Meningitis?

Question 1

define meningitis?

Answer 1

inflammation of the leptomeningeal (pia and arachnoid mater) coverings of the brain, most commonly due to infection

Question 2

most common causative agent of meningitis?

Answer 2

Streptococcus pneumoniae

Question 3

bacteria causing meningitis in 0-3 months?

Answer 3

• Group B streptococci
• Escherichia coli -
• Listeria monocytogenes

Question 4

bacteria causing meningitis in 3 MONTHS – 6 YEARS ?

Answer 4

• Haemophilus influenzae -
• Neisseria meningitidis -
• Streptococcus pneumoniae +

Question 5

bacteria causing meningitis in 6- 60 years?

Answer 5

• Neisseria meningitidis -UNIVERSITY STUDENTS
• Streptococcus pneumoniae +
• Tuberculosis

Question 6

bacteria causing meningitis in >60 years?

Answer 6

• Streptococcus pneumoniae +

* Listeria monocytogenes

Question 7

bacteria causing meningitis in immunosuppressed?

Answer 7

• Listeria monocytogenes

Question 8

most common viral cause of meningitis?

Answer 8

o Enteroviruses

Question 9

most common fungal cause of meningitis?

Answer 9

o Cryptococcus

Question 10

risk factors of meningitis?

Answer 10

o	Close communities (e.g. college halls)  
o	Basal skull fractures  
o	Mastoiditis  
o	Sinusitis  
o	Inner ear infections  
o	Alcoholism 
o	Immunodeficiency 
o	Splenectomy  
o	Sickle cell anaemia  
o	CSF shunts  
o	Intracranial surgery

Question 11

presenting complaints of meningitis?

Answer 11

• Severe headache
• Photophobia
• Neck stiffness
• Irritability
• Drowsiness
• Vomiting
• High-pitched crying or fits (common in children)
• Reduced consciousness
• Fever

Question 12

signs of meningism?

Answer 12

o Photophobia
o Neck stiffness
o Kernig’s Sign - with the hips flexed, there is pain/resistance on passive knee extension
o Brudzinski’s Sign - flexion of the hips when the neck is flexed

Question 13

signs of infection?

Answer 13

o	NON BLANCHING rash 
o	Fever  
o	Tachycardia 
o	Hypotension 
o	Altered mental state

Question 14

first line investigation?

Answer 14

Bloods 
o	Two sets of blood cultures 
o	FBC 
o	CRP 
o	Coagulation screen  
o	Blood glucose
o	Blood gas

Question 15

gold standard investigation?

Answer 15

Lumbar Puncture

Question 16

what might a bacterial CSF show?
Appearance
Glucose
Protein
White cells

Answer 16

Cloudy
Low (< 1/2 plasma)
High (> 1 g/l)
10 - 5,000 polymorphs/mm³

Question 17

what might a viral CSF show?
Appearance
Glucose
Protein
White cells

Answer 17

Clear/cloudy
60-80% of plasma glucose*
Normal/raised
15 - 1,000 lymphocytes/mm³

Question 18

what might a TB CSF show?
Appearance
Glucose
Protein
White cells

Answer 18

Slight cloudy, fibrin web
Low (< 1/2 plasma)
High (> 1 g/l)
30 - 300 lymphocytes/mm³

Question 19

what might a fungal CSF show?
Appearance
Glucose
Protein
White cells

Answer 19

Cloudy
Low
High
20 - 200 lymphocytes/mm³

Question 20

immediate management plan for meningitis in GP setting?

Answer 20

o IM Benzylpenicillin may be used straight away in a GP setting

Question 21

immediate management plan for meningitis in hospital?

Answer 21

IV Antibiotics (before LP) 
o	First choice: IV cefotaxime

Question 22

what should be given along side antibiotics?

Answer 22

• Dexamethasone IV

Question 23

what Prophylaxis should be given?

Answer 23

o Oral ciprofloxacin or rifampicin

Question 24

complications of meningitis?

Answer 24

• Septicaemia - LOW BP
• Sensorineural hearing loss – most common complication
• Shock
• DIC
• Renal failure
• Seizures
• Peripheral gangrene
• Cerebral oedema
• Cranial nerve lesions
• Cerebral venous thrombosis
• Hydrocephalus

Question 25

prognosis of bacterial meningitis?

Answer 25

worse with sepsis

Question 26

prognosis of viral meningitis?

Answer 26

self limiting - will recover with no medication