Bacterial Meningitis

Question 1

Classic CSF findings in bacterial meningitis to differentiate from other causes:

Answer 1

Glu: Way low (50)
PMNs: Very high percentage compared to lymphocytes

Question 2

Your pt has suspected bacterial meningitis and is 2 weeks old. What are the likely causative agents?

Answer 2

GBS, E. coli, and Listeria monocytogenes (seen in very young/old)

Question 3

Your pt has suspected bacterial meningitis and is 90 years old. What are the likely causative agents?

Answer 3

Listeria, Strep pneumo

Question 4

Your pt has suspected bacterial meningitis and is 8 months old. What are the likely causative agents?

Answer 4

S. pneumo, Neisseria meningitidis

Question 5

Your pt has suspected bacterial meningitis and immunocompromised. What are the likely causative agents?

Answer 5

Staph, E. coli, Pseudomonas, [Cryptococcus, Toxoplasmosis (AIDS)]

Question 6

You suspect your pt has bacterial meningitis. What is your next immediate course of action?

Answer 6

Start Dexamethasone + 3rd gen cephalosporin + Vanc IV for S. pneumo +/- Ampicillin for Listeria if neonate/old.
THEN get CT. If CT neg. do LP. Culture/PCR for definitive.

Question 7

MCC of bacterial meningitis in US?

Vaccines for this?

Answer 7

S. pneumo

Vaccines: Pneumovax for old ppl, HIV, asplenia, and those otherwise IC

Prevnar for infants

Question 8

Who is at risk for Neisseria m.?
Transmission?
VFs?
Vaccines?
Watch out for?!

Answer 8

People living in close proximity to one another, alcoholics, C6 deficiency.
Aerosol droplets. (3-foot rule)
LPS- Lipid A endotoxin
Old capsular vaccine for military
New Capsular vaccine for kids 11-12 yo. 

Watch out for DIC and Friderichsen-Waterhouse Syndrome (blood-bag adrenals)

Question 9

Vaccine for H. influenzae?
Transmisson?
Diseases?

Answer 9

Hib
Aerosol
Type B Dz: think hAEMOPilus- Arthritis, Epiglotitis, Meningitis, Osteomyelitis, Pneumonia

Untyped Dz: Otitis media

Question 10

Who is at risk for Listeria?
How does it get from cell-cell?
Transmission?

Answer 10

Very young and old. Pregnant women.
F-actin rockets from cell-cell!
Foodborne- cheese, deli meats, counters