ID - Meningitis Flashcards Preview

Year 3 - Medicine Block 2 > ID - Meningitis > Flashcards

Flashcards in ID - Meningitis Deck (8)
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1
Q

name the common symptoms of meningitis

A
  1. headache
  2. neck stiffness
  3. fever
  4. photophobia
  5. seizures
2
Q

name the common signs of meningitis

A
  1. signs of meningeal irritation:
    • nuchal rigidity
    • +ve Kernig’s sign (pain and resistance on passive knee extension when hips are fully flexed)
    • +ve Brudzinski’s sign (hips flex on bending head forwards)
    • +ve JOLT test (worsened headache on rapidly moving head from side to side)
  2. non-blanching petechial/purpuric rash (meningococcal meningitis)
  3. cranial and peripheral n. examination: paresis (partial paralysis) and focal neurological deficits (inc.. abnormal pupils)
  4. signs of shock, e.g. tachycardia, hypotension, resp. distress, altered mental state, decreased UO
  5. bulging fontanelle (in infants)
3
Q

name the causative agents of meningitis in neonates, 2-5 yrs, 5-30 yrs and elderly/immunocompromised

A
  • neonates: E. coli, L. monocytogenes, group B streptococci
  • 2-5 yrs: H. influenzae type B
  • 5-30 yrs: N. meningitides, S. pneumoniae, H. influenzae type B
  • elderly: S. pneumoniae, L. monocytogenes, TB
4
Q

which Ix should be performed in a pt with suspected meningitis?

A
  1. Lumbar puncture - perform immediately if no signs of RICP (do CT head if doubt)
  2. Bloods
    - FBC: raised WCC
    - CRP: raised
    - UandEs: assess renal function
    - coagulation screen: ?DIC
    - blood culture and whole blood PCR for N. meningitidis (in children and young adults)
    - blood glucose
    - ABG: ?metabolic acidosis/sepsis
  3. Bedside tests
    - urine, stool and nasal swab: culture and virology
  4. Imaging
    - CXR: >lung abscess
    - MRI head: if ?complications
5
Q

how would you manage a pt with suspected meningitis in a pre-hospital situation?

A

Single dose of IV BENZYLPENICILLIN (or IM if vein not available) at earliest opportunity:

  • <1 yr - 300 mg
  • 1-9 yrs - 600 mg
  • > 10 yrs - 1,200 mg
6
Q

how would you initially manage a pt with meningitis?

A
  1. empirical antibiotic therapy (immediately after LP or straight away if LP delayed >30 mins): IV CEFTRIAXONE +/- ACYCLOVIR.
  2. DEXAMETHASONE 8.3 mg every 6 hrs for 4 days (steroids reduce risk of hearing loss and neurological sequelae).
  3. Supportive: fluids, analgesia, antipyretics…
7
Q

how would you adjust antibiotic Tx once causative MO identified?

A
  • N. meningitidis: IV CEFTRIAXONE 7 days min.
  • Group B streptococci: IV CEFOTAXIME 14 days min.
  • Listeriosis: add IV amoxicillin
  • Herpes simplex: acyclovir
8
Q

how can meningitis cause an acute adrenal crisis?

A

WATERHOUSE-FRIDERICHSEN SYNDROME: bilateral adrenal gland haemorrhage causing adrenal insfficiency