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.
- Severe Headache
- Leg Pains
- Cold hands + feet
- dusky skin tone
- Neck Stiffness
- Petechial Rash
If any of the bold symptoms appear, assume Meningitis, and treat urgently.
- 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.
- 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!
- <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
- 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.
- Cognitive Impairment