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  • Bacterial Meningitis: Jeremy Fernando (2011)

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    Surya Raj
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    Bacterial meningitis is a pyogenic infection of the cerebral ventricles and subarachnoid space that is usually confined to the meninges. It can be caused by several bacteria and transmitted through three routes. Symptoms include malaise, fever, headache, vomiting, and stiff neck. Examination may show altered level of consciousness and meningism. Investigations include lumbar puncture and CT head to identify the causative organism. Treatment involves early high dose antibiotics and dexamethasone to reduce complications which can include abscesses, cerebritis, deafness, and cognitive impairment. Public health measures are needed to control spread of certain bacteria like Neisseria meningitidis.

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    meningitis bakterialis

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    Bacterial Meningitis

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    Bacterial meningitis is a pyogenic infection of the cerebral ventricles and subarachnoid space that is usually confined to the meninges. It can be caused by several bacteria and transmitted through three routes. Symptoms include malaise, fever, headache, vomiting, and stiff neck. Examination may show altered level of consciousness and meningism. Investigations include lumbar puncture and CT head to identify the causative organism. Treatment involves early high dose antibiotics and dexamethasone to reduce complications which can include abscesses, cerebritis, deafness, and cognitive impairment. Public health measures are needed to control spread of certain bacteria like Neisseria meningitidis.

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    © All Rights Reserved
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    7 views2 pages

    Bacterial Meningitis: Jeremy Fernando (2011)

    Uploaded by

    Surya Raj
    Bacterial meningitis is a pyogenic infection of the cerebral ventricles and subarachnoid space that is usually confined to the meninges. It can be caused by several bacteria and transmitted through three routes. Symptoms include malaise, fever, headache, vomiting, and stiff neck. Examination may show altered level of consciousness and meningism. Investigations include lumbar puncture and CT head to identify the causative organism. Treatment involves early high dose antibiotics and dexamethasone to reduce complications which can include abscesses, cerebritis, deafness, and cognitive impairment. Public health measures are needed to control spread of certain bacteria like Neisseria meningitidis.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 2

    Bacterial Meningitis

    31/8/10
    PY Mindmaps
    Data Interpretation - Venkatesh

    = pyogenic infection of the cerebral ventricles and subarachnoid space -> CSF
    - usually confined to meninges (although in neonates and adults with Listeria monocytogenes
    -> cerebritis, encephalitis and abscesses can form)
    - 3 routes: vascular, transdural or tranparenchymal

    HISTORY

    - malaise
    - fever
    - headache
    - vomiting
    - stiff neck

    EXAMINATION

    - normal -> altered LOC -> coma


    - meningism
    - papilloedema

    INVESTIGATION

    - LP - ideally prior to antibiotics (chances of getting bug decrease dramatically, however need
    to give as early if new seizure, papilloedema, focal neurology), opening pressure, WCCs,
    decreased glucose
    - CT Head first if: (1) new onset seizures, (2) immunocompromised, (3) GCS < 10, (4) focal
    neurological signs in keeping with a space occupying lesion.
    - routine blood tests
    - blood cultures
    - enterovirus PCR
    - cryptococcal antigen
    - neurosyphillis
    - mycobacterium culture or PCR
    - immunocompromized + gram positive rods: Listeria

    MANAGEMENT

    Empiric Treatment

    - antibiotics within 30 min of initial assesment


    - dexamethasone 0.15mg/kg Q6 hourly
    - ceftriaxone (immunocompetent) or vancomycin + ciprofloxacin/moxifloxacin
    - ceftriaxone + benzylpencillin (immunocompromised to cover Listeria)
    - add vancomycin if staph seen on gram stain

    Jeremy Fernando (2011)


    Directed Treatment

    - Neisseria meningitidis benzylpenicillin OR ceftriaxone OR ciprofloxacin


    - Streptococcus pneumonia MIC <0.125mg/L to penicillin -> benzylpenicillin, MIC =
    0.125mg/L to pencillin -> ceftriaxone + vancomycin OR rifampicin OR moxifloxacin
    - Haemophilus influenzae ceftriaxone OR cefotaxime OR amoxicillin OR ciprofloxacin
    - Listeria monocytogenes penicillin OR amoxicillin OR co-trimoxazole
    - Streptococcus agalactiae benzylpenicillin
    - Cryptococcus neoformans or gattii amphortercin B + flucytosine then go to fluconazole
    once CSF clear

    COMPLICATIONS

    Intracranial

    - abscess
    - cerebritis
    - deafness
    - cognitive impairment
    - hydrocephalus

    Extracranial

    - septic shock
    - adrenal insufficiency from infarction (Waterhouse Friderichsen syndrome)
    - ARF
    - purpura fulminans
    - necrotising vasculitis -> skin necrosis and digital gangrene

    PUBLIC HEALTH CONSIDERATIONS

    - N. meningitidis -> requires respiratory isolation, prophylaxis for close contacts

    Jeremy Fernando (2011)

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