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pharmacotherapy 4270 > 12. Bacterial Meningitis MT2 > Flashcards

12. Bacterial Meningitis MT2 Flashcards

1
Q

this is an inflammation of the cranial and spinal leptomeninges

A

meningitis

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2
Q

the meninges consist of 3 outer coverings of the brain and spinal cord which include

A
  • Dura; inside layer tightly adherent to the cranial periosteum
  • Arachnoid: middle layer that loosely covers the brain and spinal cord
  • Pia Matter: outside layer that is continuous with the surface of the brain and spinal cord
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3
Q

cerebrospinal fluid is found in the _________ space, which is enclosed between the arachnoid and Pia matter

A

subarachnoid

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4
Q

what are the main causes of meningitis?

A
  • bacteria
  • viruses
  • mycobacteria
  • parasites
  • fungi
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5
Q

true or false: meningitis can be noninfectious

A

true - may be drug induced or carcinomatous

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6
Q

the most common pathogens of bacterial meningitis are the same that colonize the mucosal surface of the respiratory tract which includes

A
  • Streptococcus pneumoniae
  • neisseria meningitidis
  • haemophilus influenzae
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7
Q

true or false: bacteria from the GI tract, such as Listeria and group B streptococcus, can cause bacterial meningitis

A

true

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8
Q

how do the bacteria get into past the blood brain barrier in order to cause meningitis?

A

colonization of the mucosa occurs and the bacteria enter the bloodstream due to a break in the mucosal barrier (usually between epithelial cells)
presence of bacteria in the bloodstream allows them to invade the BBB - once the bacteria are present inside the subarachnoid space, there is little host defence

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9
Q

true or false: bacteria can often cause meningitis due to defects in the base of the skull, such as the cribriform plate near the ethmoid sinus

A

false - very rare

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10
Q

true or false: bacteria such as S. pneumoniae can cause meningitis from otitis media or sinusitis

A

true

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11
Q

once bacteria enter the CNS, they begin to multiply. this leads to a release of a cascade of inflammatory cytokines such as TNF-alpha and IL-1. does this increase or decrease BBB permeability

A

increases

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12
Q

release of cytokines can increase influx of _____________

A

granulocytes

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13
Q

these two infections can produce bacteria that can travel through the blood AND brain abscess in order to get to the meninges

A

Otitis media and Sinus infection

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14
Q

this type of infection can produce bacteria that can travel through the blood AND cribriform plate defect in order to get to the meninges

A

colonization of the nasopharynx

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15
Q

what do the following represent:
- brain abscess
- brain herniation
- cerebrates or ventriculitis
- CNS infarction
- diabetes insipidus
- seizure
- shock
- venous sinus thrombosis

A

acute complications of bacterial meningitis

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16
Q

what do the following represent:
- ataxia
- behavioural difficulties
- epilepsy
- hydropcephalus
- intellectual deficit
- sensorineural hearing loss
- visual problems

A

neurologic sequelae of bacterial meningitis

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17
Q

describe the clinical presentation of a child < 2 with bacterial meningitis

A
  • may present with only a change in temperature (fever or hypothermia)
  • nonspecific lethargy or LOC
  • inconsolable crying or altered quality of cry, irritability, seizures, poor feeding, V/D, rash, bulging anterior fontanelle
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18
Q

describe the clinical presentation of older children and adults with bacterial meningitis

A

fever, headache, photobophobia, neck stiffness, altered mental status

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19
Q

this is essential for the diagnosis of bacterial meningitis

A

examination of the CSF for cell count, culture and sensitivity, and glucose and protein concentrations

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20
Q

true or false: empiric antimicrobial therapy should be delayed if a lumbar puncture can’t be performed at the time of presentation

A

false - empiric therapy should never be delayed

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21
Q

what are some instances where a lumbar puncture can not be performed? (contraindicated)

A
  • increased intracranial pressure
  • seizures
  • shock or coagulopathy
  • the infection is at the proposed site of lumbar puncture
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22
Q

will CSF be cloudy or clear if pt has bacterial meningitis

A

cloudy

23
Q

will CSF have decreased or increased WBCs if pt has bacterial meningitis

A

increased WBCs

24
Q

will CSF have decreased or increased glucose if pt has bacterial meningitis

A

decreased glucose

25
Q

will CSF have decreased or increased protein if pt has bacterial meningitis

A

normal or elevated protein

26
Q

CSF gram stain is positive in 80-90% of meningitis, but this ______________ (decreases/increases) if the patient was on antimicrobials prior to LP

A

decreases

27
Q

what should you do if a pt. presents with papilledema and/or focal neurological deficits

A
  1. obtain a blood culture
  2. begin empiric antibiotics
  3. CT scan of head: if there is a mass lesion consult neuro, if no lesion perform LP and continue ABX
28
Q

what should you do if a patient has some symptoms of meningitis but papilledema and/or focal neurological deficits are absent

A
  1. obtain and blood culture and LP stat
    2a. if CSF exam = bacterial meningitis and there is a positive gram stain: start focused ABX therapy
    2b. if CSF exam = bacterial meningitis but there is no gram positive stain: start empiric ABX therapy
29
Q

what is a likely gram positive diplococci in BM

A

S. pneumoniae

30
Q

what is a likely gram positive bacilli in BM

A

listeria

31
Q

what is a likely gram negative coccobacilli in BM

A

haemphilius

32
Q

what is a likely gram negative cocci in BM

A

Neisseria

33
Q

S. pneumoniae, N. meningitides and H. influenzae are the expected bacterial pathogens in this age group

A

1 month - 50 years

34
Q

S. agalactiae, E. coli, K. pneumoniae and L. monocytogenes are the expected bacterial pathogens in this age group

A

0-1 month

35
Q

S. pneumonia, L. monocytogenes, and aerobic gram negative bacilli are the expected bacterial pathogens in this age group

A

> 50 years

36
Q

what are some drugs that have excellent penetration into the CNS

A
  • metronidazole
  • minocycline
  • TMP/SMX
  • rifampin
37
Q

true or false: in order for an antibiotic to work in the CNS it should be used at the max dose

A

true

38
Q

what is the first-line regimen and alternative Tx in the 0-1month age group

A

first line: ampicillin + cefotaxime
alternative: ampicillin + gentamicin

39
Q

what is the first-line regimen and alternative Tx in the 1 month - 50 yrs age group

A

first line: ceftriaxone + vancomycin + dexamethasone
alternative: meropenem + vancomycin + dexamethasone

40
Q

what is the first-line regimen and alternative Tx in the >50 years age group

A

first line: ceftriaxone + vancomycin + ampicillin + dexamethasone
alternative: meropenem + vancomycin + dexamethasone

41
Q

this medication can cause an infusion reaction, which presents like an allergic reaction, but the infusion rate just needs to be slowed

A

vancomycin

42
Q

these are used to decrease the inflammation associated with the infection of the CNS

A

corticosteroids

43
Q

why should corticosteroids be administered after the first dose of antibiotic

A

the antibiotics can access the infection in the CNS due to the inflammation caused by meningitis. decreasing the inflammation with corticosteroids may inhibit the antibiotic from getting in

44
Q

corticosteroids provide beneficial effects in these two bacteria

A

H. influenzae type b in children and S. pneumoniae in adults

45
Q

what is the duration of therapy regarding N. meningitis

A

7 days

46
Q

what is the duration of therapy regarding H. influenzae

A

7 days

47
Q

what is the duration of therapy regarding S. pneumoniae

A

10-14 days

48
Q

what is the duration of therapy regarding S. agalactiae

A

14-21 days

49
Q

what is the duration of therapy for aerobic gram negative bacilli

A

21 days

50
Q

what is the duration of therapy for L. monocytogenes

A

> 21 days

51
Q

how can bacterial meningitis be prevented

A

conjugated vaccines

52
Q

this vaccine has lead to the virtual disappearance of meningitis due to that that bacteria

A

h. influenzae type b vaccine

53
Q

this vaccine is routinely recommended for all infants

A

conjugated pneumococcal vaccine

54
Q

this vaccine against N. meningitis is routinely recommended in all infants

A

conjugated meningococcal vaccine

pharmacotherapy 4270 (19 decks)

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