Bacterial Meningitis

Question 1

Organisms causing meningitis in age <1 month

Answer 1

Group B Streptococcus
E. Coli
Listeria monocytogenes
Klebsiella species

Question 2

Organisms causing meningitis in age 1-23 months

Answer 2

S. pneumoniae
Neisseria meningitidis
H. influenzae (Type B)
E. coli

Question 3

Organisms causing meningitis in age 2-50 years

Answer 3

N. meningitidis
S. pneumoniae

Question 4

Risk factors for meningitis in neonates

Answer 4

Preterm birth
Low birth weight
Chorioamnionitis
Maternal endometritis
Maternal GBS colonization
Prolonged duration of intrauterine monitoring (>12 hours)
Prolonged rupture of membranes
Traumatic delivery
Urinary tract abnormalities

Question 5

Risk factors for meningitis in children

Answer 5

Asplenia
Primary immunodeficiency
HIV
Sickle cell anemia
Cochlear implant
CSF leak
Recent URI
Daycare attendance
Exposure to a case of meningococcal or H. influenzae type b meningitis
Penetrating head trauma
Lack of immunizations

Question 6

Presentation of meningitis in infants

Answer 6

Poor feeding
Vomiting
Fever/temperature instabilities
Seizures
Irritability
Lethargy
Bulging fontanelle

Question 7

Presentation of meningitis in children

Answer 7

Fever
Headache
Lethargy
Vomiting
Myalgia
Photophobia
Stiff neck
Seizure
Confusion

Question 8

Diagnosis of meningitis

Answer 8

H&P
Analysis of CSF from lumbar puncture (LP) *Gold standard (> 1000 WBC/mcL, >45 mg/dL protein, < 40 mg/dL glucose, positive bacterial culture)
Blood cultures (2 separate blood cx and a CBC w/ differential should be obtained before starting abx)

Question 9

Contraindications to lumbar puncture

Answer 9

Increased intracranial pressure, coagulopathy, hemodynamic/respiratory instability, skin infection over LP site

Question 10

CSF findings in bacterial meningitis
Opening pressure
Glucose
Protein
WBC
Differential

Answer 10

Opening pressure: 100-300
Glucose: Neonates </= 0.6, all other ages </= 0.4
Protein: 100-500
WBC: 1000-5000
Differential: 80-95 neutrophils

Question 11

CSF findings in viral meningitis
Opening pressure
Glucose
Protein
WBC
Differential

Answer 11

Opening pressure: 80-150
Glucose: Normal (0.75-0.8 in neonates, 0.5-0.55 in all other ages)
Protein: 30-150
WBC: 100-1000
Differential: 50 lymphocytes

Question 12

Empiric treatment of meningitis in <1 month of age

Answer 12

Ampicillin + AG
Ampicillin + cefotaxime
(+ acyclovir if herpes simplex virus suspected)

Question 13

Empiric treatment of meningitis in 1-23 months of age

Answer 13

Vancomycin + cefotaxime or ceftriaxone

Question 14

Empiric treatment of meningitis in 2-50 years of age

Answer 14

Vancomycin + cefotaxime or ceftriaxone

Question 15

Duration of therapy for meningitis based on organism

Answer 15

Neisseria meningitidis: 7 days
H. Influenzae: 7 days
S. pneumoniae: 10-14 days
GBS: 14-21 days
Aerobic GNB: 21 days
Listeria monocytogenes: >/= 21 days

Question 16

Dexamethasone place in meningitis therapy

Answer 16

To decrease hearing loss in patients with H. influenzae meningitis in infants and children >6 weeks old
May be used as adjunctive therapy 10-20 minutes before or with the 1st dose of antibiotics
0.15 mg/kg/dose IV q6h for 2-4 days
May be considered with S. pneumoniae if high risk of mortality

Question 17

Prevention of meningitis

Answer 17

Vaccines!
Hib (H. influenzae type B), PCV15/PCV20 (S. pneumonae), Meningiococcal (Neisseria meningitidis)