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Meningitis

From Mediwikis

Bacteria, viruses or fungi can cause Meningitis. Viruses are the most common cause, and bacteria cause a quicker, more severe picture with a high risk of complications. Infectious in a similar way to the flu, or by skull fractures or previous illness elsewhere in the body.

Symptoms

Early

Symptoms of Meningitis.png

Nonspecific:

  • Severe Headache
  • Leg Pains
  • Cold hands + feet
  • dusky skin tone

Late

  • Neck Stiffness
  • Pyrexia
  • Photophobia,
  • ↓Conciousness
  • Seizure
  • Petechial Rash

If any of the bold symptoms appear, assume Meningitis, and treat urgently.

Signs

  • Kernig's sign(extension of leg on flexed hip creates sacral pain)
  • Non-blanching rash means meningococcal septicaemia
  • Signs of sepsis: ↓BP, ↑Pulse, ↑Temperature.
  • Papilloedema indicates ↑Intracranial Pressure.

Investigations

  • Full Range of U+E, FBC, LFT, Glucose, Blood culture, Arterial Blood Gases
  • Throat swabs.
  • A Lumbar Puncture is required only if a rash is not present; a non blanching rash means meningococcal septicaemia.
    • Prior to performing an LP, perform a CT to check for raised intracranial pressure- if present, don't do the LP, this can lead to coning of the brainstem!

Bacteriology

Age:

  • <3 months= Group B Streptococcus
  • 1 month- 6 years old= Neisseria meningitidis (and Haemophilus influenzae type B in countries that do not offer vaccination)
  • 6 years or greater= Streptococcus pneumonia

Management

  • Stablise using ABCDE approach
  • First line antibiotics are Cefotaxime/Ceftriaxone and Ampicillin, once pathogen is known, this may be adapted.
  • Steroids also play a role in reducing inflammation.
  • Meningitis is a public health issue, so contact tracing and prophylaxis for partners and the patient's household is important.

Complications

  • Deafness
  • Epilepsy
  • Cognitive Impairment