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Thera VII > 35 Bacterial Meningitis Steinberg > Flashcards

35 Bacterial Meningitis Steinberg Flashcards

1
Q

What is Meningitis?

A

Inflammation of the meninges (membranous coverings of the CNS). Stiff neck and pain with neck movement. Marked pleocytosis (increased in white cells and differential)

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2
Q

What is Encephalitis?

A

Inflammation of brain parenchyma. Altered mental status (confusion, obtundation –> coma). Headache and photophobia. Mild pleocytosis

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3
Q

What is Meningoencephalitis?

A

Inflammation of the brain parenchyma with meningeal involvement. Combination of both signs and symptoms. Mild to moderate pleocytosis

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4
Q

What are the layers of the meningies (from outer to inner)?

A

Dura mater. Arachnoid. Pia mater

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5
Q

What is the Dura Mater?

A

Parchment-like membrane directly beneath and adherent to the skull

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6
Q

What is the Pia Mater?

A

Lies directly over the brain tissue

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7
Q

What is the Arachnoid?

A

Middle layer between dura and pia mater

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8
Q

What is the Subarachnoid Space?

A

CSF formed by ependymal cells in the lateral ventricles (infection of this space = meningitis). Adults : 110-160 ml

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9
Q

What is Vasogenic Edema?

A

Cytokines damage endothelial cells and BBB

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10
Q

What is Cytotoxic Edema?

A

Damage to brain cells –> increase of intracellular water

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11
Q

What is Interstitial Edema?

A

Obstruction of CSF flow and uptake

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12
Q

What can happen with increased intracranial pressure?

A

Reduced cerebral perfusion secondary to edema, (-) autoregulation. Cerebral ischemia secondary to thrombosis of meningeal vessels. Vasculitis. Direct neuronal cell damage secondary to bacterial elements, activated leukocytes, cytokines, and other inflammatory mediators

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13
Q

What is Brain Herniation?

A

Can result from increased ICP. Can result from sudden pressure change during/after LP (lumbar puncture; inserted between 3rd and 4th lumbar vertebrae)

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14
Q

What are the Sequelae?

A

Seizures. Hearing impairment. Vascular complications. Learning impairment, mental retardation. Hemiparesis, hemiplegia, paralysis, focal neurologic sensory/motor deficits. Hydrocephalus

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15
Q

What are the signs/symptoms of Meningitis in adults and older children?

A

Fever > 104 F. HA. Vomiting. Stiff neck; Kernig’s or Brudzinski’s sign. Irritability and drowsiness. Photosensitivity. Altered mental status. Focal neurologic deficits. Seizures. Coma (rare)

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16
Q

What are the signs/symptoms of Meningitis in infants and young children?

A

Any from the adults. Whimpering and crying in a high-pitched tone. Difficulty walking; lethargic, moribund. Fussiness when being held or cuddled. Arching or retracting the neck. Staring blankly at their surroundings. Reduced feeding, vomiting. Appearing pale or mottled, jaundice. Bulging fontanelle

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17
Q

When should a lumbar puncture be avoided?

A

When patient has: Cerebral infarction, Cerebral edema, Brain abscess, Hydrocephalus

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18
Q

What are the WBC (/mm3) counts like for the different types of Meningitis?

A

Bacterial (> 200-5000). Viral (< 200). Fungal/TB (100-1000)

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19
Q

What are the Differentials (%) like for the different types of Meningitis?

A

Bacterial (> 80% PMNs). Viral (> 60% mono). Fungal/TB (> 60% mono/lymph)

20
Q

What is Protein (mg/dL) like for the different types of Meningitis?

A

Bacterial (> 150). Viral (50-150). Fungal/TB (100-200/ > 200)

21
Q

What is Glucose like for the different types of Meningitis?

A

Bacterial (0-30). Viral (low to norm). Fungal/TB (0-30)

22
Q

Which bacteria primarily cause meningitis in < 2 months of age?

A

GBS

23
Q

Which bacteria primarily cause meningitis in 2-23 months of age?

A

Primarily Step. pneumoniae, some GBS and Neisseria meningitidis

24
Q

Which bacteria primarily cause meningitis in 2-34 years of age?

A

Even amounts of S. pneumonia and N. meningitidis

25
Q

Which bacteria primarily cause meningitis in 35+ years of age?

A

S. pneumoniae

26
Q

What are some general characteristics of Meningitis caused by S. pneumoniae?

A

Associated w/ prior/simultaneous otitis, sinusitis, pneumoniae, bacteremia. PCV-13 will increase coverage and protection against expanding serotypes; herd immunity noted in adults. Higher rates of seizures w/ this pathogen. Associated w/ more severe sequelae than other organisms

27
Q

What are some general characteristics of Meningococcal Disease caused by Neisseria meningitidis?

A

Usually occurs winter/spring. Five main serogroups in invasive infection (A, B (individual cases), C (epidemics), Y (pneumonia), W-135). Can be meningitis alone (good prognosis) or sepsis/septic shock (poor prognosis). No problems w/ PCN or CEPH resistance; vaccination

28
Q

What is the primary serogroup of N. meningitidis in < 5 years old?

A

Serogroup B

29
Q

What is the primary serogroup of N. meningitidis in 5-10 years old?

A

Serogroup B ~ Serogroups A, C, Y, W-135

30
Q

What is the primary serogroup of N. meningitidis in 11+ years old?

A

Serogroups A, C, Y, W-135

31
Q

Who has an increased risk for Meningococcal Disease?

A

People living in crowded conditions. Active/passive smoking teenagers. Anatomic or functional asplenia

32
Q

What are the treatment options for Meningococcal Disease?

A

Rifampin (2 days). Ciprofloxacin (adults only; 2 days or single dose). Ceftriaxone (single dose)

33
Q

What is Enteroviral Meningitis?

A

Estimated cause of 80% of all viral meningitis, summer prevalence. Broad range of serotypes (Coxsackievirus, Echoviruses are major causes). MAJOR cause of HA!!!

34
Q

What are the principles of antibiotic treatment of meningitis?

A

Empiric choice dependent on age, underlying disease, or risk factors suggestive of a specific pathogen. Penetration past blood-brain barrier: lipid solubility, low MW, inflammation, pH differential, serum protein binding. Activity in purulent CSF

35
Q

Which antibiotics are used when “Needs Inflammation”?

A

Penicillin, Ampicillin. Ciprofloxacin. 3rd-gen CEPHs. Imipenem, Meropenem. Aztreonam. Vancomycin, Daptomycin. Clindamycin. Acyclovir, Ganciclovir. Ethambutol

36
Q

Which antibiotics are used “Without Inflammation”?

A

Chloramphenicol. Some FQs. INH, Rifampin, Pyrazinamide. Metronidazole. Trimethorpim/Sulfonamides. Linezolid. Fluconazole, Itraconazole, Voriconazole

37
Q

What is always given when suspected bacterial meningitis is present, but no lab tests back yet?

A

Dexamethasone + Empirical therapy

38
Q

What is the usual Empiric choice for meningitis?

A

Vancomycin + Cefotaxime/Ceftriaxone

39
Q

What is the definitive choice of abx for Pneumococcus?

A

Pen G or Ampicillin (MIC < 0.1). Cefotaxime/Ceftriaxone (MIC 0.1-1). Vancomycin + Cefotaxime/Ceftriaxone (MIC > 2 or CEPH MIC > 1). 10-14 days

40
Q

What is the definitive choice of abx for Meningococcus?

A

Cefotaxime or Ceftriaxone. 7-10 days

41
Q

What is the definitive choice of abx for H. influenzae?

A

Cefotaxime/Ceftriaxone. 7-10 days

42
Q

What is the definitive choice of abx for Group B Strep?

A

Penicillin G or Ampicillin +/- Aminoglycoside. 14-21 days

43
Q

What is the definitive choice of abx for E. coli?

A

Cefotaxime or Ceftriaxone +/- Aminoglycoside. Minimum 21 days

44
Q

What are some significant predictive factors for unfavorable outcomes of meningitis in adults?

A

HR > 120. CSF WBC < 100 or 100-999. Blood Cx +. Absence of petechial rash. CSF/blood glucose ratio. S. pneumoniae. Tachycardia. Lower admission GCS. Focal cerebral abnormality. ABx delay. Age. Presence of seizures. Malignancy/DM/EtOHism

45
Q

What is the use of corticosteroids as adjunct to treatment like?

A

Used to reduce the inflammation seen in bacterial meningitis as a byproduct of increased inflammation cytokines and cell wall/membrane antigens after cell lysis. Should optimally be given prior to the first dose of the antibiotic. Absolute necessity in TB meningitis in reducing mortality

Thera VII (37 decks)

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