PHAM02 > meningitis > Flashcards

meningitis Flashcards

(42 cards)

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1
Q

What is meningitis?

A

inflammation of the membranes covering the brain and spinal cord (meninges)

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2
Q

causes of meningitis

A

– Viruses
– Bacteria
– Fungi

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3
Q

Inc risk of meningitis after what?

A

head trauma

in presence of ventriculo-peritoneal shunts (brian surgery, putting in shunts)

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4
Q

layers of meninges

A

dura matter (out)

arachniod (middle)

pia matter (inner)

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5
Q

most common cause of bacterial meningitis

A

Neisseria meningitidis

(gram negative diplococci)

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6
Q

Neisseria meningitidis

A
  • 13 types (serogroups)
  • characterised by surface structures in the capsule and outer cell membrane
  • 5 responsible for most cases of invasive disease
  • A, B, C, Y and W-135
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7
Q

other bacterial causes

A
  • S. Pneumoniae
    (G+ve cocci)
  • H. influenzae type B
    (G-ve rods)
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8
Q

What does causastive agent depend on?

A

age of pt

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9
Q

viral causes of meningitis

A
  • less severe than bacterial meningitis
  • usually resolves without Tx
  • caused by viruses that live in the intestines
  • Enteroviruses (most common)
  • mumps and measles viruses and herpes viruses
  • poor hygiene may increase the risk of transmission
  • not all people exposed to the virus will develop meningitis
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10
Q

fungal causes of meningitis

A
  • life threatening
  • rare disease
  • usually in pts with compromised immune fxn
  • slow progression
  • difficult to diagnose and treat
  • Cryptococcus, Candida
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11
Q

non-infective causes of meningitis

A
  • complication of head injury, brain surgery, some cancers
  • sometimes drugs
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12
Q

greatest age risk for meningitis

A

< 5 years

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13
Q

common bacterial pathogens in newborns

A
  • Group B streptococci
  • E coli
  • Listeria monocytogenes
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14
Q

common bacterial pathogens in infants

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Streptococcus pneumoniae
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15
Q

common bacterial pathogens in children

A
  • N meningitidis
  • S pneumoniae
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16
Q

common bacterial pathogens in adults

A
  • S pneumoniae
  • N meningitidis
  • Mycobacteria
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17
Q

most common cause in Africa

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A

Group A meningococcus

18
Q

vaccine for what casue of meningitis

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A

Meningitis A

(Group A meningococcus)

19
Q

Neisseria meningitidis - spread

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A
  • normally in nasopharynx
  • transmitted by droplets/ secretions from the URTI
  • spread by close contact (not highly transmissible)
  • epidemics in crowded environments
20
Q

RF

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A
  • infants & young children
  • community settings - inc close contact
  • asplenia
  • immunocompromised
  • exposure to active/passive tobacco smoke
  • elderly
  • pregnancy and working with animals inc risk of meningitis with Listeria bacteria
21
Q

presentation of Neisseria Meningitidis

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A
  • Bacterial meningitis (15%)
  • Meningococcal septicaemia (25%)
  • Combination of both (60%)
22
Q

classic signs & Sx

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A
  • Fever
  • Headache
  • Photophobia
  • Neck stiffness
  • Petechial rash
23
Q

signs and Sx in young children

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A
  • fever
  • N&V
  • poor feeding
  • irritability
  • drowsiness
  • confusion
  • sudden fever & rigors
  • muscle & joint aches
  • cold extremeties
  • Sx of raised ICP (bulging fontanelle, irregular breathing, abnormal tone)
  • petechial rash (usually N meningitidis)
24
Q

Petechial rash

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A
  • usually in septicaemia but may be absent in meningitis
  • blanching and macropapular in early disease, develops into petechial, non-blanching rash
  • rapidly evolving rash = severe disease
  • non-blanching = MED EMERGENCY

(glass test not in NICE guidance)

25
Kernig's and Brudzinski's sign in meningitis
* severe stiffness of the HAMSTRINGS causes an inability to straighten leg when hip is flexed to 90 degrees * severe neck stiffness causes hips and knees to flex when the neck is flexed
26
diff between meningitis and sepsis
PRODROME SAME - fever - N&V - malaise - lethargy MENINGITIS - severe headache - neck stiffness - photophobia - drowsiness/confusion ** death from inc ICP SEPSIS - limb/joint pain - cold hands/feet - pale/mottled skin - oliguria/thirst - rash - tachycardia - rigors - abdo pain ** death from CV failure
27
diagnosis
* Hx and examination * blood tests * nasopharyngeal swab through mouth
28
blood tests for diagnosis
* FBC * blood films * CRP * blood culture * serology & PCR * testing of CSF sample = GOLD STANDARD diagnostic test
29
When to start Tx?
empirical Tx initiated on strong clinical suspicion & should not be witheld until cultures taken
30
CSF sample
* Lumbar puncture drains CSF from back below end spinal cord * NOT performed if pts: – features of raised (ICP) – haemodynamic instability – clotting abnormalities or thrombocytopenia * if meningitis, CSF sample appears turbid * causative organism cultured from CSF sample * bacteria may not be cultured if ABX have already been administered
31
general Tx for meningitis
* broad spec IV ABX * ABX choice depends on most likely causative organism * determined by age * good CSF penetration essential * ABX changes if necessary once causative organism ID * guidelines reflect local patterns of resistance
32
empirical Tx - early Tx before hospital if practical
benzylpenicillin (NICE) benzylpenicillin & cefotaxime (parenteral)
33
When is benzylpenicillin witheld?
only in allergy only due to anaphylaxis
34
empirical Tx - hospital
ceftriaxone (3rd gen cephalosporin) 1st line over 3 months
35
Tx in under 3 months
* need ABX active against listeria * cefotaxime + ampicillin/amoxicillin * Listeria most likely in U3mths
36
supportive therapies
* Corticosteroids * Intravenous fluids * Enteral nutrition * Anticonvulsant therapy if app (convulsions from inc ICP, pressure on brain) * Management of complications of septicaemia and shock – Respiratory support – Correction of metabolic disturbances – IV fluids – Vasoactive therapies – Renal replacement therapies if required
37
LT complications
* Hearing loss * Orthopaedic complications * Skin complications * Psychosocial problems * Neurological and developmental problems * Renal failure
38
When is chemoprophylaxis indicated?
* prolonged close contacts - same household during the 7 days before presentation * transient close contacts - directly exposed to large particle droplets/secretions from the RT of pt around time of admin to hospital * patient - given as soon as able to take oral meds, unless treated with ceftriaxone
39
When is chemoprophylaxis NOT indicated?
– Staff and children attending same nursery/school – Residents of nursing/residential homes – Food/drink sharing or similar low level of salivary contact – Travelling in next seat on same plane/train/bus
40
Chemoprophylaxis options
* given asap after diagnosis * choice of ABX includes: 1. Ciprofloxacin - rec for all age groups and pregnancy - single dose admin 2. Rifampicin - suitable for all pt groups (without c/i) - BD for 2 days - interactions 3. Ceftriaxone - injection so only used when other Txs unsuitable
41
vaccination
Hib / Men C vaccine * routine immunisation at 1 year Quadrivalent Vaccines * meningococcal polysaccharides A, C, W135 and Y vaccine (ACWY Vax®) * quadrivalent meningococcal diphtheria-conjugate vaccine (MCV-4) * suitable for individuals at risk & meningitis patients & close contacts Men B vaccine * NHS for babies born after Sept 2015 * Routine immunisation at 2, 4, 12mths Other vaccines * 5-in-1 vaccine - DTaP/IPV/Hib vaccine - routine imm at 8, 12, 16 weeks * Pneumococcal vaccine - routine imm at 8, 16 weeks, 1yr
42
reporting meningitis
if diagnosis of meningitis suspected, dr legally obliged to report to local health protection unit of the health porteciton agenct
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