Viral and Bacterial Meningitis

Question 1

Meningitis is inflammation of the meninges of the brain, notifiable to…

Answer 1

PHE

Question 2

Name some viral causes of meningitis

Answer 2

Enteroviruses eg coxsackie
HSV-2 (herpes simplex virus)
VZV (varicella zoster virus)

Question 3

Are viral or bacterial causes of meningitis more common?

Answer 3

Viral

Question 4

Name some bacterial causes of meningitis

Answer 4

Strep. pneumoniae
Neisseria meningitidis

Question 5

True or false:
Bacterial meningitis is more severe than viral meningitis

Answer 5

True

Question 6

What are risk factors for meningitis?

Answer 6

Extremes of age
Immunocompromised
Non-vaccinated
Crowded environment

Question 7

What bacteria commonly causes meningitis in neonates (1-3 months)

Answer 7

Group B alpha haem-strep
(Strep. agalactiae)

Also:
listeria, E. coli, S pneumoniae

Question 8

Describe features of Neisseria Meningitidis

Answer 8

Gram negative
Diplococcus

Question 9

What is a sign of Neisseria Meningitidis?

Answer 9

Non blanching purpuric rash

(meningococcal septicaemia causes DIC so very easily bleeds)

Question 10

Describe the features of strep. pneumoniae

Answer 10

Gram positive
In pairs (diplococcus) or in short chains

Question 11

What vaccine protects against strep pneumoniae?

Answer 11

PCV vaccine

Question 12

How come group B strep is the most common cause of neonatal meningitis?

Answer 12

Group B strep colonises the maternal vagina

Question 13

True or false: Group B strep is gram positive coccus in chains

Answer 13

True

Question 14

What food is listeria monocytogenes found in?

Answer 14

Cheese

Question 15

What group is affected most by listeria?

Answer 15

Extremes of age and pregnant ladies

Question 16

What are symptoms of meningitis?

Answer 16

Headache
Neck stiffness
Fever
Photophobia
Rash
Altered consciousness
Seizures

Question 17

What are signs of meningitis?

Answer 17

Kernig (can’t extend knee when hip is flexed without pain)

Brudzinski (when neck flexed, knees and hips automatically flex

Pyrexia (fever)

Question 18

How do you diagnose meningitis?

Answer 18

Lumbar puncture and CSF analysis

Question 19

Should you lumbar puncture with raised intracranial pressure?

Answer 19

No, increased risk of herniation

Question 20

Where is a lumbar puncture taken?

Answer 20

L3-L4

Question 21

What colour will the CSF be from bacterial meningitis?

Answer 21

Cloudy yellow

Question 22

True or false:
The CSF from viral meningitis will be cloudy yellow

Answer 22

False
Will be clear and look normal

Question 23

What is the opening pressure in lumbar puncture of patient with bacterial meningitis?

Answer 23

High

Question 24

What is the opening pressure in lumbar puncture of patient with viral meningitis?

Answer 24

Normal

Question 25

True or false: there is more than 1g of protein per litre in lumbar puncture of bacterial and fungal meningitis

Answer 25

True (viruses may release a small amount of protein, they don't use glucose)

Question 26

What happens to the white cell count in CSF of bacterial meningitis patient?

Answer 26

Neutrophilia

Question 27

Describe the CSF collected from bacterial meningitis

Answer 27

Cloudy, low glucose, high protein, neutrophilia (Bacteria release proteins and use up glucose. Immune system releases neutrophils in response to bacteria)

Question 28

Describe the CSF collected from viral meningitis

Answer 28

Clear, normal glucose, mildly raised protein, high lymphocytes (Viruses don't use up glucose but may release small amount of protein. Immune system releases lymphocytes in response to viruses)

Question 29

What happens to the white cell count in CSF of viral meningitis patient?

Answer 29

lymphocytosis (same as fungal or TB meningitis)

Question 30

How do you treat bacterial meningitis?

Answer 30

Ceftriaxone or Cefotaxime with Dexamethasone (steroid)

Question 31

What antibiotic covers listeria?

Answer 31

Amoxicillin

Question 32

How do you treat meningitis caused by an enterovirus?

Answer 32

No treatment

Question 33

What antibiotic is used for meningitis caused by HSV or VZV?

Answer 33

Aciclovir

Question 34

What is given for prophylaxis for those who have been contact traced as having 7+ days of prolonged contact preceding a meningitis patient's symptoms starting?

Answer 34

One off dose of ciprofloxacin

Question 35

If a patient present in the GP with a non-blanching rash and meningococcal septicaemia is suspected, what do they do?

Answer 35

Give IM benzylpenicillin and immediate hospital referral

Question 36

What is a complication of meningitis?

Answer 36

DIC due to meningococcal septicaemia

Question 37

What is Waterhouse Friedrichsen Syndrome?

Answer 37

Adrenal insufficiency caused by intra-adrenal haemorrhage as a result of meningococcal DIC