Week 221 - Meningitis Flashcards by Tom Lawson

Week 221 - Meningitis: What are the risk factors for developing meningitis?

Age 60
DM
Renal or adrenal insufficiency
Immunosupression
Sickle cell disease
Alcoholism and cirrhosis
Recent exposure to meningitis
Contiguous infection
Dural defect
IV drug abuse

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Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates (<1month)?

E.Coli
Pneumococcal meningitis
Listeria monocytogenes
Nisseria meningitides

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Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children older than 2 months?

Pneumococcocal
N. Menigitides
H. Influenza

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Week 221 - Meningitis: What are the two main mechanisms by which bacteria enter the subarachnoid space?

Haematogenous spread from respiratory tract.

* Direct spread from a contiguous infection (sinusitis, mastoiditis) or from an injury.

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Week 221 - Meningitis: What are the symptoms of meningism?

Photophobia
Headache
Stiff neck

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Week 221 - Meningitis: You may not see meningism in babies, what are the symptoms that you may see that would suggest meningitis?

Hyper/hypothermia
change in sleeping or eating habits.
irritability or lethargy.
high pitched cry
bulging fontenelle

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Week 221 - Meningitis: What is Kernig’s sign?

Patient is in supine position, hip and knee is flexed to 90º, patient feels pain when leg is extended.

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Week 221 - Meningitis: What is Brudzinski sign?

When supine, passively flex neck, this causes the lower extremities (hips and knees) to flex.

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Week 221 - Meningitis: The non-blanching petechial rash is a sign of what?

Sepsis.

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Week 221 - Meningitis: What are the signs of encephalitis?

Fever, headache and decreased neurological function.

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Week 221 - Meningitis: Which investigations should be performed for suspected meningitis?

FBC, Coagulation studies, serum glucose.
ABG
Throat swab
H1N1
PCR
Lumbar puncture (if not contraindicated)

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Week 221 - Meningitis: A CT is indicated before a lumbar puncture in which patients?

> 60 y.o., immunocompromised, known CNS lesions, seizure within 1 week of presentation, suspicion of elevated ICP (Papilloedema, high BP but low HR).

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Week 221 - Meningitis: What are the absolute contraindications for a lumbar puncture?

Infected skin at site.
Raised ICP
Shock
Focal neurological signs
Unequal pressures between supratentorial and infratentorial compartments (from CT)

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Week 221 - Meningitis: What would you expect the lumbar puncture result to be in viral meningitis?

Opening pressure - Normal or High
Colour - Clear
Cells/mm - 5-1000
Predominant cell - Lymphocytes
CSF:plasma glucose - Normal
Protein - Normal

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Week 221 - Meningitis: What would you expect the lumbar puncture result to be in bacterial meningitis?

Opening pressure - High
Colour - Cloudy
Cells/mm - 100-50000
Predominant cell - Neutrophil
CSF:plasma glucose - Low
Protein - Elevated

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Week 221 - Meningitis: What would you expect the lumbar puncture result to be in tuberculous meningitis?

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Opening pressure - High
Colour - Cloudy/yellow
Cells/mm - 25-500
Predominant cell - Lymphocyte
CSF:plasma glucose - Low/very low
Protein - elevated

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in fungal meningitis?

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Opening pressure - High/Very high
Colour - Clear/cloudy
Cells/mm - 0-1000
Predominant cell - Lymphocyte
CSF:Plasma glucose - Normal/low
Protein - Normal

Week 221 - Meningitis: Which antibiotic should be used in neonates for listeria and Group b strep?

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Listeria - Ampicillin and Aminoglycoside/Cefotaxime

* Group B strep - Benzylpenicillin and cefotaxime

Week 221 - Meningitis: Which class of antibiotics is used to treat meningitis (not neonates)?

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Cephalosporin

Week 221 - Meningitis: Which antibiotic is used for the prophylaxis of meningitis?

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Ciprofloxacin

Week 221 - Meningitis: Which organisms that cause meningitis are routinely vaccinated against?

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H influenze
Menningococcal C
Strep Pneumoniae
MMR

Week 221 - Meningitis: What are the complications of meningitis?

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Focal neurological sequelae
Hemiparesis, Facial palsy
Visual field defects, hearing loss, blindness,
Syndrome of inappropriate ADH secretion.
Cranial nerve palsies

Week 221 - Meningitis: What are the measures in place to prevent transmission across the blood brain barrier?

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Capillaries have tight junctions that do not exist in normal circulation.
There is also a thick basement membrane.
There is active transport for certain metabolites whilst small molecules like 02,CO2 and hormones are able to diffuse across.

Week 221 - Meningitis: What are the names of the cells that line the choroid plexus and ventricles?

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Ependymal cells.

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates?

* E. Coli * Streptococci * Listeria

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children?

* H. influenza * Pneumococcal * Meningococcal

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in young adults?

* Pneumococcal | * Meningococcal

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in older adults?

* Pneumococcal * Listeria * Gram -ve organisms

Week 221 - Meningitis: Lyme disease is caused by which organism? What are the symptoms?

Borelia Burgdorferi | • Rash, arthritis, aseptic meningitis, focal nerve palsy, mild encephalopathy.

Week 221 - Meningitis: What are the features of viral meningitis?

* Acute onset of meningism, fever, irritability. * Usually self-limiting with complete recovery. * Often have systemic features.

Week 221 - Meningitis: Which organisms cause viral meningitis?

Echo, coxsackie, mumps, HIV.

Week 221 - Meningitis: Which organisms cause viral encephalitis?

* Herpes simplex 1 * Herpes simplex 2 * CMV * Herpes zoster * Arboviruses * HIV * Rubella/Toxoplasmosis

Week 221 - Meningitis: What are the features of viral encephalitis caused by Herpes simplex type 1?

* Mostly children and young adults. * Affects temporal and inferior frontal lobes. * Oedema, necrosis, haemorrhage, specific viral inclusion bodies. * 40-70% mortality if left untreated.

Week 221 - Meningitis: How much fluid should be given to a child experiencing shock due to meningitis?

• 20ml/kg (25% of circulating volume)

Week 221 - Meningitis: What family of viruses most commonly causes viral meningitis?

Enteroviruses (echo, coxsachie, polio)

Week 221 - Meningitis: Which bacteria is the most common cause of bacterial meningitis in the UK?

Neisseria meningitides - (Meningococcal)

Week 221 - Meningitis: What are the two sites where the blood brain barrier is most commonly crossed? What conditions commonly occur when pathogens cross at these sites?

* Brain microvascular endothelial cells - Causes encephalitis or brain abscess. * Choroid plexus - Causes meningitis.

Week 221 - Meningitis: Why is the choroid plexus a weak spot for the crossing of the blood-brain barrier?

Endothelium is fenestrated, tight junctions are weaker and epithelium has fast rate of endocytosis.

Week 221 - Meningitis Flashcards

(38 cards)