Meningococcal Meningitis And Septicaemia

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Meningococcal Meningitis And Septicaemia - Quiz

This quiz is based on the implementation of the current National Institute for Health and Clinical Excellence (NICE) UK Guideline for the management of bacterial meningitis and meningococcal septicaemia in children and young people in primary and secondary care.


Questions and Answers
  • 1. 

    Case fatality rates in bacterial meningitis in children and young people is:

    • A.

      1-2%

    • B.

      2-11%

    • C.

      15-20%

    • D.

      25-50%

    • E.

      Less than 1%

    Correct Answer
    B. 2-11%
    Explanation
    Bacterial meningitis in children and young people is associated with case fatality rates of 2-11%, the rate being particularly high (10%) in neonates

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  • 2. 

    The highest case fatality rates in bacterial meningitis is in the:

    • A.

      Neonates

    • B.

      Infants and toddlers

    • C.

      2 to 5years

    • D.

      School age between 5 and 10 years

    • E.

      Adolescence and early adulthood

    Correct Answer
    A. Neonates
    Explanation
    The fatality rate for meningococcal disease in childhood is highest (10%) in neonates.

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  • 3. 

    The two highest incidence of meningococcal disease occurs in what age groups are:

    • A.

      Children under 2 years

    • B.

      2 to 5years

    • C.

      School age between 5 and 10 years

    • D.

      Adolescence and early adulthood

    Correct Answer(s)
    A. Children under 2 years
    D. Adolescence and early adulthood
    Explanation
    The highest incidence of meningococcal disease occurs in children under 2 years, with further peaks in incidence occurring in adolescence and early adulthood.

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  • 4. 

    The NICE (UK) guideline was published in:

    • A.

      Jan 2010

    • B.

      June 2010

    • C.

      Jan 2009

    • D.

      Dec 2009

    • E.

      Oct 2010

    Correct Answer
    B. June 2010
    Explanation
    The NICE (UK) guideline was published in June 2010.

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  • 5. 

    Commonest causes of bacterial meningitis in neonates include:

    • A.

      S agalactiae (group B streptococcus)

    • B.

      E coli

    • C.

      N meningitidis (meningococcus)

    • D.

      Strep pneumoniae

    • E.

      Listeria monocytogenes

    Correct Answer(s)
    A. S agalactiae (group B streptococcus)
    B. E coli
    D. Strep pneumoniae
    E. Listeria monocytogenes
    Explanation
    In neonates, bacterial meningitis is often caused by organisms acquired from the maternal genital tract and gastrointestinal tract around the time of birth. Such organisms include S agalactiae (group B streptococcus), E coli, Strep pneumoniae, and Listeria monocytogenes.

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  • 6. 

    Commonest causes of bacterial meningitis in older children and young people include:

    • A.

      N meningitidis (meningococcus)

    • B.

      S agalactiae (group B streptococcus)

    • C.

      E coli

    • D.

      S pneumoniae (pneumococcus)

    • E.

      Haemophilus influenzae type b

    Correct Answer(s)
    A. N meningitidis (meningococcus)
    D. S pneumoniae (pneumococcus)
    E. Haemophilus influenzae type b
    Explanation
    In older children and young people, bacterial meningitis is usually caused by N meningitidis (meningococcus), S pneumoniae (pneumococcus), or Haemophilus influenzae type b, which colonise the upper respiratory tract and can cause invasive disease in susceptible people.

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  • 7. 

    Neisseria  Meningitidis is:

    • A.

      A heterotrophic gram-negative diplococcal

    • B.

      A heterotrophic gram-positive diplococcal

    • C.

      First discovered by Anton Weichselbaum in 1887

    • D.

      It exists as normal flora in the nasopharynx of up to 5-15% of adults.

    • E.

      Can be is spread through the exchange of saliva and chewing on toys

    Correct Answer(s)
    A. A heterotrophic gram-negative diplococcal
    C. First discovered by Anton Weichselbaum in 1887
    D. It exists as normal flora in the nasopharynx of up to 5-15% of adults.
    E. Can be is spread through the exchange of saliva and chewing on toys
    Explanation
    Neisseria Meningitidis is an heterotrophic gram-negative diplococcal first discovered by Anton Weichselbaum in 1887
    It exists as normal flora in the nasopharynx of up to 5-15% of adults.

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  • 8. 

    Associated signs in children with petechiae indicating high risk of having meningococcal disease include:

    • A.

      Spreading petechiae

    • B.

      The rash becoming purpuric or necrotic

    • C.

      The rash becoming pustular

    • D.

      Neck stiffness

    • E.

      Signs of shock

    Correct Answer(s)
    A. Spreading petechiae
    B. The rash becoming purpuric or necrotic
    D. Neck stiffness
    E. Signs of shock
    Explanation
    Give intravenous ceftriaxone immediately to children and young people with a petechial rash if any of the following occur at any point during the assessment (these children are at high risk of having meningococcal disease):
    − petechiae start to spread
    − the rash becomes purpuric
    − there are signs of bacterial meningitis
    − there are signs of meningococcal septicaemia
    − the child or young person appears ill to a healthcare professional

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  • 9. 

    What are the two confirmatory investigations of meningococcal meningitis and septicaemia?

    • A.

      Whole blood real-time PCR testing (EDTA sample) for N meningitides

    • B.

      Lumbar puncture

    • C.

      FBC

    • D.

      CRP

    • E.

      Blood Culture

    Correct Answer(s)
    A. Whole blood real-time PCR testing (EDTA sample) for N meningitides
    B. Lumbar puncture
    Explanation
    Special investigations for meningoccal disease are whole blood real time Polymerase chain reaction and LP to confirm a diagnosis of meningococcal disease.

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  • 10. 

    Signs of meningitis are:

    • A.

      Photophobia

    • B.

      Kernig’s sign or Brudzinski’s sign

    • C.

      Bulging fontanelle

    • D.

      Diarrhoea, abdominal pain, or distension

    • E.

      Focal neurological deficit

    Correct Answer(s)
    A. Photophobia
    B. Kernig’s sign or Brudzinski’s sign
    C. Bulging fontanelle
    D. Diarrhoea, abdominal pain, or distension
    E. Focal neurological deficit
    Explanation
    Signs of meningitis are Photophobia, Kernig’s sign or Brudzinski’s sign, Paresis or Seizures, Bulging fontanelle, Diarrhoea, abdominal pain, or distension, Focal neurological deficit.

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  • 11. 

    Signs of septicaemia are:

    • A.

      Toxic or moribund state

    • B.

      Shock

    • C.

      Hypotension

    • D.

      Leg pain

    • E.

      Sore throat or coryza

    Correct Answer(s)
    A. Toxic or moribund state
    B. Shock
    C. Hypotension
    D. Leg pain
    Explanation
    Signs of septicaemia include Impaired consciousness, Toxic or moribund state, Shock, Hypotension, Leg pain, Cold hands or feet

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  • 12. 

    Contraindications to a lumbar puncture are:

    • A.

      Signs suggesting raised intracranial pressure

    • B.

      Shock

    • C.

      Extensive or spreading purpura

    • D.

      Extreme preterm neonate

    • E.

      After convulsions until stabilised

    Correct Answer(s)
    A. Signs suggesting raised intracranial pressure
    B. Shock
    C. Extensive or spreading purpura
    E. After convulsions until stabilised
    Explanation
    Contraindications to a lumbar puncture include signs suggesting raised intracranial pressure, shock, extensive or spreading purpura, after convulsions until stabilised, coagulation abnormalities, local superficial infection at the lumbar puncture site, respiratory insufficiency

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  • 13. 

    Signs of shock include:

    • A.

      Capillary refill time longer than 2 seconds

    • B.

      Unusual skin colour

    • C.

      Tachycardia or hypotension

    • D.

      Respiratory symptoms or breathing difficulty

    • E.

      Leg pain

    Correct Answer(s)
    A. Capillary refill time longer than 2 seconds
    B. Unusual skin colour
    C. Tachycardia or hypotension
    D. Respiratory symptoms or breathing difficulty
    E. Leg pain
    Explanation
    Signs of shock include Capillary refill time longer than 2 seconds, Unusual skin colour, Tachycardia or hypotension, Respiratory symptoms or breathing difficulty, Leg pain, Altered mental state or decreased consciousness, Poor urine output

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  • 14. 

    Intravenous fluid resuscitation in meningococcal septicaemia include:

    • A.

      20 ml/kg 0.9% sodium chloride fluid bolus over 5–10 minutes if there are signs of shock

    • B.

      20 ml/kg 10% Glucose fluid bolus over 5–10 minutes if there is hypoglycaemia

    • C.

      A second bolus of 20 ml/kg of sodium chloride 0.9% if the signs of shock persist

    • D.

      A second bolus of 10 ml/kg of sodium chloride 0.9% if the signs of shock persist

    • E.

      A second bolus of 20 ml/kg of human albumin 4.5% solution if the signs of shock persist

    Correct Answer(s)
    A. 20 ml/kg 0.9% sodium chloride fluid bolus over 5–10 minutes if there are signs of shock
    C. A second bolus of 20 ml/kg of sodium chloride 0.9% if the signs of shock persist
    E. A second bolus of 20 ml/kg of human albumin 4.5% solution if the signs of shock persist
    Explanation
    Do not restrict fluids unless there is evidence of − raised intracranial pressure, or increased antidiuretic hormone secretion.
    If the signs of shock persist after the first 20ml/kg bolus, immediately give a second bolus of 20 ml/kg of intravenous or intraosseous normal saline or human albumin 4.5% solution over 5–10 minutes

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  • 15. 

    You can give fluid boluses by which routes for management of shock:

    • A.

      Intravenous

    • B.

      Intraosseous

    • C.

      Subcutaneous

    • D.

      Intratracheal

    • E.

      Oral

    Correct Answer(s)
    A. Intravenous
    B. Intraosseous
    Explanation
    You can give fluid boluses by the Intravenous or Intraosseous routes for management of shock

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  • 16. 

    How do you manage the patient further if the signs of shock still persist after the first 40 ml/kg:

    • A.

      Immediately give a third bolus of 20 ml/kg of 0.9% sodium chloride or human albumin 4.5% solution over 5–10 minutes

    • B.

      Call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation

    • C.

      Start treatment with vasoactive drugs and discuss further management with a paediatric intensivist

    • D.

      Avoid giving more than 40 ml/kg of fluid over a short period of time even if there is inadequate circulating volume

    • E.

      Consider giving further fluid boluses at 20 ml/kg normal saline or human albumin 4.5% solution over 5–10 minutes based on clinical signs and appropriate laboratory investigations including urea and electrolytes

    Correct Answer(s)
    A. Immediately give a third bolus of 20 ml/kg of 0.9% sodium chloride or human albumin 4.5% solution over 5–10 minutes
    B. Call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation
    C. Start treatment with vasoactive drugs and discuss further management with a paediatric intensivist
    E. Consider giving further fluid boluses at 20 ml/kg normal saline or human albumin 4.5% solution over 5–10 minutes based on clinical signs and appropriate laboratory investigations including urea and electrolytes
    Explanation
    If the signs of shock still persist after the first 40 ml/kg:
    ◊ immediately give a third bolus of 20 ml/kg of intravenous or intraosseous sodium chloride 0.9% or human albumin 4.5% solution
    ◊ call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation and
    ◊ start treatment with vasoactive drugs

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  • 17. 

    Meningococci are susceptible to several antimicrobial agents:

    • A.

      Ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that penetrate sufficiently into CSF from blood and are useful in the treatment of bacterial meningitis

    • B.

      Meningococci, are susceptible to chloramphenicol, rifampin, erythromycin, and tetracyclines and ciprofloxacin

    • C.

      Treat children aged older than 3 months with intravenous ceftriaxone

    • D.

      Most patients with uncomplicated meningococcemia defervesce within the first 24 hours of antibiotic therapy

    • E.

      Treat children younger than 3 months with intravenous cefotaxime plus amoxicillin or ampicillin

    Correct Answer(s)
    A. Ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that penetrate sufficiently into CSF from blood and are useful in the treatment of bacterial meningitis
    B. Meningococci, are susceptible to chloramphenicol, rifampin, erythromycin, and tetracyclines and ciprofloxacin
    C. Treat children aged older than 3 months with intravenous ceftriaxone
    D. Most patients with uncomplicated meningococcemia defervesce within the first 24 hours of antibiotic therapy
    E. Treat children younger than 3 months with intravenous cefotaxime plus amoxicillin or ampicillin
    Explanation
    The given answer provides a comprehensive explanation about the antimicrobial agents that are effective against meningococci. It states that ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that can penetrate into the cerebrospinal fluid (CSF) from the blood, making them suitable for the treatment of bacterial meningitis. It also mentions that meningococci are susceptible to chloramphenicol, rifampin, erythromycin, tetracyclines, and ciprofloxacin. Additionally, it provides specific treatment recommendations for children based on their age.

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  • 18. 

    Clinical presentation of meningococcal disease include:

    • A.

      Mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children

    • B.

      A well child who has been exposed to a patient with meningococcal meningitis in the past 7 days

    • C.

      More specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia

    • D.

      Symptoms and signs may become more severe and more specific over time

    • E.

      Shock

    Correct Answer(s)
    A. Mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children
    C. More specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia
    D. Symptoms and signs may become more severe and more specific over time
    E. Shock
    Explanation
    Clinical presentation of meningococcal disease include mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children or shock, more specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia.

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  • 19. 

    Possible complications of meningococcal septicaemia and meningitis include:

    • A.

      Hearing loss

    • B.

      Hepatosplenomegaly

    • C.

      Damage to bones and joints

    • D.

      Skin scarring from necrosis

    • E.

      Psychosocial problems

    Correct Answer(s)
    A. Hearing loss
    C. Damage to bones and joints
    D. Skin scarring from necrosis
    E. Psychosocial problems
    Explanation
    Possible complications of meningococcal septicaemia and meningitis include hearing loss, damage to bones and joints, skin scarring from necrosis, psychosocial problems
    neurological disorders, delayed or impaired development and renal failure.
    Rarer complications include Waterhouse-Friderichsen syndrome and DIC

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  • 20. 

    Chemoprophylaxis recommended for meningococcal disease include:

    • A.

      All recent significant contacts of the infected patient over the 7 days before onset of symptoms

    • B.

      Possible chemoprophylaxis with rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin

    • C.

      Chemoprophylaxis is not recommended during epidemics because of multiple sources of exposure and prolonged risk of exposure

    • D.

      Children could receive either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days, according to body weight

    • E.

      Ciprofloxacin is not recommended in persons older than 18 years

    Correct Answer(s)
    A. All recent significant contacts of the infected patient over the 7 days before onset of symptoms
    B. Possible chemoprophylaxis with rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin
    C. Chemoprophylaxis is not recommended during epidemics because of multiple sources of exposure and prolonged risk of exposure
    D. Children could receive either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days, according to body weight
    Explanation
    The correct answer includes all the recommended measures for chemoprophylaxis in meningococcal disease. These measures include providing chemoprophylaxis to all recent significant contacts of the infected patient, using rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin as possible options for chemoprophylaxis, avoiding chemoprophylaxis during epidemics due to multiple sources of exposure and prolonged risk, and administering either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days to children based on their body weight. Ciprofloxacin is not recommended for individuals older than 18 years.

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  • 21. 

    What constitutes significant exposure for meningococcal chemoprophylaxis?

    • A.

      Prophylaxis should be given to contact young children and their carers or nursery-school contacts

    • B.

      Anyone who had direct exposure to the patient through kissing, sharing utensils, or medical interventions such as mouth-to-mouth resuscitation

    • C.

      Anyone who frequently ate, slept or stayed at the patient's home during the 14 days before the onset of symptom

    • D.

      A person who sat beside the patient on an airplane flight of more than 8 hours

    • E.

      Co-workers and school classmates

    Correct Answer(s)
    A. Prophylaxis should be given to contact young children and their carers or nursery-school contacts
    B. Anyone who had direct exposure to the patient through kissing, sharing utensils, or medical interventions such as mouth-to-mouth resuscitation
    D. A person who sat beside the patient on an airplane flight of more than 8 hours
    Explanation
    The correct answer includes individuals who had direct exposure to the patient through close contact activities such as kissing, sharing utensils, or medical interventions like mouth-to-mouth resuscitation. It also includes individuals who had significant exposure by sitting beside the patient on a long airplane flight of more than 8 hours. Additionally, prophylaxis should be given to contact young children and their carers or nursery-school contacts. This means that anyone who frequently ate, slept, or stayed at the patient's home during the 14 days before the onset of symptoms should also receive prophylaxis. Co-workers and school classmates are not mentioned as constituting significant exposure for meningococcal chemoprophylaxis.

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  • 22. 

    Indications for Corticosteroids in meningococcal meningitis include:

    • A.

      Children younger than 3 months

    • B.

      Dose is 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days

    • C.

      Frankly purulent cerebrospinal fluid

    • D.

      CSF wbc count greater than 1000/μl count with protein concentration greater than 1 g/l

    • E.

      Bacteria CSF on Gram stain

    Correct Answer(s)
    B. Dose is 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days
    C. Frankly purulent cerebrospinal fluid
    D. CSF wbc count greater than 1000/μl count with protein concentration greater than 1 g/l
    E. Bacteria CSF on Gram stain
    Explanation
    The indications for corticosteroids in meningococcal meningitis include a dose of 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days. Other indications include the presence of frankly purulent cerebrospinal fluid, CSF white blood cell count greater than 1000/μl with a protein concentration greater than 1 g/l, and the presence of bacteria in the CSF on Gram stain. These criteria help determine when corticosteroids should be used as a treatment for meningococcal meningitis.

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  • 23. 

    When do you want to review children and young people with the results of their hearing test after discharge from hospital?

    • A.

      4–6 weeks

    • B.

      2-3 months

    • C.

      2 -3 weeks

    • D.

      4-6 months

    • E.

      6-8 months

    Correct Answer
    A. 4–6 weeks
    Explanation
    It is recommended that children and young people should be reviewed with the results of their hearing test at least 4-6weeks after discharge from hospital.

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