How common is it + who does it affect
- 2-5 per 100,000 acute bacterial
- Everyone but mainly elderly, infants, young children
What are the organisms that cause meningitis
- Meningococcus e.g. neisseria meningitides
- Pneumococcus e.g. strep pneumoniae
- Less commonly –> H. influenza, listeria monocytogenes (neonates), CMV, cryptococcus or TB if immunocompromised
What is more common viral or bacterial and which is more benign
Viral more common and more benign
How does meningitis spread
- Contact via droplets or secretions from URTI
- N. meningitides - 25% adolescent = asymptomatic carriers
- Pneumococcal disease (strep pneu) - close or direct contact w. resp droplets
- -> pneumococcal vaccine offered
What are the non-specific symptoms
- Fever, vomiting, lethargy, irritability, ill appearance, refusing food/drink, headache, muscle ache, resp symptoms
LESS COMMON
- chills/shivering, diarrhoea, abdo pain/distension, sore throat
What are the specific symptoms
- Non-blanching rash
- Stiff neck
- Cap refill >2s
- Unusual skin colour
- Shock + hypotension
- Leg pain
- Back rigidity
- Bulging fontanelle
- Photophobia
- Unconsciousness, paresis, seizures, focal neurological deficit
What are the signs of meningitis
- Kernig’s sign - unable to extend at knee when hip flexed
- Brudzinski’s sign - pt’s knee + hips flex when neck flexed
Describe the rash
- Non-blanching rash
- Scanty petechial rash - red/purple non-blanching macules <2mm
- Purpuric (haemorrhagic) rash >2mm
^^ chance MENINGOCCOAL DISEASE IN INFANT –> If petechiae starts to spread/becomes purpuric/ signs bacterial/ signs meningococcal septicaemia
N.B. pneumococcal meningitis rarely presents w/ rash
How do you investigate meningitis
- AVPU, HR + BP, RR, SpO2, °c, cap refill, throat swab (1 viral, 1 bacterial)
- Check for signs of shock
- Lumbar puncture (usually after CT) measure opening pressure (may be >40, normally 7-18cm)
- Send CSF off MC&S, gram stain, protein, glucose, virology/PCR, lactate
How do you treat it
Non-blanching rash or meningococcal septicaemia
- Benzylpenicillin/ cefotaxime
W/out non-blanching rash
- do not give Abx unless urgent transfer not poss
- Benzylpenicillin, cefotaxime, chloramphenicol
Corticosteroids used in adjunctive therapy
IDENTIFY THOSE AT RISK + give prophylactic treatment
What are the complications + prognoses of meningitis
- Top 10 cause of infection-related death
- Hearing loss (1/3rd)
