Meningitis

Bacterial Meningitis

In children, the most common causes are Neisseria Meningitidis (aka Meningococcus) and Strep Pneumoniae (aka Pneumococcus).

In neonates, the most common cause is Group B Strep (GBS), which is usually contracted during birth from the floral GBS living in the vagina.

Presentation:

• Neck stiffness

• Headache

• Photophobia

• Fever

• Vomiting

• Non-blanching rash – Occurs in Meningococcal Septicaemia

  • Due to the infection causing DIC and Subcutaneous haemorrhaging

• In babies, symptoms can be very non-specific – Poor feeding, Lethargy, Bulging fontanelle, Hypotonia, Hypothermia

Investigations:

• Kernig’s or Brudzinski’s tests – Done to stretch the meninges and cause resistance to movement

• Lumbar Puncture

• Blood and CSF culture

• Meningococcal PCR if suspected

Management:

• Community – Benzylpenicillin before hospital admission

• Hospital

  • < 3 months – Cefotaxime + Amoxicillin

  • > 3 months – Ceftriaxone

• Dexamethasone – Reduces risk of hearing loss

Viral Meningitis

The most common causes are HSV, Enterovirus, and VZV.

Management:

• Supportive management often all that’s needed

• Aciclovir can be used if suspected/confirmed HSV/VZV

Complications

• Hearing loss – key one to remember

• Seizures and epilepsy

• Learning disability

• Cerebral palsy

CSF Findings

• Bacterial - Cloudy, High protein, Low glucose, High neutrophils

• Viral - Clear, High protein, Normal glucose, High lymphocytes

N.B. Glucose is typically low as bacteria uses it up as an energy source. Protein is raised due to bacterial/viral replication.

N.B. TB CSF is very similar to viral CSF, but with a slightly decreased glucose i.e. mixed picture.