Bacteria Meningitis Flashcards
WHAT IS MENINGITIS?
The brain and spinal cord are covered by connective tissue layers collectively called the meninges which form the blood- brain barrier.
• 1-the pia mater (closest to the CNS)
• 2-the arachnoid mater
• 3-the dura mater (farthest from the CNS).
• The meninges contain cerebrospinal fluid (CSF).
• Meningitis is an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.
CAUSES OF MENINGITIS
• -Bacterial Infections
• -Viral Infections
• -Fungal Infections
• (Cryptococcus neoformans • Coccidiodes immitus)
• -Inflammatory diseases
• (SLE)
• Cancer
• -Trauma to head or spine.
ETIOLOGY/CAUSE
• The five most common causes of bacteria meningitis are
a) Streptococcus pneumonia (pneumococcus)
b) Neisseria meningitides (meningococcus) - very contagious they can be contracted through touch, kissing and coughing
c) Streptococcus agalactiae ( group B streptococcus) - found in the birth canal, baby can be infected during birth ( common in newborns)
d) Listeria monocytogen - takes advantage of weak immune system (immune compromised patients and patients taking steroids)
e) Haemophilus Influenzae
CAUSES BASED ON AGE : NEW BORN
S. agalatiae(70%)
L.Monocytogenes
S.Pneumoniae
1 MONTH-23 MONTHS
1 MONTH-23 MONTHS
S.Pneumoniae(45%)
N.Meningitidis
S.Agalatiae
2 TO 17 YEARS
2 TO 17 YEARS
N.meningitides (60%) S.pneumoniae
H.influenzae
18-50 YEARS
18-50 YEARS
S.pneumonia(60%)
N.meningitides (20%)
H.influenza
L.monocytogenes
S.agalatiae
18-50 YEARS
18-50 YEARS
S.pneumonia(60%)
N.meningitides (20%)
H.influenza
L.monocytogenes
S.agalatiae
CLINICAL MANIFESTATION
Toxic symptom all over the body – Hyperpyrexia
– Headache
– Photophobia
– Painful eye movement
– Fatigued and weak
– Malaise, myalgia, anorexia,
– Vomiting, diarrhea and abdominal pain – Cutaneous rash
– Petechiae, purpura
CLINICAL MANIFESTATION OF CNS
Meningeal irritation sign
• Neck stiffness
• Positive Kernig’s sign
• Positive Brudzinski’s sign
• Laboratory Findings
• Rout examination of cerebrospinal fluid (CSF)
– Increased pressure of cerebrospinal fluid
– Cloudiness
– Evident Increased total WBC count (>1000×109/L)
– Evident Increased neutrophils in leukocyte differential count – Evident Decreased glucose (<1.1mmol/l)
– Evident Increased protein level
– Decreased or normal chlorinate
– CSF film preparation or cultivation : positive result
• Especial examination of CSF
– Specific bacterial antigen test
• Countercurrent immuno-electrophoresis
• Latex agglutination
• Immunoflorescent test
– Neisseria meningitides (meningococcus)
– Haemophilus influenza
– Streptococcus pneumoniae ( pneumococcus) – Group B streptococcus
• Especial examination of CSF • –Other test of CSF
• LDH
• Lactic acid
• CRP
• TNF and Ig
• Neuron specific enolase (NSE)
TREAMENT Younger than 1 month
Ampicillin plus cefotaxime or Ampicillin plus amino glycosides(gentamycin or tobramycin)
Ceftriaxone is contraindicated in children
Ampicillin covers for listeria
Treatment 1-24 MONTHS
1-24 MONTHS
Vancomycin plus a third generation cephalosporin’s Alternative a carbapenem plus vancomycin
Vancomycin + ceftriaxone 100mg/kg od/ 75mg/kg bd or ceftaxime 75mg/kg qid
Treatment- 2 -50 YEARS.
2 -50 YEARS.
Vancomycin plus a third generation cephalosporin Alternative a carbapenem plus vancomycin
Children- Vancomycin 15mg/kg qid + ceftriaxone 100mg/kg od/ 75mg/kg bd or ceftaxime 75mg/kg qid
Adults- Vancomycin 15mg/kg tds + ceftriaxone 2g bd or ceftaxime 2g qid
Treatment 50 and above
Ampicillin 2g qid + vancomycin 15mg/kg tds + ceftriaxone 2g bd or ceftaxime 2g qid
Vancomycin is given as I’ve infusion not bolus , if given fast it can cause _______
Redman Syndrome
Red man syndrome is an adverse reaction characterized by flushing and erythema. It often occurs after the administration of certain medications, particularly vancomycin. It’s primarily due to an allergic reaction to medications involving the release of histamine and other inflammatory mediators.
Use of adjunctive dexamethasone in patients with community acquired meningitis is recommended ________
Regardless of aetiology
Corticosteroids reduce inflammation and restore BBB ( may reduce CSF penetration of antibiotics). Significantly reduces ________
Rate of mortality , sever hearing loss and neurological squelae (speech and paralysis loss)
Recommended prophylaxis against meningococcal infection
Ciprofloxacin 500mg po as a single dose
Rifampin 600mg bd po on 2 consecutive days
Azithromycin , pregnant woman, 500mg po as a single dose
Ceftriaxone 250mg im as a Single Dose
