DR Medhat MRCP

• General C/P : ( it`s not a must to have all the features for diagnosis)
1) Fever , headache & hypotension (in severe cases).
2) Haemorrhagic skin rash/trunk & extremities may appear.
3) Neck rigidity.
4) Back rigidity.
5) Kernig's sign is positive .
6) Brudzinski's sign is positive
7) Altered mental status .
8) Seizures.
• CSF findings :
Bacterial Viral TB
Appearance Cloudy Clear/cloudy Fibrin web
Glucose Low (< 1/2 plasma) Normal (low in mumps) Low (< 1/2 plasma)
Protein High (> 1 g/l) Normal/raised High (> 1 g/l)
White cells/mm³ 10 - 5,000 polymorphs 15 - 1,000 lymphocytes 10 - 1,000 lymphocytes
- The Ziehl-Neelsen stain is only 20% sensitive in the detection of tuberculous
meningitis and therefore PCR is sometimes used (sensitivity = 75%).
• Management of meningiococcal meningitis :
1) Penicillin (benzyl penicillin) : is the drug of choice.
2) If penicillin allergic With H/O anaphylaxis Chloramphenicol
No H/O anaphylaxis Cefotxime
• BNF recommendations for antibiotics in suspected meningitis :
Scenario
Initial empirical therapy aged < 3
months OR > 50 years
Initial empirical therapy aged 3
months - 50 years
Meningococcal meningitis
Pneuomococcal meningitis or
Haemophilus influenzae
Meningitis caused by Listeria
BNF recommendation
I.V Cefotaxime + Amoxicillin
I.V Cefotaxime
I.V Benzylpenicillin or Cefotaxime
I.V Cefotaxime
I.V Amoxicillin + Gentamicin
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