133 - Acute Meningitis Flashcards
General damage, usually due to a __ infection, will be treated as __, and local will be called __ or __, depending on the involvement of the capsule
viral
encephalitis
cerebritis
abscess
Neck stiffness is pathognomonic for __
meningeal irritation
Acute meningitis, empiric __ should be administered soon after __ was taken
Abx
cultures
What are the indications for performing imaging (CT/MRI) prior to LP?
recent trauma immunodepression CNS malignancy focal signs/papilledema decreased consciousness
Immunocompetent with normal consciousness, no previous Abx, typical viral meningitis CSF- should be treated as __. If no improvement after _ h, reevaluate including __
outpatients
48
LP
What is typical viral meningitis CSF sample? lymphocytosis _-_ protein _-_ mg/dL glucose \_\_ opening pressure _-_ \_\_ may be high in the first 48h
25-500 20-80 (normal) normal 100-350 (normal- slightly high) PMN
Acute bacterial meningitis=__
acute infection of the subarachnoid space
What are the common pathogens causing bacterial meningitis? 5
pneumococcus neisseria meningitis GBS Listeria Haemophilus (decreased thanks to vaccination)
What is the most common pathogen causing meningitis? what is the main risk factor? what is the prognosis under treatment?
S. pneumoniae
pneumococcus pneumonia
20%
Mention risk factors for S. pneumoniae meningitis beside pneumococcus pneumonia: 5
sinusitis/OM alcoholism diabetes splenectomy hypogammaglobulinemia/complement deficiency
What is the leading cause for acute bacterial meningitis in ages of 2-20? more in patients with __
neisseria meningitis
complement deficiency
What is the classical triad of bacterial meningitis?
fever
headache
neck stiffness
Acute bacterial meningitis if untreated will __ quickly within days, decreased __,nausea-vomiting, __, __ (focal/general), increased __.
deteriorate consciousness photophobia seizures ICP
Maculopapular rash might suggest __ infection
meningococcemia
When suspecting acute bacterial meningitis: __->__->__->__
blood cultures
LP
empiric treatment
dexamethasone
Diagnosing acute bacterial meningitis is based on: opening pressure >\_\_mmH20 WBC> \_\_ cells/uL (mostly\_\_) no \_\_ glucose \_\_ mg/dL G stain will be positive in \_\_% of cases culture will be positive in \_\_% of cases consider Latex agglutination test/PCR
180 100, neutrophils RBV 40 0.4 45 60 80
What is the best imaging test for meningitis?
MRI, better than CT
What are the 4 DDx you should consider when suspecting acute bacterial meningitis?
HSV encephalitis
rickettsia
focal inflammation (abscess)
non infectious process (subarachnoid hemorrhage)
In acute bacterial meningitis Abx should be given in the first __ minutes of arrival
60
What are the empiric Abx for acute bacterial meningitis?
Dexamethasone should always be added to reduce the edema
cephalosporins (3rd/4th gen)
vancomycin
acyclovir
doxycycline
Red man syndrome is a diffused__ when giving __ of __. To avoid it, choose __ drip.
erythema
IV
vancomycin
slow
Immunocompetent children >_ and adults
cefotaxime
ceftriaxone
cefepime + vancomycin
Adults > 55, any alcoholics, debilitating illness should receive the following Abx:
Ampicillin + cefotaxime/ceftriaxone
or
cefepime + vancomycin
Nosocomial meningitis, posttraumatic/post-neurosurgery op, neutropenic, impaired cell mediated immunity- should receive the following Abx:
Ampicillin + ceftazidime
or
meropenem + vancomycin
What are the best Abx for meningitis due to strep pneumonia/GBS/H. influenza?
cefotaxime
ceftriaxone
Why do we add ampicillin to weaker patients?
to cover against listeria
In which cases will you opt for metronidazole?
otitis/sinusitis/mastoiditis
Ceftazidime is recommended for bacterial meningitis __ like __ which are the only nosocomial pathogens causing meningitis
G (-)
pseudomonas
Meropenem is effective against __, __, __
listeria
pseudomonas
pneumococci
What is the Abx of choice for meningococcal meningitis? If its resistance- __/__. All of whom that have been in contact with the patient should receive
penicillin G
cefotaxime/ceftriaxone
rifampin
Listeria is a _ bacteria. If meningitis is caused- treat with __+__ for __ weeks
ampicillin
gentamicin
3
What are the deadliest pathogens causing meningitis? __(20%), __(15%), __(3-7%)
strep pneumonia
listeria
neisseria/GBS
Thanks to __,__,and __ a viral pathogen causing meningitis can be found in -% of cases
PCR
culture
serology
60-90
What are the top viruses causing acute meningitis and encephalitis? 6
enteroviruses (coxsackie/echoviruses) VZV HSV EBV arboviruses (west Nile) HIV
Secondary meningitis can be caused by inflammatory disease such as: 2
Bechet’s disease
sarcoidosis
What is usually the treatment for acute viral meningitis?
symptomatic (analgesia, antipyretic, antiemetic) as outpatient
Viral encephalitis=__
involvement of the brain’s parenchyma +/- meningitis
What are the most common neurological symptoms of viral encephalitis? 5
aphasia ataxia hemiparesis cranial nerve damage hypothalamus-hypophysial axis damage
Hypothalamus-hypophysial axis damage can lead to: 3
temperature dysregulation
diabetes insipidus
SIADH
__ should be given whenever we suspect viral encephalitis. It is best against __. Choose __ drip to minimize renal damage
acyclovir
HSV, VZV, EBV
slow
What is the drug of choice for CMV viral encephalitis?
ganciclovir
What are the main causes for subacute meningitis?
TB
Cryptococcus neoformans
T. Pallidum (syphilis)
H capsulatum
What is the empiric treatment for TB meningitis? 5
a combination of:
- pyridoxine
- pyrazinamide
- isoniazid
- rifampin
- ethambutol
When treating TB meningitis, which drugs should be discontinued after 8 weeks if the response is good? if the patient has developed hydrocephalus what should you add?
pyrazinamide
ethambutol
When treating TB meningitis, if the patient has developed hydrocephalus what should you add?
steroids
