Bacterial Infxns Flashcards
Infxn list
- Bacterial Meningitis
- Viral Meningitis
- Fungal meningitis
- Creutzfeldt-Jakob Disease
Bacterial meningitis
Where?
- college
- the Hajj
- Prisons
Bacterial Meningitis
Organism
Must be encapsulated = invade thru upper airway, survive blood and get into subarachnoid
MC S.pneumonia, N. meningitis
Bacterial Meningitis
Patho
Parenchyma - edema (inflame + BBB permeability change) = ICP up, lower perfusion
- rapidly developing fever
- stiff neck
- HA
- Altered mental status
- seizures
- photophobia
- purpural rash - meningococcemia (rare)
S/S?
Bacterial Meningitis
Serious sickness
- febrile/tac
- septic
- confused
- stiff neck(+Kernig’s /+brudzinki’s sign)
- meningococcemia
Signs?
Bacterial Meningitis
Bacterial Meningitis
Eval
*suspect = START ABX NOW
*draw blood culture
DO NOT WAIT FOR HEAD CT + LP
*CT before LP
Bacterial Meningitis
Labs
CMP, Heme 8, coags,
- Glucose DOWN, Protein UP
- WBC >5, >1 PMN, >1 eosinophils = CNS infxn
- traumatic LP = ratio should be 1 WBC:700-1000 RBCs
- Do not rule out w/ neg Gram stain
Bacterial Meningitis
Tx
IV Ceftriaxone + Vanc
Elderly >65 = Ampicillin (listeria)
*IV steroids recommended IN USA (not in HIV/TB risk area)
Bacterial Meningitis
Prognosis
1/4 die
1/4 long term health problem
Bacterial Meningitis
Prevention
Quadrivalent vacc for all kids (11-12 yr) (16 booster)
Group B vaccine at age 15
HiB + Meningitis helping
Viral Meningitis
Who?
W/ herpes simplex, enteric viruses, coxsackie viruses
*Headache, stiffness, run down w/o high fever FOR SEVERAL DAYS
*diarrhea/pharyngitis/adenopathy, rash
*Kids = confused
Adults less
S/s?
Viral Meningitis
*(Bacterial patient dies in 24 hours)
Viral Meningitis
Eval/Treatment
- CT/LP (normal)
- Neuro s/s NON-FOCAL
- Hx of HSV? Acyclovir
- IV vanc-ceph, admit, keep in hospital till cultures come back
Fungal Meningitis
Path
- Common fungi inhaled
- lungs to CSF, BBB preventing immune from attacking
- slow growers
Fungal Meningitis
organisms
*crypto
S/s can happen for awhile b/f they come
Symptoms wax wane
*HA, Fever, stiffness, nausea,
S/s?
Fungal Meningitis
Lowered immune may lower symptoms
Fungal Meningitis
Eval
- Serum cryptococcus antigen
- MRI
- LP
- opening pressure UP
- much CSF in tube 3
- india ink = cryptococcus
- protein up
Fungal Meningitis
Tx
- Anti-fungal = IV
- toxicity monitoring (Hepatic)
- high ICP = shunt (hydrocephalus)
- Life-time prophylaxis after treatment (fluconazole)
Creutzfelt-Jakob disease
Mech
- rare, progressive, fatal dementia
- cause unknown - beef
- asymptomatic for years, once s/s appear, a few years left
*Neuro abnormals = EVERY AREA
s/s?
Creutzfeldt-Jakob Disease
Creutzfeldt-Jakob disease
Tx
- None
* Supportive/psyc for family
Fungal Meningitis
Who?
ONLY Immunocompromised
*rhematoid arthritis, organ transplant, HIV W/ LOW CD 4+
Bacterial Meningitis
Who?
- crowded dorms/prison/etc.
- penn/ceftraixone-resistant S.Pneumonia
- Recent neurosurgery
- immunocompromised
Bacterial meningitis
Organisms cause what s/s?
S. Pneumonia
N. Meningitidis
Inflammatory rxn
- fever
- meningismus
- altered mental status
Fungal meningitis
Soil
South, C./S. America
*Coccidioides
Fungal Meningitis
Signs
- Chronically unwell
- immunosuppression
- NUCHAL RIGIDITY LESS LIKELY (than bacterial/viral)
Fungal meningitis
Soil w/ bird poo
*Cryptococcus
Fungal meningitis
Bird/bat poo
Midwest
*Histoplasma
Fungal meningitis
Decaying organic matter in soil
N. Midwest
*Blastomyces
Chronic Meningitis
worldwide
M. Tubercolosis, C. Neoformans
Chronic Meningitis
S. Central america
Brucella
Chronic Meningitis
USA
B. Burgdorferi
