What is meningitis
inflammation of the meninges which line the brain and spinal cord
CSF is contained within the meninges in the subarachnoid space
What is the most common cause of bacterial meningitis
Neisseria meningitides which is a gram negative diplococcus AKA meningococcus
What are the three main causes of bacterial meningitis
- Neisseria meningitides
- Strep pneumoniae
- haemophiliac influenzae
What are the two causes of bacterial meningitis specific to neonates
- group B strep
- listeria monocytogenes
What causes a non-blanching rash in meningitis
meningococcal septicaemia- the infection in the bloodstream
What are the most common causes of viral meningitis
- enteroviruses (eg coxsackie virus)
- herpes simplex virus (HSV)
- varicella zoster virus (VZV)
What are the typical symptoms of meningitis?
- fever
- neck stiffness
- photophobia
- vomiting
- headache/ altered consciousness
- seizures
What are the typical symptoms of meningitis in neonates
- hypotonia (floppy)
- poor feeding
- lethargy
- hypothermia
- bulging fontanelle
What are the two special tests for meningitis
- Kernigs sign
- Brudinskis sign
According to NICE guidelines what children require lumbar puncture
- under 1 month presenting with seizure
- 1 to 3 months who are unwell or have low/ high white cell count
What is kernigs sign
lie patient flat on back, flex knee and hip to 90 and slowly straighten knee whilst hip still flexed- creates slough stretch in meninges
will produce spinal pain/ resistance to movement
What is Brudinskis sign
lie patient flat on back and gently use hands to lift head and neck off bed- flexing chin to chest
causes patient to flex hips and knee involuntarily
What level does the spinal cord end?
L1 to L2
What level is a lumbar puncture performed at
L3-4/ L4-5 intervertebral space
Appearance of CSF in meningitis
bacterial- cloudy
viral- clear
How do bacteria and viruses live in CSF
- bacteria swimming will release proteins and use up glucose
- viruses may release protein but dont require glucose
White cell count in CSF
bacterial more neutrophils
viruses more lymphocytes
Management of bacterial meningitis
- medical emergency
- children given IM or IV benzylpenicillin in primary care
< 3months cefotaxime and amoxicillin (to cover listeria)
> 3 months ceftriaxone
When is vancomycin added to meningitis treatment
if the risk of penicillin resistant pneumococcal infection ( eg recent foreign travel/ prolonged antibiotic exposure)
Why are steroids (eg dexamethosone) used in meningitis treatment
to decrease risk of hearing or neurological problems
What prophylaxis is given to meningitis close contacts
single dose cirpofloxacin
What are the complications of meningitis
- hearing loss
- seizures and epilepsy
- cognitive impairment and learning disability
- memory loss
- focal neurological deficit
