Meningitis

Question 1

What is the definition of meningitis?

Answer 1

Inflammation of meninges covering brain/spinal cord.

Question 2

What is the most common cause of meningitis?

Answer 2

Viral, but crucial to treat as bacterial until proven otherwise due to high mortality.

Question 3

In which age groups is bacterial meningitis most common?

Answer 3

Infants, teenagers, young adults.

Question 4

What are the causative organisms of bacterial meningitis in neonates (<1 month)?

Answer 4

streptococcus agalactiae (group B strep), escherichia coli, streptococcus pneumoniae, listeria monocytogenes.

Question 5

What are the causative organisms of bacterial meningitis in children and adults (>3 months)?

Answer 5

neisseria meningitidis, streptococcus pneumoniae, haemophilus influenzae type b (Hib).

Question 6

What is meningococcal meningitis caused by?

Answer 6

N. meningitidis.

Question 7

What symptoms are associated with meningococcal sepsis?

Answer 7

Non-blanching rash.

Question 8

What diseases are included under pneumococcal disease?

Answer 8

pneumonia, meningitis, sepsis.

Question 9

What characterizes aseptic meningitis in the CSF?

Answer 9

White blood cells, gram -ve stain, no bacterial culture.

Question 10

What accounts for over half of all cases of meningitis?

Answer 10

Viral infections.

Question 11

List some viral causative organisms of aseptic meningitis.

Answer 11

enteroviruses (e.g. coxsackievirus), herpes simplex virus, varicella-zoster virus, HIV, influenza, mumps.

Question 12

What is a rare but life-threatening cause of meningitis?

Answer 12

Fungal infections, particularly caused by Cryptococcus.

Question 13

What are some risk factors for meningitis?

Answer 13

• young age
• neonatal complications
• asplenia
• immunocompromise
• organ dysfunction
• smoking
• overcrowded living environments

Question 14

What is the classic triad of symptoms for meningitis?

Answer 14

• fever
• neck stiffness
• altered mental status

Question 15

What are some early non-specific features of meningitis?

Answer 15

• fever
• headache
• nausea and vomiting
• lethargy
• myalgia
• anorexia
• coryzal symptoms
• diarrhoea

Question 16

What are some later, specific features of meningitis?

Answer 16

• bulging fontanelle (infants)
• neck stiffness (children >1 year)
• photophobia
• non-blanching rash (petechiae or purpura)
• Kernig’s sign
• Brudzinski’s sign
• mottled skin, cold hands, and feet
• altered mental state
• shock
• neurological symptoms

Question 17

What is Kernig’s sign?

Answer 17

Pain & resistance on passive knee extension with hips fully flexed.

Question 18

What is Brudzinski’s sign?

Answer 18

Knees and hips flex on bending head forward.

Question 19

What is the recommended procedure for lumbar puncture in suspected meningitis?

Answer 19

Within one hour of hospital arrival, pre-antibiotic treatment if possible.

Question 20

What does CSF analysis show in acute bacterial meningitis?

Answer 20

WBC >100.

Question 21

What are some contraindications for lumbar puncture?

Answer 21

• raised ICP
• shock
• extensive or spreading purpura

Question 22

What are the aims of management for meningitis?

Answer 22

• supportive treatment
• treatment of causative organism
• treatment of complications

Question 23

What urgent treatment should be given for suspected meningococcal sepsis?

Answer 23

IV or IM benzylpenicillin.

Question 24

What antibiotic treatment is recommended for infants <3 months old with bacterial meningitis?

Answer 24

IV cefotaxime + amoxicillin/ampicillin.

Question 25

What antibiotic treatment is recommended for children >3 months old with bacterial meningitis?

Answer 25

IV ceftriaxone + IV dexamethasone.

Question 26

What prophylactic antibiotics should close contacts of a meningitis patient receive?

Answer 26

*ciprofloxacin* or *rifampicin*.

Question 27

What are some acute complications of bacterial meningitis?

Answer 27

* sepsis * septic shock * disseminated intravascular coagulation * cerebral oedema * raised ICP * seizures * coma * SIADH

Question 28

List some common permanent neurological sequelae after bacterial meningitis.

Answer 28

* hearing loss * seizures * motor deficit * cognitive impairment