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Flashcards in Meningitis Deck (10)
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1
Q

Definition

A

Acute inflammation of the protective coverings - leptomeinges (arachnoid and pia matter) and spinal cord

2
Q

Classification

A
  • Acute pyogenic- bacterial
  • aspetic - viral
  • chronic - TB, Spirochetal
3
Q

Causes of bacterial meningitis

A
  • neonates - escheria coli, + group B strep
  • young adults - Neisseria menigitis
  • Adults- neiseeria meningitis (meningococcus), strep pneumonia (pneumococcus), haemophillus influenza
4
Q

cause of viral meningits

A

enterovirus

5
Q

Early clinical features

A
  • headache
  • leg pains
  • cold hands and feet
  • abnormal skin colour
6
Q

Later

A

Meningism

  • neck stiffness
  • photophobia
  • kernigs sign (flex the knee at 90 degrees)

Decreased conscious level

Petchial rash - non-blanching

Focal signs CNS

Seizures

7
Q

Investigations

A
  • Throat swab - 1 for bacteria 1 for virus
  • FBC
  • U and Es
  • Retal swab
  • Lumbar puncture - raised protein and glucose
8
Q

Management

A
  1. start antiiotics immediately (penicillin) - pre hospital
  2. airways, breathing, circulation
  3. Blood cultures if possible
  4. lumbar puncure- confirm
  5. CT prior to LP nly if (mass or cerebral oedema)
  6. 3rd Generation Cephalosporins should be used and vancomycin +/- rifampicin should be added if penicillin-resistant pneumococcus is suspected.
  7. Patients older than 55 years and those with immunosuppression should receive high dose amoxicillin +/- gentamicin to empirically treat listeriosis.
    Antibiotic therapy should be given prior to CT scanning.
  8. CT scans should be performed in patients with suspected pneumococcal meningitis and in all patients >60 years, those with history of CNS disease or immunosuppression and those with reduced LOC, seizures or neurological signs.
  9. Dexamethasone 10mg 6 hourly should be administered to all patients with suspected BM either prior to or at the time of antibiotic administration and should be continued for 4 days in those with suspected pneumococcal meningitis.
  10. AB therapy should continue for about 7 days in meningococcal and at least 2 weeks in pneumococcal meningitis.
  11. All patients with BM should have audiometry assessed following recovery.
9
Q

Public health measures

A
  • all suspected should be reported to public health
  • neuro-cognitive dollow up
  • immunisation against pnemococcal in splentonised patients
10
Q

Ab therapy

A
  • Treat meningococcal (1 wee)
  • Treat pneumococcal 2 weeks

Rifampicin- all houselhold patents and contacts

3rd generation cephalosporins (ceftriaxone - aduls and children, ceftriazone in pregnany) and vancomycin +/- rifampicin if penicillin-resistant pneumococcus suspected

Patients older than 5 should receive a haigh dose of amoxicillin +/- gentamicin to empiraclly treat listerisos