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Meningitis 101

Meningitis 101. Armaan Khalid. What is meningitis?. Inflammation of the meninges Implies undercurrent infection Types of infection Bacterial Viral Fungal/Parasite At risk Young/Elderly Immunocompromised Sepsis Cranial trauma. Common causative organisms.

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Meningitis 101

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  1. Meningitis 101 Armaan Khalid

  2. What is meningitis? • Inflammation of the meninges • Implies undercurrent infection • Types of infection • Bacterial • Viral • Fungal/Parasite • At risk • Young/Elderly • Immunocompromised • Sepsis • Cranial trauma

  3. Common causative organisms • Neisseria meningitidis* (serogroup B) • Strep pneumoniae* • HIb • L monocytogenes • Group B Strep • Gram negative bacilli • Staph aureus 70% of acute bacterial meningitis outside neonate period

  4. Clinical Features • Meningitic Syndrome • Headache • Neck stiffness • Fever • Other Signs/Symptoms • Vomiting • Photophobia • Rigors • Petecchial rash (N meningitidis) • Kernig’s & Brudzinski’s sign

  5. Bacterial VS Viral Meningitis • Viral meningitis • Usually less prominent signs • Duration less acute • Self limiting in nature * Bacterial meningitis may ‘masquerade’ as viral meningitis

  6. Differential Diagnosis • Meningitis • Septicaemia • Subarachnoid haemorrhage • Migraine • Mass lesion • Malaria

  7. Investigations • FBE, U&E, LFT, BSL, Coag screen • CRP, Blood culture • Lumbar puncture • Whole blood PCR (EDTA sample) • To confirm meningococcal disease • CT

  8. Lumbar Puncture • Primary investigation • Do not delay empirical Abx to do LP • Done @ level of the iliac crest • L3-4 • Should feel slight ‘give’ once in subarachnoid space

  9. When LP is CI

  10. Raised ICP • CI in Lumbar Puncture

  11. Management • Time is of the essence, don’t delay Rx • If referred from GP, ensure IV/IM BenPen 1.2g is given • Empirical Abx • Ceftriaxone or Cefotaxime • Dexamethasone • 0.15mg/kg (max 10mg) QID for 4 days

  12. Mgmt of Bacterial Meningitis

  13. Role of Dexamethasone • Indicated in pt > 3mths w empirical Abx when CSF shows: • Frankly purulent • CSF WBC count > 1000/microlitre • CSF protein > 1g/litre • Bacteria on Gram stain

  14. Things to note • Immunisations • Make sure you are immunised for meningococcal (A & C) and HIb • Especially impt for college students • Contact tracing • Close contacts should be given oral ciprofloxacin or rifampicin & consider immunisation

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