Meningitis

Question 1

Ix

Answer 1

LP

Question 2

contraindication to LP

Answer 2

any signs of raised ICP e.g.

focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation

Question 3

do you lp a patient with meningococcal septicaemia

Answer 3

no

blood cultures and pcr

Question 4

Mx

Answer 4

1. abx
2. steroids
3. fluids
4. cerebral monitoring
5. public health notification and abx prophylaxis of contacts

Question 5

Abx treatment < 3 months

Answer 5

< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime

Question 6

Abx treatment > 3 months

Answer 6

IV cefotaxime (or ceftriaxone)

Question 7

when should dexamethasone be considered?

Answer 7

should be considered if the lumbar puncture reveals any of the following:

frankly purulent CSF
CSF white blood cell count greater than 1000/microlitre
raised CSF white blood cell count with protein concentration greater than 1 g/litre
bacteria on Gram stain

Question 8

what abx prophylaxis is given to contacts

Answer 8

ciprofloaxacin

Question 9

organsims in neonatal to 3 months

Answer 9

Group B Streptococcus - from mother

E. coli and other Gram -ve organisms

Listeria monocytogenes

Question 10

organisms 1 month - 6 years

Answer 10

Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae

Question 11

organsims > 6 years

Answer 11

Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)