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Meningitis is a condition caused by inflammation of the meninges (the…
Meningitis is a condition caused by inflammation of the meninges (the outer membranes covering the brain and spinal cord).
Causes
infective- Bacterial, Viral and Fungal
non infective -certain cancers, autoimmune disorders, injury, and drugs
In neonates (younger than one month of age), Streptococcus agalactiae, Escherichia coli, S. pneumoniae, and Listeria monocytogenes are the most common causative organisms
Bacterial meningitis: can be life threatening and often affects babies and young children.
Neisseria meningitidis infection can result in bacterial meningitis, or meningococcal septicaemia (when N. meningitidis infection enters the bloodstream).
Meningococcal disease refers to meningococcal meningitis, meningococcal septicaemia, or a combination of both.
Transmission
Neisseria meningitidis is usually commensal
Incubation period usually 2-7 days
Bacterial meningitis and meningococcal disease are transmitted through close contact via droplets or secretions from the upper respiratory tract. Transmission usually requires either frequent or prolonged close contact.
References
https://cks.nice.org.uk/meningitis-bacterial-meningitis-and-meningococcal-disease#!management
Management
In any concerning cases arrange emergency admission to secondary care for assessment and management.
In non-blanching rash or meningococcal septicaemia – emergency admission 999 ambulance, while awaiting can administer benzylpenicillin (GPs carry) if not contraindicated.
Risk Factors
History of basal skull fractures with leakage of cerebrospinal fluid.
Winter season
Young or older 65s- Immunocompromised
Absent or non functioning spleen
Organ dysfunction
Smoking including passive
Over crowding living
Complications
Hearing Loss
Seizures
Death
Cognitive impairment
Motor deficit
Hydrocephalus
Visual Disturbance
Diagnosis
Note that symptoms can present as non-specific and mirror other less serious infections. In infants there may be no symptoms. Be aware that symptoms and patient condition can change rapidly. Note parent/carer concern and escalate any possible cases of concern to secondary care for immediate assessment
Possible symptoms-Fever, vomiting, irritable/lethargic, ill appearance, refusal of diet and fluids, headaches, muscle ache and respiratory symptoms.
More specific symptoms: non blanching rash, stiff neck, crt <2 seconds, unusual skin colour, shock, back rigidity, bulging fontanelle, paresis, seizures or photophobia.
Less common symptoms may include shivers/chills, diarrhoea or abdominal pain
Assessment- Obtain vital signs and conscious level and CRT time.
Assess the rash as per guidance (colour/blanching/spreading/size).
Examination-Whole body for rash and unusual skin colour.
Differentials
Other infective meningitis’.
Viral encephalitis.
Brain and CNS malignancy.
Brain or spinal epidural abscess.
Autoimmune disorders.