Bacterial Meningitis Flashcards
FYI : Meningococcal = Pneumococcal = Streptococcal =
Meningococcal = N. meningitidis Pneumococcal = S. pneumoniae Streptococcal† = Group A/B Streptococcus
Listeria risk factor
Alcoholism Immunocompromised state Age < 1 month Age > 50 years
FYI: Risk factors for bacterial menigitis (BM)
Head trauma Otitis media Sinusitis or mastoiditis Neurosurgery Dermal sinus tracts Systemic sepsis Immunosuppression High-dose (long-term) steroids Immunoglobulin deficiency Chemotherapy Splenectomy Sickle Cell disease Exposure to cigarette smoke - Meningococcal Cochlear implants - Pneumococcal
Systematic complication for BM
Sepsis (FYI) Disseminated intravascular coagulation Acute respiratory distress syndrome Septic/reactive arthritis Typically a result of bacteremia that often accompanies meningitis
Neurologic complication for BM
Altered mental status Confusion, lethargy, coma Increased intracranial pressure and cerebral edema Mild to Moderate: HA, confusion, irritability, N/V Severe: Coma, vision loss, cerebellar herniation Seizures Focal neurologic deficits Cranial nerve palsy, hemiparesis, aphasia, ataxia Cerebrovascular abnormalities Thrombosis, vasculitis, aneurysm, hemorrhage Sensorineural hearing loss Intellectual impairment
Likely etiology by age groups
Newborn - 1 months and > 50 years old: Group B Streptococcus, E. coli, Klebsiella, Enterobacter, Listeria monocytogenes 1 month - 50 years old: S. pneumoniae, N. meningitidis, H. influenzae
Clinical Presentation of BM
Varies with age Classic Tetrad (≥ 2 of 4 sxs in > 90% of adults w/ ABM) -Fever -Nuchal rigidity -Altered mental status -Headache Signs Kernig sign Brudzinski sign Dermatological Manifestations Purpuric and petechial skin lesions Other symptoms Chills, vomiting, and photophobia Bulging fontanelle, irritability, refusal to eat, apnea, purpuric rash, and convulsions in young children
FYI: Nuchal rigidity
Impaired neck flexion resulting from muscle spasm (not actual rigidity) of the extensor muscles of the neck; usually attributed to meningeal irritation.
Kernig sign
The thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). This may indicate subarachnoid hemorrhage or meningitis.
Brudzinski sign
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
Goal of therapy
Relieve signs/symptoms of infection Eradicate infection Avoid/resolve additional infectious problems E.g., CNS deterioration Prevent complications associated with antimicrobial therapy
Lumbar Puncture and complications
Puncture into subarachnoid space of lumbar region to obtain spinal fluid for diagnostic or therapeutic purposes (aka LP or spinal tap) Complications: - Headache - Back discomfort or pain - Bleeding - Brainstem herniation
Lumbar Puncture: CSF Evaluation
FYI: Delayed Lumbar Puncture
•LP after CT scan to identify possible CNS mass lesion
oAltered mentation
oFocal neurologic signs
oPapilledema
oSeizure within the previous week
oImpaired cellular immunity
•Possible Contraindications to LP (populations above)*
oPossible raised intracranial pressure
oThrombocytopenia or other bleeding predisposition (including ongoing anticoagulant therapy)
oSuspected spinal epidural abscess
What is the suspected organism for GPCs in pairs and chains?
Streptococcus pneumoniae
Duration of therapy
ABx dosing for BM
