64. Meningitis (2%) - RC Flashcards

1
Q

Chez un patient présentant une maladie fébrile non spécifique, recherchez des signes de méningite, en particulier chez un patient chez qui le risque de cette maladie est élevé.

Nommez des examples

A
  • personnes immunodéprimées
  • alcoolisme
  • neurochirurgie récente
  • blessure à la tête
  • chirurgie abdominale récente
  • nouveau-nés
  • groupes autochtones
  • étudiants vivant en résidence
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2
Q

Si vous soupçonnez la présence d’une méningite, assurez-vous qu’une ___ est effectuée en temps opportun.

A

ponction lombaire

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3
Q

Dans le cadre de la différenciation entre une méningite virale et une méningite bactérienne, interprétez les données à la lumière d’une antibiothérapie récente.

A
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4
Q

Pour une méningite bactérienne soupçonnée, faut faire quoi d’emblée ?

A
  • commencez un traitement antibiotique IV empirique d’urgence
  • avant même que les investigations soient terminées).

(Start IV ATB STAT after lumbar puncture, < 1 hr after arrival)

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5
Q

Quoi faire pour les personnes ayant été en contact avec des personnes atteintes de méningites ?

A

Communiquez avec les services de santé publique afin d’assurer une prophylaxie appropriée pour la famille, les amis et les autres contacts de chacune des personnes atteintes de méningite.

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6
Q

Describe physical exam : Meningitis

A
  • Kernig (Extend Knee with hip flexed)
  • Brudzinski (Lift Brain (head) off bed)
  • Not as helpful : Jolt accentuation, nuchal rigidity
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7
Q

What other drugs to give in meningitis ?

A

Give STEROIDS before antibiotics
* Give if age > 3 months
* COntinue if organism is pneumococcus or HiB

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8
Q

What are the advantages of steroids in meningitis ?

A

Possibly reduces mortality, hearing loss

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9
Q

What’ normal opening pressure for cerebrospinal fluid ?

A

N = 6 - 25 cm H2O

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10
Q

Describe typical CSF findings in meningities

A

Bacteria are made of PROTEIN and EAT SUGAR

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11
Q

Describe typical CSF findings

A
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12
Q

Describe ATB meningitis in adults

A
  • Ceftriaxone + Vancomycin
  • If > 50 age, add ampicillin
  • After CSF results, targeted tx
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13
Q

If meningococcal meningitis infx, what tx?

A

Penicillin G

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14
Q

If viral meningitis infx, what tx?

A

Acyclovir

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15
Q

Describe meningitis prophylaxis

A

Administer to close contacts of MENINGOCOCCUS
Ideal within 24 hrs of dx
Can give within 10 days
* Rifampin (E2 orange urine), Ciprofloxacin or ceftriaxone

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16
Q

When to give steroids in peds meningitis

A

Steroids only if H flu or pneumococcus & < 2 hrs from antibiotics

17
Q

Name typical bugs in pediatric meningitis

A
  • Typicall S.pneumo and N.meningitides
  • Consider E.coli and GBS if < 3 months
18
Q

What ATB to give in pediatric meningitis ?

A
  • If < 1 month : Ampicilin and cefotaxime
  • If > 1 month : Ceftriaxone and Vancomycin
  • Add ampicilin if listeria suspected / immunocompromised