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meningitis Flashcards

(59 cards)

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1
Q

meningism

A

symptom complex

headache
photophobia
vomiting with muscle spasm
neck stiffness: stiffness on passive neck flexion is key

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2
Q

causes of meningism

A

meningitis
SAH
infection w bacteraemia

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3
Q

meningitis

A

infection of meninges
inflammation and meningeal irritation
can cause death, permanent disability

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4
Q

meningitis pathophysiology

A
  1. attachment to mucosal epithelial cells e.g.bacteria to nasopharynx mucosa, enterovirus to gut mucosa
  2. transgression of mucosal barrier
  3. survival in bloodstream
  4. entry into CNS
  5. production of overt infection in meninges +/- encephalopathy
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5
Q

common bacterial causes meningitis

A

neisseria meningitis
streptococcus pneumoniea

neonates: e.coli, group b strep

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6
Q

common viral causes meningitis

A 
enterovirus
parechovirus
coxasackie A, B 
mumps 
HSV
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7
Q

common non-infectious causes meningitis

A

tumour cells in CSF
drugs
SLE, sarcoid

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8
Q

aseptic meningitis

A

CSF elevated lymphocytes and protein

no organism cultured/detected

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9
Q

when should meningeal infection be suspecter

A

every pt with Hx URTI and one meningeal symtpoms

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10
Q

acute meningitis

A

signs/symptoms <24hrs and rapidly progressive e.g. meningococcal

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11
Q

subacute meningitis

A

signs/symptoms 1-7days e.g. viral

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12
Q

acute meningitis risk factors

A

recent skull trauma
DM
alcoholism
exposure to meningococcus

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13
Q

meningitis Ix

A

LP - CSF testing
blood cultures
CT if focal signs or papilloedema
FBC, U&Es, LFTs

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14
Q

CSF testing

A

biochem: Glc, protein
microbio: gram stain, differential cell count, bacterial culture, antigen detection test

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15
Q

normal adult CSF features

A 
clear
small number cells <5
mostly lymphocytes 
normal Glucose (60% blood level) 
normal protein
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16
Q

bacterial meningitis CSF features

A 
turbid 
inc cell number
mostly neutrophils
reduced Glc
inc proteins
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17
Q

viral meningitis CSF features

A 
clear to turbid 
inc cell number
mostly lymphocytes
glucose normal 
increased proteins
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18
Q

TB meningitis CSF features

A 
clear to turbid
inc cell numbers
lymphocytes or mixed
reduced Glc
inc protein
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19
Q

greatest risk factor for bacterial meningitis

A

colonisation

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20
Q

reducing death rate of acute meningitis

A

early clinical recognition
rapid antigen detection
rapid initiation bacteriocidaal antimicrobial Rx
early treatment of sequelae: DIC, acidosis
antibiotic prophylaxis for contacts

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21
Q

bacterial meningitis antibiotic therapy

A

benzylpenicillin only reaches CSF in sufficient amount if meningeal inflammation and 4hrly doses

ceftriazone reaches CSF in efficient quanitities only if inflammed meninges

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22
Q

meningococcal meningitis

A

neisseria meningitis
children and young adults

gram stain shows gram negative diplococci

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23
Q

meningococcal meningitis features

A

+/- septicaemia
petechial skin rash
meningeal symptoms
systemic upset

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24
Q

fulminant meningococcal septicaemia

Study These Flashcards
A 
very sudden onset
purpuric skin rash
reduced consciousness, fever
septicaemic shock, renal failure CSF
CSF sterile
50% die first 24hrs
25
MX meningococcal meningitis
if GP suspects it give parenteral penicillin prior to hosp transmission ceftriazone prior to LP but after taking blood cultures benzylpenicillin or ceftriaoxne supportive management rifampicin or ciprofloxacin at discharge to erradicate neisseria meningitidis carriage
26
meningococcal meningitis bad prognostic markers
clinical: delay antib, extremes age, purpuric lesions, hyperpyrexia lab: DIC, metabolic acidosis, absence polymorph leucocytosis
27
what is most frequent cause bacterial meningitis in adults
pneumococcal meningitis - strep pneumoniae
28
pneumococcal meningitis microbiology
gram positive diplococci | alpha haemolytic
29
pneumococcal meningitis predisposing factors
``` pnuemonia sinusitis alcoholism head trauma endocarditis splenectomy ```
30
pneumococcal meningitis clinical
acute onset - 1/2 days more likely to have reduced consciousness/focal neuro signs than meningococcal and hameophilus petechiae uncommon concurrent sinus/ear infection
31
pneumococcal meningitis complications
``` death hearing loss CN deficits hemiparesis hydrocephalus seizures ``` dexamethasone reduces likehood of complications occuring
32
pneumococcal meningitis management
early administration high dose ceftriaxone
33
Hib meningitis clinical features
young kids mild URTI then rapid detioration fever, drowsy, lethargy nuchal rigitidy often absent late disaese: coma, seizures
34
Hib meningitis microbiology
gram negative cocci and bacilli
35
Hib meningitis treatment
ceftriaxone +/- dexamethasone rifampicin prophylaxis to close contancts
36
TB meningitis
meningitis follows rupture of subependymal tubercle into subarachnoid space kids assoc w miliary TB or effusion
37
TB meningitis clinical
subacute onset lethargy headache change in mentation
38
TB meningitis poor prognostic markers
extremes age illness >2mo neuro defiict
39
leptospirosis and lyme disease
caused by spirochates | may cause apparent aseptic meningitis
40
leptospirosis features
``` septicaemic illness fever, rigors myalgia, vomiting conjunctical effusion meningism rash liver and renal damage ```
41
lyme disease features
skin rash neurological symptoms inc meningitis peripheral or cranial neuropathies
42
most common causes viral meningitis
enteroviruses - echovirus, coxsackie
43
viral meningitis features
non-specific prodromal ilness rapid onset: headache, photophobia, stiff neck, fever rash if enteroviral pt usually lucid and alert
44
viral meningitis Ix
CSF PCR - enteroviruses - mumps - HSV
45
viral meningitis prevention
MMR | good hand hygeine
46
viral meningitis treatment
enterovirus and parechovirus: supportive Rx, usually recover 72hrs chronic infection (immunocompromised): IVIg HSV: aciclovir
47
cryptococcal meningitis
cryptococcus neoformans HIV, immunosuppressed, lymphoma, DM
48
fungal meningitis microbiology
organism is yeast with a polysacharride capsule gram stain shows yeast cells culture C. neoformans serum cryptococcal polysacharide antigen
49
fungal meningitis clinical features
``` subacute onset fever headache nausea lethargy confuson abdo pain mengism less common but can develop ```
50
fungal meningitis Mx
parenteral amphocetin +/- flucytosine high dose fluconazole as alternative
51
fungal meningitis prevention
if HIV pt gets cryptococcal meningitis then prophylaxis with fluconazole
52
how does neonatal meningitis differ from adult
features non-specific, not well localices | GBS, e.coli, l. monocytogenes
53
neonatal meningitis predisposing factors
low birth wait PROM maternal DM
54
group b strep
gram +ive cocci benzylpenicillin, amoxycillin
55
e.coli
gram - bacilli cefotaxamine
56
l.monocytogenes
g + bacilli ampicillin and gentamicin
57
neonatal meningitis early onset
within 3days birth resp distress, ,bactermia assoc w prematurity, difficult/prolonged birth
58
neonatal meningitis late onset
>1wk after birth | pulm involvement rare
59
diagnosing neonatal meningitis
bacterial: CSF, blood cultures viral: CSF, EDTA blood, faecal + nasopharyngeal secretions

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