Meningitis Management

Question 1

Investigations in meningitis

Answer 1

FBC
Acute phase reactants
Blood culture
CSF investigations 
RFT
Cranioimaging

Question 2

LP samples

Answer 2

CSF full report
CSF sugar
CSF protein
CSF culture
CSF AFB + culture
CSF antigen testing

Question 3

LP contraindications

Answer 3

Suspicion of mass lesion in the brain or cord

Any cause raised ICP

Local sepsis near infection site

Congenital lesions in the lumbosacral region

PLT count <40*109/L and other clotting abnormalities including anticoagulant drugs

Unconcious pts and those with papilloedema must have a CT scan before LP

Question 4

How to a LP?

Answer 4

Consent

Exclude raised ICP and intracranial mass lesion

Place the pt on the edge

Left lateral position

Knees and chin as close as together

Sterile procedure -

2% Lidocaine into the dermis- raises a bleb in either
3rd or 4th lumbar interspace

LP needle straight and slightly towards the head
Head and spine supported by pillows

When you feel the needle penetrate the dura, withdraw stylet and allow few drops to escape

Measure CSF pressure with a manometer

Normal CSF- 60-150mm

Collect CSF in three bottles

Take a blood sugar sample

Note the appearance clear cloudy yellow(xanthochromic) red

Lie flat to avoid post LP headache

Analgesia for post LP headache

Question 5

Treatment for neonatal meningitis

Answer 5

Penicillin/ ampicillin
+
Cefotaxime

Avoid Ceftriaxone

Question 6

Treatment bacterial meningitis

1-3 months

Answer 6

Penicillin/Ampicillin
+
Cefotaxime/ Ceftriaxone

Question 7

Bacterial meningitis

3mo -65 years

Answer 7

Cefotaxime/Ceftriaxone

+/- Vancomycin

Question 8

Acute bacterial meningitis

>65years, Alcoholic pts, debilitating disease

Answer 8

Cefotaxime/ceftriaxone
\+
Ampicillin
\+/-
Vancomycin