What symptoms would prompt urgent action in a case of suspected meningitis?
If the patient has 2 of the following symptoms and is not yet in hospital administer benzylpenicillin 1.2g IM/IV
- Headache
- Pyrexia
- Neck stiffness
- Altered mental state
What is the glass test in suspected meningitis testing for?
Septicamic petechiae
What are the early symptoms of Meningitis?
- Headache
- Leg pains
- Cold hands and feet
- Abnormal skin colour
If in a case of meningitis there are signs of raised intracranial pressure, what do you do?
Summon help immediately and inform the neurosurgeons
What is the treatment for meningitis for children less than 3 months and adults older than 55 yrs?
Cefotaxime + Ampicillin/Amoxicillin
What is the treatment for meningitis in children and adults <55 yrs?
Cefotaxime
What does the amipicillin/amoxicillin in the treatment of children <3 months and adults over 55yrs cover?
Listeria monocytogenes
What are the 2 signs that can be looked for in a suspected case of meningitis?
Kernigs sign and brudzinskis sign
What is brudzinskis sign?
Sever neck stiffness causes the patients hips and knees to flex when their neck is flexed
What is kernigs sign?
Severe stiffness of the hamstring causes an inability to straighten the leg when the hip is flexed to 90°
What are 4 later stages of meningitis?
- Meningism → Neck stiffness, Photophobia, kernigs sign
- ↓ Conscious lvl
- Seizures → ± focal CNS signs ± opisthotonus
- Petechial rash → May be only 1 or 2 spots
What do you give a patient in suspected viral meningitis?
Aciclovir
What is the main contraindication for a lumbar puncture in suspected meningitis?
Raised intracranial pressure
What are the NICE recommended first line investigations for suspected Meningitis?
- full blood count
- CRP
- coagulation screen
- blood culture
- whole-blood PCR
- blood glucose
- blood gas
When would you do a lumbar puncture?
- Usually after a CT head
* BUT if GCS 15, no symptoms of raised intracranial pressure and no focal neurological deficit then can be done without.
What is viral meningitis often called?
Aseptic meningitis
What are the 3 most common causative agents of meningitis in children <3 months old?
- Group B Streptococcus (most common cause in neonates)
- E. coli
- Listeria monocytogenes
What are the most common causative agents of Meningitis in children aged 3 months - 6 yrs?
- Neisseria meningitidis
- Streptococcus pneumoniae
- Haemophilus influenzae
What are the most common causative agents of Meningitis in patients aged 6 yrs - 60 yrs?
- Neisseria meningitidis
* Streptococcus pneumoniae
What are the most common causative agents of meningitis in patients aged over 60yrs?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Listeria monocytogenes
What is the main causative agent in meningitis in patient who is immunosuppresed?
Listeria monocytogenes
What would you find in bacterially infected CSF?
- Cloudy appearance
- ↓ glucose → < 1/2 blood glucose score
- ↑ protein → High (> 1 g/l)
- ↑↑ White cell count → 10 - 5,000 polymorphs/mm³
What would you find in a virally infected CSF?
- Clear cloudy appearance
- reduced glucose → 60-80% predicted
- Normal/raised protein
- ↑ Whitebloodcells → 15 - 1,000 lymphocytes/mm³
What would you find in tuberculous Meningitis CSF?
- Slight cloudy, fibrin web appearance
- ↓ glucose → < 1/2 blood glucose score
- ↑ Protein → High (> 1 g/l)
- ↑ Whitebloodcells → 10 - 1,000 lymphocytes/mm³
