Meningitis
Blood pressure and urine protein (to exclude pre-eclampsia), urinalysis and culture, and a lumbar puncture if meningitis is suspected.
Meningitis
- Presentation: Severe infection of the meninges. High fever, severe headache, nuchal rigidity (stiff neck), altered mental status, photophobia, and seizures. Infants may present with irritability, poor feeding, and a bulging fontanelle. Kern
- Complications: High mortality and significant neurological sequelae (e.g., hearing loss, developmental delay).
Read this in Streptococcus pneumoniae: Characteristics, Pathogenesis, and Management
What our notes say
- Blood pressure and urine protein (to exclude pre-eclampsia), urinalysis and culture, and a lumbar puncture if meningitis is suspected. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- Lumbar puncture when the baby is stable (cells, protein, glucose and culture) to exclude meningitis, and urine culture in late-onset sepsis. (Integrated case paper: Medicine, Surgery, Gynaecology and Paediatrics (160 marks)
- Imaging: chest X-ray for pneumonia, abdominal X-ray if necrotising enterocolitis is suspected, and cranial ultrasound if there is meningitis. (Integrated case paper: Medicine, Surgery, Gynaecology and Paediatrics (160 marks)
- Parapneumonic effusion and empyema, lung abscess, sepsis and septic shock, respiratory failure and ARDS, pleurisy, pericarditis, lobar collapse, metastatic infection (meningitis, endocarditis, arthritis), bronchiectasis (long term). (Pneumonia)
- Empyema and bronchopleural fistula, massive haemoptysis, spread (brain abscess, meningitis), sepsis, amyloidosis (chronic), chronic cavity that becomes colonised by *Aspergillus* (aspergilloma), recurrent infection. (Lung Abscess)
- Bacterial meningitis: stat ceftriaxone and lumbar puncture (Treatment of Infectious Disease: 5-case clinical quiz)
Study material on Meningitis
- Cryptococcal Meningitis: Symptoms, Causes & Fungal Treatment
- Streptococcus Classification, S. pyogenes, Rheumatic Fever, AGN
- Medical Microbiology III Exam: Viruses, Fungi & Diagnosis
- MASTER PHARMACOLOGY NOTES
- Pharmco Notes
- Streptococcus pneumoniae: Characteristics, Pathogenesis, and Management
- EXAM: Vaccines & Antivirals, Rabies, CMV & EBV, Adenovirus & Enteroviruses
- CNS PATHOLOGY
- Pharmacology CRASH Course
- Antifungals, Antivirals, Antihelminthics & Antiprotozoals
- MEDICAL BACTERIOLOGY (MBMM3311) - MCQs
- Medical Bacteriology MCQs
- MBPL3822 Chemotherapy CAT 1 MCQs
- Weekly Year 2: Microbiology Exam - June 12, 2026 (Section A: MCQs)
- Weekly Year 2: Microbiology Exam - May 29, 2026 (Section A: MCQs)
- Weekly Year 2: Microbiology Exam - April 21, 2026 (Section A: MCQs)
Practice questions on Meningitis
Which of the following microorganisms can be part of normal vaginal flora and can cause meningitis in newborns?
- Corynebacterium species
- Ureaplasma urealyticum
- Staphylococcus epidermidis
- Group B Streptococci
Answer: D. Group B Streptococcus can be vaginal flora and cause neonatal meningitis. ---
Which of the following is NOT a most important cause of acute bacterial meningitis in adults?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Haemophilus influenzae type b
- Listeria monocytogenes
Answer: C. While Haemophilus influenzae type b (Hib) is a significant cause of meningitis, it is more common in unvaccinated children. In adults, Streptococcus pneumoniae and Neisseria meningitidis are the most common bacterial causes of meningitis.
A 20-year-old woman presents to the emergency room with headache, stiff neck, and fever for 2 days and is diagnosed with meningitis. Which is the best agent for the treatment of meningitis in this patient?
- Cefdinir
- Cefuroxime axetil
- Cefotaxime
- Cefazolin
- Limited to a single tissue compartment
Answer: A. Cefotaxime is a 3rd generation cephalosporin with excellent CSF penetration and broad coverage against common meningitis pathogens (S. pneumoniae, N. meningitidis, H. influenzae). Cefdinir and cefuroxime axetil are only available orally and not appropriate for serious CNS infections. Cefazolin has inadequate CSF penetration and spectrum. ---
Which of the following is NOT the most important cause of acute bacterial meningitis?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Streptococcus pyogenes
- Hemophilus influenza Answer:
Answer: A. *S. pyogenes* is not a major cause of bacterial meningitis; the other three (pneumococcus, meningococcus, *H. influenzae*) are classic major causes depending on age group. --- ---
A 28-year-old female sex worker with HIV presents with headaches and CSF showing reduced glucose, elevated protein, 450 mononuclear cells/mL. Compatible with Cryptococcus, Coccidioides, or Candida meningitis. Which test is confirmatory for Candida?
- Positive CSF cryptococcal capsular antigen test
- Positive CSF complement fixation antibodies to coccidioidin
- Microscopic observation of oval yeast cells and pseudohyphae in CSF
- Positive skin test to coccidioidin
Answer: C. For Candida meningitis, microscopic observation of oval yeast cells and pseudohyphae in the CSF is confirmatory. Cryptococcus is confirmed by antigen tests, and Coccidioides by serology (complement fixation). ---
The following are characteristics of Aseptic meningitis except
- CSF culture shows absence of bacterial organisms
- Mainly viral in aetiology
- More fulminant than pyogenic meningitis
- Enteroviruses are the most common aetiological factors
- CSF glucose is almost always normal ✅ Answer: C
Answer: A. Aseptic meningitis is typically less fulminant and has a milder course compared to pyogenic (bacterial) meningitis.