What is the most common cause of meningitis?
Enteroviruses i.e. Echovirus, Coxsackie, Poliovirus, Mumps, Herpes Simplex
Herpes Simplex and Varicella zoster can cause which life-threatening condition?
What is the most common cause of bacterial meningitis?
N. Meningitidis. This is a capsulated gram -ve Diplococcus.
This is also what causes the red flag "purpuric rash" symptom.
Other than N Meningitidis, which two other bacterial infections are common causes of bacterial meningitis?
Streptococcus Pneumoniae (9%)
Haemophilus Influenza B (1%)
What could be a cause of a slow onset meningitidis?
Which part of the brain do bacteria cross (in meningitis), in order to access the CSF?
The choroid plexus.
What is Brudzinski's sign?
This is involuntary flexion of hips when the neck flexed
What is Kernig's sign?
There is pain in the leg, when the pt raises it whilst knee is flexed.
This happens because the sciatic N is stretched, pulling on the meninges.
How does normal CSF appear?
0-4 lymphocytes per mm-3
Protein 0.15-0.40 g/l
Glucose 2.7-4.0 mmol/l
Clear and colourless
What CSF results would you expect in bacterial meningitis?
++ Polymorphs (different forms/shapes)
Glucose is decreased or absent
Opaque and turbid
What are the CSF results in Viral meningitis?
Glucose is normal (unlike bacteria, viral infections don't use up sugar)
Clear and colourless
What are the CSF results in tuberculous meningitis?
Clear or opalescent appearance
What are the CSF results in viral encephalitis?
+polymorphs, then initially
Clear and colourless
A -ve gra stain of CSF fluid suggests which cause of infection?
A +ve Gram stain of CSF suggests which cause of meningitis?
An AFB stain of CSF suggests what cause of meningeal infection?
What is the first line treatment for adults with meningitis (bacterial?)
Why is it more difficult for pathogens to enter the CNS through the capillaries of the blood/brain parenchyma, than through the choroid plexus?
Entry via the capillaries is difficult because of tight cell junctions between endothelial cells, and a low endocytosis rate - both of which reduce transcellular reflux.
The choroid plexus is an easier route of entry because there are fenestrations between endothelial cells, and there is also a high endocytosis rate.
Other than by infection from the blood - what are the other ways in which a meningeal infection may occur?
- Direct implantation - IE Trauma
- Local spread - I.E from mastoiditis (ear infection)
- From peripheral nervous system - I.E V. Zoster virus
A patient with suspected meningeal infection has an MRI head scan. There is noted extensive, asymetric necrosis of the temporal lobes. Which infection causes this?
What are transmissable spongiform encephalopathies, and how are they caused?
These are caused by prions (different forms of familiar proteins).
It's kind of like a zombie wave - when a prion touches a normal protein, it makes that protein a prion, and so a chain reaction starts. Think walking dead, but on a small scale.
Result? Spongy brain parenchyma.
It progresses with rapidly progressive dementia .
Example: Creutzfeld- Jacob disease
How is african Typanosomiasis transmitted?
Via tsetse fly during a blood meal.
What are the things you could be asked from Week 221?
Meninges, bridging veins, dura, major external structures.
EMQ/DATA - MRI (unlikely) or Comparison of CSF fluid (V likely)
what are the functions of CSF?
While the primary function of CSF is to cushion the brain within the skull and serve as a shock absorber for the central nervous system, CSF also circulates nutrients and chemicals filtered from the blood and removes waste products from the brain
what is the foramen of luschka?
This is a small aperture through which CSF flows. It is located anterior to the cerebellum, and alllows CSF to flow from the fourth ventricle into the sub arachnoid space.
what is the forman magendie?
This is an aperture at the top of the spinal cord, just below trhe cerebellum. Like the forman of lushcke, it allows flow of CSF into the subarachnoid space.
What type of cells produce CSF?
Ependymal cells of the choroid plexus produce more than two thirds of CSF. The choroid plexus is a venous plexus contained within the fourventricles of the brain, hollow structures inside the brain filled with CSF.
What is the most common fungal cause of meningitis?
Which of these is NOT a classical symptom of Bacterial Meningitis?
B. Neck Stiffness
What sign does the picture show?
A. Kernig’s Sign
B. Pastia’s Sign
C. Bulging Fontanelle
D. Brudzinski’s Sign
Kernigs - Pain on hip/knee flexion
Pastia - lines on elbows - scarlett fever
Brudzinskis - flexion of knee/hips on neck flexion
Exopthalmus - big eyes!
The Posterior Fontanelle closes by ____ months of age and the Anterior by ____ months.
The Posterior Fontanelle closes by 2-3 months of age and the Anterior by 18 months.
Which of the following is NOT a contraindication to lumbar puncture?
A. Infection at site of entry
B. Increased ICP
E. Brain abscess
Which of these is the most common cause of Bacterial Meningitis in the first month of life?
A. Listeria monocytogenes
B. Mycoplasma Pneumonia
C. H. influenzae
D. Staph aureus
What is the mortality rate for children with Meningococcal disease?
1 in 10 (approx)
What would be your first choice antibiotic for bacterial meningitis in a 5 year old child?
#• First line treatment in Neonates is usually Ampicillin and an Aminoglycoside or a Cephalosporin such as Cefotaxime
• Children between 30 and 60 days old need Ampicillin and a Cephalosporin.
• In older children a Cephalosporin or Ampicillin plus Chloramphenicol can be used.
Which of the following is the most common complication of Strep Pneumonia Meningitis?
E. Seizure Disorder
Hearing loss is the most common complication of Pneumococcal Meningitis, with around 21% of children who survive the disease suffering from some form of hearing impairment.
Which of these is NOT a risk factor for Meningitis?
A. Age 5-60
C. IV Drug Abuse
The 2 most at risk groups for Meningitis are those above 60 or below 5 years of age
An 8 year old child has been diagnosed with laboratory confirmed meningococcal meningitis. The child has been treated with cefotaxime and is making an uneventful recovery. Assuming that there were no contraindications, what would you prescribe in the following situations? (please choose an option A, B, C or D, for each scenario)
A Ciprofloxacin 500 mg as a single dose
B Ciprofloxacin 250 mg as a single dose
C Ciprofloxacin 125 mg as a single dose
D Chemoprophylaxis not indicated
1. The child’s 10 year old sibling who has lived in the same household for the past week.
2. The child’s father who has lived in the same household for the past week.
3. The child’s 4 year old cousin who stayed overnight in the same room as the child four days before the child became unwell.
4. The child themselves, who has been diagnosed with laboratory confirmed meningococcal meningitis.
5. The child’s 6 year old cousin who stayed overnight in the same room as the child nine days before the child became unwell.
1. The child’s 10 year old sibling who has lived in the same household for the past week. B
2. The child’s father who has lived in the same household for the past week. A
3. The child’s 4 year old cousin who stayed overnight in the same room as the child four days before the child became unwell. C
4. The child themselves, who has been diagnosed with laboratory confirmed meningococcal meningitis. B The case should receive chemoprophylaxis when able to take oral medication and before discharge from hospital, unless the disease has already been treated with ceftriaxone. Those treated with cefotaxime should still receive prophylaxis because it is not known whether cefotaxime eradicates carriage.
5. The child’s 6 year old cousin who stayed overnight in the same room as the child nine days before the child became unwell. D They are likely to have been in prolonged close contact with the child at the time of the visit. However, this contact was over seven days before the onset of the illness.
What are the normal vaccinations given at 2 months of age?
- Diphtheria ,Tetanus ,Pertussis ,Polio ,Haemophilus influenza (DTaP/IPV/Hib)
- Pneumococcal Conjugate Vaccine (PCV)
Wht are the normal vaccinations given at 3 months of age?
Which vaccine is usually recieved at between 12 and 13 months of age?
Which vaccine do GIRLS ONLY receive at between 12-13 years?
When is the second MMR vaccine recieved (usually)?
3 years 4 months