Which abx targets Listeria monocytogenes?
Ampicillin, amoxicillin, penicilin
When is lumbar puncture contraindicated?
Increased intracranial pressure, brain shift, infection at lumbar puncture site, rapidly spreading purpura
What are the causes of meningitis?
Infection (bacteria, virus e.g. enterovirus, herpes; fungal), drugs (co-trimoxazole), autoimmune disease
Symptoms of meningitis?
HA, backache, neck stiffness, mental status changes, photophobia
What special symptom is characteristic of Neisseria meningitidis meningitis?
Purpura or petechiae
What are physical signs of meningitis?
Kerning sign, Brudzinki sign, bulging fontane (infants)
Difference between normal, bacterial and viral CSF? (turbidity, WBC, protein, glucose)
Normal: clear, <5 WBC/mm3, protein <0.4g/L, CSF:blood glucose >0.66
Bacterial: turbid, raised WBC >100/mm3 (mainly neutrophils), raised protein >1.5g/L, CSF:blood glucose <0.4 (very low glucose)
Viral: clear, raised WBC >1000/mm3 (mainly lymphocytes), normal to slightly raised protein, normal to slightly low glucose
What are the most likely bacteria to cause meningitis in neonates (<1m)?
Group B strep (strep agalactiae), E coli, Listeria monocytogenes
What are the most likely bacteria to cause meningitis in infants and children (1-23m)?
S pneumo, N meningitidis, grp B strep (strep agalactiae), E coli, H influenzae
What are the most likely bacteria to cause meningitis in children and adults (2-50y)?
S pneumo, N meningitidis
What are the most likely bacteria to cause meningitis in adults (>50y)?
S pneumo, N meningitidis, L monocytogenes, aerobic gram -ve (E coli, Klebsiella)
Where is Listeria monocytogenes usually found?
Moist env, soil, water, foods (even in fridge like cold deli meats, unpasteurised dairy products)
When to start empiric abx for meningitis?
Within 1h
Empiric treatment for meningitis in neonates?
Ceftriaxone + ampicillin (listeria)
(ceftriaxone can only be used for PMA≥41w or <28d & no hyperbilirubinemia)
Empiric treatment for meningitis in children and adults (1m-50y)?
Ceftriaxone + vancomycin (for penicillin & cephalosporin resistant species)
Empiric treatment for meningitis in adults (>50y)?
Ceftriaxone + vancomycin (for penicillin & cephalosporin resistant species) + ampicillin (listeria)
Treatment for Strep pneumo meningitis and duration?
- Penicillin susceptible: penicillin G / ampicillin
- Penicillin resistant, cephalosporin susceptible: ceftriaxone
- Penicillin & cephalosporin resistant: vancomycin + rifampicin
- Duration: 10-14 days
Treatment for Neisseria meningitidis meningitis and duration?
- Penicillin susceptible: penicillin / ampicillin
- Penicillin resistant or mild allergy: ceftriaxone
- Duration: 5-7 days
Treatment for Listeria monocytogenes meningitis and duration?
- Penicillin G or ampicillin
- Penicillin allergy: co-trimoxazole, meropenem
- Duration: ≥21 days
Treatment for Grp B strep (strep agalactiae) meningitis and duration?
- Penicillin or ampicillin
- Penicillin resistant or allergy: ceftriaxone
- Duration: 14-21 days
Should PO or IV antibiotics be used for meningitis?
IV
How long should empiric treatment be if cultures come back negative?
14 days (10 days on NICE)
What age can dexamethasone be used as adjunct?
3 months
Which bacteria can dexamethasone be used for and why?
H influenzae (less hearing loss), S pneumo (less hearing loss & mortality)
