Meningitis

• inflammation of the meninges

Organisms

• Neonates
  • Escherichia coli
  • Group B Streptococcus
  • Listeria monocytogenes
  • Salmonella
• < 5years
  • Neisseria meningitidis
  • (Haemophilus Influenzae)
    • should be reduced incidence due to vaccination
• Teenage, young adult
  • Neisseria meningitidis
  • Viral Meningitis
• Older adults
  • Streptococcus pneumoniae
• Immunosuppressed
  • Mycobacterium tuberculosis
  • Cryptococcus
• Shunts
  • Staphylococcus
    • Staphylococcus epidermidis
    • Staphylococcus aureus

History

• fever
• headache
• vomiting
• photophobia

Examination

• bulging fontanelle
• pallor
• cerebral irritation
  • high-pitched cry
• neck stiffness
• pain on straight leg raising
• impaired consciousness level
• purpuric / petechial rash (meningococcal meningitis)

Tuberculous meningitis

• more insidious onset
• developing over days to weeks
  • drowsiness
  • headache
  • neck stiffness
  • vomiting
  • mood changes
  • anorexia
  • cranial nerve palsies, focal neurological deficits
  • coma

Investigations

• lumbar puncture

Treatment

• benzylpenicillin IV immediately if meningococcal suspected
• ceftriaxone if in hospital, no rash
• under 3 months give ampicillin (against Listeria)
• Rifampicin to eliminate nasal carriage of N. meningitidis / H. influenzae
  • 2-4 day course to household contacts
• If H.influenzae then corticosteroids reduce risk of hearing loss
• Regular paracetamol
• monitor fluid balance

Complications

• Neurological
  • Brain Abscess
  • obstructive Hydrocephalus
  • subdural empyema
  • Epilepsy
  • Intellectual deficit
  • Deafness (especially with Haemophilus Influenzae)
• Septicaemia
• Arthritis
• Skin-necrosis
• subacute / chronic allergic due to immune complex deposition
  • arthritis
  • cutaneous vasculitis
  • episcleritis
  • pericarditis

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