitis
``` Clear to turbid Moderate increase in cells Main cells are lymphocytes or a mix of cells Reduced glucose Greatly increased protein ```
53
Ventricular atrial shunt meningitis main cause
Staph epidermis
54
What is Kernigs sign?
Hamstring spasm preventing leg straightening
55
CSF investigations
``` Gram stain Differential cell count Antigen detection test Bacterial culture Mycobacteria or fungal culture PCR for viruses PCR for bacteria Glucose Protein ```

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