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Yr 4 - Paediatrics > Meningitis & Encephalitis > Flashcards

Meningitis & Encephalitis Flashcards

1
Q

What bacteria causes meningococcal septicaemia?

A

Neisseria meningitidis

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2
Q

What is meningococcal septicaemia?

A

Refers to the meningococcus bacterial infection in the bloodstream.

This is the cause of the classic “non-blanching rash”.

The rash indicates the infection has caused disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages.

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3
Q

What are the 2 most common causes of bacterial meningitis in children & adults?

A

1) Neisseria meningitidis (meningococcus)

2) Strep. pnuemoniae (pneumococcus)

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4
Q

In neonates, what is the most common cause of bacterial meningitis?

A

Group B strep (GBS) (Strep. agalactiae)

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5
Q

How is GBS contracted in the neonates?

A

During birth from GBS bacteria that live harmlessly in the mother’s vagina.

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6
Q

Clinical features of bacterial meningitis?

A
  • headache
  • fever
  • nausea/vomiting
  • photophobia
  • drowsiness
  • seizures
  • neck stiffness
  • purpuric rash (particularly with invasive meningococcal disease)
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7
Q

Presentation of bacterial meningitis in neonates?

A

Non-specific signs e.g. hypotonia, poor feeding, lethargy, hypothermia, and a bulging fontanelle.

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8
Q

When is a lumbar puncture indicated in children?

A

1) Under 1 month presenting with fever

2) 1 to 3 months with fever and are unwell

3) Under 1 year with unexplained fever and other features of serious illness

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9
Q

What 2 special tests can be done to look for meningeal irritation?

A

1) Kernig’s test

2) Brudzinski’s test

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10
Q

What does Kernig’s test involve?

A

Lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees.

This creates a slight stretch in the meninges.

Where there is meningitis it will produce spinal pain or resistance to movement.

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11
Q

What does Brudzinski’s test involve?

A

Lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest.

In a positive test this causes the patient to involuntarily flex their hips and knees.

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12
Q

Investigations in suspected meningitis?

A
  • FBC
  • CRP
  • Coagulation screen
  • Blood culture
  • Whole blood PCR
  • Blood glucose
  • Blood gas
  • Lumbar puncture (if no signs of raised intracranial pressure)
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13
Q

Give some contraindications to LP

A

Any signs of raised ICP:

1) Focal neurological signs
2) Papilloedema
3) Significant bulging of the fontanelle
4) DIC
5) Signs of cerebral herniation

Also LP is contraindicated in meningococcal septicaemia.

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14
Q

What should be obtained instead of a LP for patients with meningococcal septicaemia?

A

Blood cultures & PCR for meningococcus

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15
Q

CSF findings in bacterial meningitis:

a) appearance
b) glucose
c) protein
d) white cells

A

a) cloudy
b) low (<1/2 plasma)
c) high (>1g/l)
d) high (neutrophils)

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16
Q

1st line management of children seen in the primary care setting with suspected meningitis AND a non blanching rash?

A

Urgent stat injection (IM or IV) of benzylpenicillin prior to transfer to hospital.

Dose dependent on age.

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17
Q

1st line management of PENICILLIN ALLERGIC children seen in the primary care setting with suspected meningitis AND a non blanching rash?

A

Where there is a true penicillin allergy, transfer should be the priority rather than finding alternative antibiotics.

I.e. Giving antibiotics should not delay transfer to hospital.

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18
Q

What is the most common cause of bacterial meningitis in neonates (<3 months)?

A

GBS

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19
Q

What are the 3 most common causes of bacterial meningitis in children aged 3 months to 6 years?

A

1) Neisseria meningitidis

2) Streptococcus pneumoniae

3) Haemophilus influenzae

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20
Q

What are the 2 most common causes of bacterial meningitis in people aged 6-60 years?

A

1) Neisseria meningitidis

2) Streptococcus pneumoniae

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21
Q

What are the 3 most common causes of bacterial meningitis in people aged >60 years?

A

1) Streptococcus pneumoniae

2) Neisseria meningitidis

3) Listeria monocytogenes

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22
Q

What are the 3 most common causes of bacterial meningitis in nenoates (aged <3 months)?

A

1) Group B Streptococcus (most common cause in neonates)

2) E. coli

3) Listeria monocytogenes

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23
Q

Who does listeria cause meningitis in?

A

Extremes of age i.e. >65 y/o or <3 months.

Also immunosuppressed.

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24
Q

What is the 1st line management of bacterial meningitis in neonates <3 months?

A

IV amoxicillin + IV cefotaxime

Note - amoxicillin is to cover listeria contracted during pregnancy.

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25
Q

What is the 1st line management of bacterial meningitis in children >3 months?

A

IV ceftriaxone (or cefotaxime)

26
Q

What should be added to the Abx treatment of bacterial meningitis if there is a risk of penicillin resistant pneumococcal infection e.g. recent foreign travel or prolonged antibiotic exposure?

A

Vancomycin

27
Q

Steroids can also be used in the management of bacterial meningitis.

What is their role?

A

Reduce frequency and severity of hearing loss and neurological damage.

28
Q

Which steroid is indicated in bacterial meningitis?

A

Dexamethasone

29
Q

When are steroids advised in bacterial meningitis?

A

If child is >3 months old.

If LP reveals any of the following:
1) frankly purulent CSF
2) CSF white blood cell count >1000/microlitre
3) raised CSF white blood cell count with protein concentration greater than 1 g/litre
4) bacteria on Gram stain

30
Q

What Abx is used for PROPHYLAXIS of bacterial meningitis for contacts?

A

Single dose of ciprofloxacin

31
Q

When do cases of meningitis need to be reported to public health?

A

Bacteria meningitis and meningococcal infection are notifiable diseases.

32
Q

Is viral or bacterial meningitis more severe?

A

Bacterial

Viral meningitis tends to be milder than bacterial and often only requires supportive treatment.

33
Q

What is the most common viral cause of meningitis?

A

Non-polio enteroviruses e.g. Coxsackie virus

34
Q

Give some causes of viral meningitis

A

1) Enterovirus e.g. Coxsackie virus

2) HSV

3) VZV

4) Mumps

35
Q

What clinical features would indicated meningoencephalitis?

A
  • Significant change in behaviour
  • Seizures
  • Disorientation
  • Marked deterioration in mental state
36
Q

CSF analysis in viral meningitis:

a) appearance
b) protein
c) glucose
d) white cell

A

a) clear
b) mildly raised or normal
c) normal
d) high (lymphocytes)

37
Q

Management of viral meningitis?

A

Generally speaking, viral meningitis is self-limiting, with symptoms improving over the course of 7 - 14 days and complications are rare in immunocompetent patients.

Aciclovir can be used to treat suspected or confirmed HSV or VZV infection.

38
Q

What can be used to treat suspected or confirmed HSV or VZV meningitis?

A

Aciclovir

39
Q

Where is the needle usually inserted in a LP?

A

L3-L4 intervertebral space (as the spinal cord ends at L1-L2).

40
Q

What is the most common complication of meningitis?

A

sensorineural hearing loss

41
Q

What is given to reduce risk of hearing loss in meningitis?

A

Steroids (dexamethasone)

42
Q

What are some complications of meningitis?

A
  • hearing loss
  • seizures
  • neurological deficit
  • sepsis
  • intracerebral abscess
  • cerebral palsy: with focal neurological deficits such as limb weakness or spasticity
  • pressure: herniation, hydrocephalus
43
Q

Patients with meningococcal meningitis are at risk of Waterhouse-Friderichsen syndrome.

What is this?

A

Adrenal insufficiency secondary to adrenal haemorrhage

44
Q

What syndrome are patients with meningococcal meningitis at risk of?

A

Waterhouse-Friderichsen syndrome

45
Q

What is encephalitis?

A

Inflammation of the brain.

This can be the result of infective (e.g. HSV) or non-infective (autoimmune) causes.

46
Q

What is the most common cause of encephalitis?

A

Viral –> HSV

47
Q

What is the most common cause of encephalitis in children vs neonates?

A

Children: HSV-1 (from cold sores)

Neonates: HSV-2 (from genital herpes, contracted during birth)

48
Q

Give 5 viral causes of encephalitis

A

1) HSV

2) VZV

3) CMV

4) Epstein-Barr virus

5) Enterovirus

49
Q

Why is it important to ask about vaccination history in encephalitis?

A

As the polio, mumps, rubella and measles viruses can cause encephalitis as well.

50
Q

What lobe does HSV encephalitis characteristically affect?

A

Temporal lobes

Patients may demonstrate temporal lobe signs e.g. aphasia.

51
Q

Clinical features of encephalitis?

A
  • Fever, headache, seizures, vomiting,
  • Altered consciousness
  • Altered cognition
  • Unusual behaviour
  • Focal features e.g. aphasia
52
Q

What investigations are indicated in encephalitis?

A

1) LP for CSF viral PCR testing

2) CT scan (if a LP is contraindicated)

3) MRI scan (after the LP to visualise the brain in detail)

4) EEG recording

5) HIV testing: recommended in all patients with encephalitis

53
Q

Give some contraindications to a LP

A
  • GCS <9
  • Haemodynamically unstable
  • Active seizures
  • Post-ictal
  • Signs of raised ICP e.g. papilloedema
54
Q

What will CSF show in HSV encephalitis?

A

Lymphocytosis & elevated protein

55
Q

Management of HSV encephalitis?

A

IV aciclovir

56
Q

Management of VZV encephalitis?

A

IV aciclovir

57
Q

Management of CMV encephalitis?

A

Ganciclovir

58
Q

What is usually performed to ensure successful treatment prior to stopping antivirals in encephalitis?

A

Repeat LP

59
Q

What is usually started empirically in suspected encephalitis until results are available?

A

Aciclovir

60
Q

What are some complications of encephalitis?

A
  • Lasting fatigue and prolonged recovery
  • Change in personality or mood
  • Changes to memory and cognition
  • Learning disability
  • Headaches
  • Chronic pain
  • Movement disorders
  • Sensory disturbance
  • Seizures
  • Hormonal imbalance
  • High mortality rate if left untreated
61
Q
A

Yr 4 - Paediatrics (78 decks)

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