Week 221 - Meningitis Flashcards
(38 cards)
Week 221 - Meningitis: What are the risk factors for developing meningitis?
- Age 60
- DM
- Renal or adrenal insufficiency
- Immunosupression
- Sickle cell disease
- Alcoholism and cirrhosis
- Recent exposure to meningitis
- Contiguous infection
- Dural defect
- IV drug abuse
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates (<1month)?
- E.Coli
- Pneumococcal meningitis
- Listeria monocytogenes
- Nisseria meningitides
Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children older than 2 months?
- Pneumococcocal
- N. Menigitides
- H. Influenza
Week 221 - Meningitis: What are the two main mechanisms by which bacteria enter the subarachnoid space?
- Haematogenous spread from respiratory tract.
* Direct spread from a contiguous infection (sinusitis, mastoiditis) or from an injury.
Week 221 - Meningitis: What are the symptoms of meningism?
- Photophobia
- Headache
- Stiff neck
Week 221 - Meningitis: You may not see meningism in babies, what are the symptoms that you may see that would suggest meningitis?
- Hyper/hypothermia
- change in sleeping or eating habits.
- irritability or lethargy.
- high pitched cry
- bulging fontenelle
Week 221 - Meningitis: What is Kernig’s sign?
Patient is in supine position, hip and knee is flexed to 90º, patient feels pain when leg is extended.
Week 221 - Meningitis: What is Brudzinski sign?
When supine, passively flex neck, this causes the lower extremities (hips and knees) to flex.
Week 221 - Meningitis: The non-blanching petechial rash is a sign of what?
Sepsis.
Week 221 - Meningitis: What are the signs of encephalitis?
Fever, headache and decreased neurological function.
Week 221 - Meningitis: Which investigations should be performed for suspected meningitis?
- FBC, Coagulation studies, serum glucose.
- ABG
- Throat swab
- H1N1
- PCR
- Lumbar puncture (if not contraindicated)
Week 221 - Meningitis: A CT is indicated before a lumbar puncture in which patients?
> 60 y.o., immunocompromised, known CNS lesions, seizure within 1 week of presentation, suspicion of elevated ICP (Papilloedema, high BP but low HR).
Week 221 - Meningitis: What are the absolute contraindications for a lumbar puncture?
- Infected skin at site.
- Raised ICP
- Shock
- Focal neurological signs
- Unequal pressures between supratentorial and infratentorial compartments (from CT)
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in viral meningitis?
- Opening pressure - Normal or High
- Colour - Clear
- Cells/mm - 5-1000
- Predominant cell - Lymphocytes
- CSF:plasma glucose - Normal
- Protein - Normal
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in bacterial meningitis?
- Opening pressure - High
- Colour - Cloudy
- Cells/mm - 100-50000
- Predominant cell - Neutrophil
- CSF:plasma glucose - Low
- Protein - Elevated
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in tuberculous meningitis?
- Opening pressure - High
- Colour - Cloudy/yellow
- Cells/mm - 25-500
- Predominant cell - Lymphocyte
- CSF:plasma glucose - Low/very low
- Protein - elevated
Week 221 - Meningitis: What would you expect the lumbar puncture result to be in fungal meningitis?
- Opening pressure - High/Very high
- Colour - Clear/cloudy
- Cells/mm - 0-1000
- Predominant cell - Lymphocyte
- CSF:Plasma glucose - Normal/low
- Protein - Normal
Week 221 - Meningitis: Which antibiotic should be used in neonates for listeria and Group b strep?
- Listeria - Ampicillin and Aminoglycoside/Cefotaxime
* Group B strep - Benzylpenicillin and cefotaxime
Week 221 - Meningitis: Which class of antibiotics is used to treat meningitis (not neonates)?
Cephalosporin
Week 221 - Meningitis: Which antibiotic is used for the prophylaxis of meningitis?
Ciprofloxacin
Week 221 - Meningitis: Which organisms that cause meningitis are routinely vaccinated against?
- H influenze
- Menningococcal C
- Strep Pneumoniae
- MMR
Week 221 - Meningitis: What are the complications of meningitis?
- Focal neurological sequelae
- Hemiparesis, Facial palsy
- Visual field defects, hearing loss, blindness,
- Syndrome of inappropriate ADH secretion.
- Cranial nerve palsies
Week 221 - Meningitis: What are the measures in place to prevent transmission across the blood brain barrier?
- Capillaries have tight junctions that do not exist in normal circulation.
- There is also a thick basement membrane.
- There is active transport for certain metabolites whilst small molecules like 02,CO2 and hormones are able to diffuse across.
Week 221 - Meningitis: What are the names of the cells that line the choroid plexus and ventricles?
Ependymal cells.
