(!) Meningitis

Question 1

Leading organism for meningitis

Answer 1

Bacterial- NHS
adults- Neiserissa, Hib and Strep Pneumoniae

0-3m- GBS, ecoli, Listeria
3m-6y- N. Men, Hib
6-60y- S.Pneumo, N. Men
>60-S.Pneumo, N.Men, Listeria

Immunosuppresed- Listeria, Fungal
TUBERCULOSIS

viral- young/teens–many, not specific- cocksackie, but complications of Mumps, varicella, Herpes, other

Question 2

Sx of Meningitis

Answer 2

Neck stiffness, photophobia, headache, Fever
altered mental status

Focal neuro, and seizures- encephelitis/meninioencephelitis

(+any signs of ICP rise- papilloedema, confusion, focal neuro, eye movement changes etc)

Kernings sign- Pain in back/thigh when bend HIP
up
Brudinskis sign- forced flex of neck causes flex of hips

Bacterial- pt tends to be worse all around
Worse photophobia
Rash- non-blanching petichial or purpuric red rash- meningococcal

TB- slower progressing- indolent sx like TB (FLAWS) + reccurent headaches

Fungal- Immunocompromised

Question 3

Ix and Mx of Meningitis

Answer 3

A-E approach- pts are very very unwell

ABG- obtain Glucose (ddx), Lactate
+ Normal bloods
+ BLOOD CULTURE BEFORE ABX

diagnostic- need a LP, but care if any signs of ICP raise, severe sepsis, other worrying signs
so for pt safety can give abx first (but reduce the usefulness of CSF cultures)
(LP results in other card)

Culture CSF+ PCR, Zhiels Nielssen stain (TB)/auramine stain can throat swab too

GIVE –
Abx-at least 2 w- empirical often used- Ceftriaxone +/- amoxicillin depending (CHILDREN GET IM BENPEN AT GP)
IV steroids often used(NOT IN BABY)
Contact ITU
COnsider adding Aciclovir if doubts of encephelitis

EMPIRICAL CONTACT TREATMENT-give Abx to contacts-ciproflaxin

(ABX indications in other card)

Question 4

LP results for different meningitides

Answer 4

Viral-
Clear fluid, normal OP, Protein normal/up, glucose normal, LYMPHOCYTE++ (1000)

Bacterial
Cloudy, high OP, Protein UP, glucose DOWN (less than half plasma gluc), LEUKOCYTE ++

Tuberculosis-Cloudy, fibrin web, Protein high, Gluc less than half plasma gluc, LYMPHOCYTE + (300)

Fungal-cloudy, prot high, gluc low, Lympho +

Question 5

Abx for meningitis management

Answer 5

Empiricals given before cultures are back–

0-3m- mainly GBS- Cefotaxime+amox (listeria cover)
Any child-give IM BENPEN AT GP IF SUSPECTED THERE

6y-60y- Ceftriaxone alone
Over 60- Give CEF+ AMox again

pretty much- Cefotaxime/Ceftriaxone- N.Men, HiB and S.Pneum cover
Amox- Listeria cover

for contacts- Ciproflaxin

Question 6

Do you give IM benpen to a kid with bacterial meningitis if theyre allergic to penicillin

Answer 6

do it

except if previous anaphylaxis reactions

Question 7

signs of raised icp making you not want to LP

Answer 7

signs suggesting raised intracranial pressure

reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)

relative bradycardia and hypertension

focal neurological signs

abnormal posture or posturing

unequal, dilated or poorly responsive pupils

papilloedema

abnormal ‘doll’s eye’ movements

extensive or spreading purpura

after convulsions until stabilised

Question 8

Meningitis complications

Answer 8

Most common- sensorineural hearing loss

then
seizures
focal neuro

infectious-absess, sepsis
pressure- herniation