Meningitis and Encephalitis Flashcards
(36 cards)
What is the definition of meningitis?
Inflammation of the meninges
What is the definition of encephalitis?
Inflammation of the brain
What are the symptoms and signs of a case of meningococcal meningitis caused by neisseria meningitidis (Bacterial)
Symptoms 12 hour gradual onset headache Severe + generalised Feverish Photophobic Nuchal rigidity – not moving neck
Signs Temp – 38.9 HR – 110 bpm BP – 100/60 No rash
Describe the carriage and transmission of meningococcal meningitis
Throat carriage in approx. 10% population
25% of 15 to 19 year olds
Person-person spread
Inhalation of respiratory secretions
Close prolonged contact, e.g. household members
Direct contact (kissing)
Disease in minority
What can meningococcal disease cause? What are the differentiations?
Can either cause septicaemia or meningitis:
Septicaemia – non-blanching rash (starts off as pinpoint purple dots on hands/feet)
Meningitis without septicaemia – no rash
25% just septicaemia
60% both
15% just meningitis
What is the prognosis of meningococcal meningitis
Fatal in approx. 10% with disease:
Up to 50% with septicaemia
Approaching 100% if untreated
1 in 8 suffer long term morbidity e.g. headache, joint stiffness, epilepsy, hearing loss, learning difficulties
What is the treatment for meningococcal meningitis?
Early antibiotics improve prospect of recovery
IV ceftriaxone or cefotaxime – must be after blood cultures, should in theory be after lumbar puncture but normally is due to lack of funding.
Can start antibiotics before set diagnosis just in case
No evidence for corticosteroids for meningococcal meningitis
When are vaccines given for meningococcal meningitis?
Men C vaccine – given to 1-3 y.o. since 1999
Men B vaccine – given to 2-4 month olds since 2015
Men ACWY vaccine – given to teenagers since 2015
What are the symptoms and signs of a meningitis caused by streptococcus pneumoniae?
Symptoms 24 hour history of gradual onset headache Feverish Confused in last 12 hours No travel Hypertension Allergic Rhinitis
Signs Temp – 38 HR – 64 bpm BP 105/90 GCS 14/15 Photophobia Nuchal rigidity No rash No focal neurological signs
How would the CSF results and gram stain of a pneumococcal meningitis look?
CSF Results:
CSF glucose is lower than blood
Increased proteins
Cloudy
Gram stain:
Gram positive – purple colour
Streptococcus pneumoniae – paired
Which type of meningitis is corticosteroids treatment for? What is the treatment?
Dexamethasone for 4 days if streptococcus pneumoniae is confirmed
Significantly reduced mortality and neurological disability at 8 weeks if GCS< 11
What are the signs and symptoms of meningitis due to listeria monocytogenes?
Symptoms Unwell for 4 days Vomiting and diarrhoea Fever Muscle aching 2 days gradual onset severe global headache No rash
Signs Temp 38.8 HR 100bpm BP 110/70 GCS 14/15 (disoriented in time and place) Photophobia Nuchal rigidity No rash present No focal neurological signs
What are the CSF results of meningitis due to listeria
Lymphocytes not polymorphs
No organisms seen on gram stain – similar to fungal
How does listeria cause meningitis, who is at risk? What is the mortality?
Blood cultures
3rd common cause of bacterial meningitis in adults (rarer than meningococcal or pneumococcal)
Eat listeria – shouldn’t cause a problem unless immunocompromised/pregnant or neonates
If gets into blood such as with those who are immunosuppressed it causes meningitis in 55-70%
Mortality approx. 25%
How would you treat listeria meningitis?
treat with amoxicillin 2g every 4 hours aswell as normal antibiotics (ceftriaxone or cefotaxime) until know for sure the cause from lumbar puncture
What are the signs and symptoms of viral meningitis due to enterovirus
Symptoms
2 day history gradual onset severe headache
Preceding 3 days muscle aching + lethargy
Feeling hot and cold
Photophobia
Neck stiffness
Signs Temperature 38.6°C Heart rate 110 bpm BP 100/60 Alert, orientated Photophobia Nuchal rigidity No rash present
What are the csf results of a enteroviral meningitis
Protein is only a little up and not significant blood glucose to CSF glucose – suggests viral
Clear colourless – viral
What are some common causes of viral meningitis
Enteroviruses Herpes Simplex Virus (Mollaret’s) Mumps Measles Adenovirus HIV Non viral: Lyme disease, syphilis, drugs Often have other symptoms too e.g. measles has rash
What is the treatment for viral meningitis?
Self limiting
Doesn’t need specific treatment- just treat symptoms
What are the symptoms of TB meningitis?
Symptoms
Unwell for 2 months 2 stone weight loss Fever Drenching night sweats 1 month gradual onset worsening headache
What are the risk factors of TB meningitis?
HIV, alcoholism, diabetes, steroids, anti-TNF agents, immigration from area of high prevalence
What is the treatment for TB meningitis?
Start treatment without waiting for results
12 months treatment:
rifampicin, isoniazid, pyrazinamide, ethambutol
Dexamethasone (Thwaites regimen)
Acetazolamide + frusemide, or repeated LP for communicating hydrocephalus
Consider early ventriculo-peritoneal shunting for non-communicating hydrocephalus
What are the symptoms of cryptococcal menigitis due to fungal cryptococcus neoformans?
3 stone weight loss in 6 months
Gradual onset headache + fever for 2 weeks
No photophobia
No neck stiffness
No rash
Received antibiotics for chest infection 6 weeks ago
What is treatment for cryptococcal meningitis
AmBisome (liposomal amphotericin B) and flucytosine for 2 weeks (anti-fungal)
Serial lumbar punctures
8 weeks fluconazole – 400mg daily
