Meningitis

Inflammation of the meninges (lining of the brain and spinal cord)

Aetiology

  • Bacterial - Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus) in children and adults, group B strep in neonates
  • Viral - herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV)

Clinical presentation

Symptoms

  • Fever
  • Neck stiffness
  • Vomiting
  • Headache
  • Photophobia
  • Altered consciousness and seizures

Signs

  • Where there is meningococcal septicaemia children can present with a non-blanching rash
  • Absence of a rash does not exclude meningitis
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Investigations

  • Lumbar puncture

Management

Bacterial

  • Under 3 months - cefotaxime plus amoxicillin 
  • Above 3 months - ceftriaxone
  • If penicillin allergic: chloramphenicol
  • Steroids e.g. dexamethasone are also used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological damage

Viral

  • Tends to be milder and often only requires supportive treatment
  • Aciclovir can be used to treat suspected or confirmed HSV or VZV infection