Central Nervous System Infections

Question 1

What are abscess

Answer 1

Pockets of puss

Question 2

What is the most common infection of the central nervous system

Answer 2

Meningitis

Question 3

What are the treatment objectives for central nervous system infections

Answer 3

Therapy will cure the infection, minimal risk of neurological damage and drug related toxicity

Question 4

What is meningitis

Answer 4

inflammation of meninges (membranes covering the brain and spinal cord) that occurs where the cerebral spinal fluid flows through

Question 5

What are common meningitis presentations between adults and young infeants

Answer 5

Fever and seizures

Question 6

What are unique meningitis presentations for adults

Answer 6

Headache, Visusal disturbances, confusion, and neck stiffness

Question 7

What are unique meningitis presentations for young infants

Answer 7

Irritability, vomiting, and decreased oral intake

Question 8

How long do acute meningitis sysmptoms last, what causes them

Answer 8

Hours to days but are rapidly fatal, bacteria and viruses

Question 9

How long do chronic meningitis symptoms last, what causes them

Answer 9

At least 4 weeks, M. tuberculosis and fungi

Question 10

What confirms the diagnosis of meningitits, what would be present in acute bacterial meningitis

Answer 10

Cerebral spinal fluid/ WBC greater than 500, Major cell type is PMNs, high protien, low glucose

Question 11

Because bacterial meningitis is rapidly fatal and can lead to permannent neurological damage what empiric antibiotic characteristics be present

Answer 11

Broad spectrum, high dose, intravenous, bactericidal

Question 12

In ages 1-23 months what are the common pathogens that cause bacterial meningitis, ages 2-50

Answer 12

S.pneumoniae, N. meningitidis, H. influenzae/ N. meningitidis, S. pneumoniae

Question 13

What is the empiric antibioitic choice to treat meningitis regardless of age

Answer 13

Vancomycin plus 3rd generation cephalosporin

Question 14

What is the role of steroids in treating meningitis

Answer 14

Decrease inflammation and pressure due to Bactericidal agents causing more inflammation due to bacteria death

Question 15

When are steroids given for treatment of meningitis

Answer 15

Before or with the first dose of antibiotics

Question 16

What major pathogens are covered by the 3rd generation cephalosporin (ceftriaxone or cefotaxime)

Answer 16

H. Influenzae, N. meningitidis, S. pneumoniae that is penicillin susceptible

Question 17

What major pathogens are covered by vancomycin

Answer 17

S. pneumoniae that is pencillin susceptible and non-penicillin susceptible

Question 18

Why is a gram stain of CSF helpful

Answer 18

preliminary pathogen identification`

Question 19

T/F: If the meningitis is caused by H. influenzae then vancomycin and ceftriaxone should be continued

Answer 19

False: The regimen should be changed to just ceftriaxone because vancomycin has no coverage for H. influenezae

Question 20

What is the best prophylaxis for H. influenzae meningitis

Answer 20

Vaccines

Question 21

What is Redman’s syndrome, what can cause it, what can prevent it

Answer 21

pruritis and erythema that is most prominent over the upper body, associated with rapid infusion of vancomycin dose, minimize by giving vancomycin over 1 hour

Question 22

T/F: All 3rd generation cephalosporins are not interchangeable

Answer 22

True

Question 23

What are the cephalosporins that are interchangeable for meningitis

Answer 23

Ceftriaxone and Cefotaxime

Question 24

What is the dosing frequency of ceftriaone and cefotaxime

Answer 24

Ceftriaxone: every 12-24 hours, Cefotaxime: every 6 to 8 hours

Question 25

What is a concern of using ceftriaxone

Answer 25

Significant biliary elimination that could cause precipiration in the biliary tract of kids

Question 26

What are other antibiotic choices for S. pneumoniae caused meningites, which is not used as often and why

Answer 26

Meropenem and Imipenem, Imipenem because it increases a risk for seizures in kids

Question 27

For S. pneumoniae what will influence antibiotic choice

Answer 27

Penicillin and cephalosporin MIC

Question 28

What are the options if the Penicillin MIC is less than or equal to 0.06 mcg/ml for S. pneumoniae , greater than 0.12

Answer 28

penicillin G OR ceftriaxone/ Vancomycin plus ceftriaone

Question 29

What are the options if the Ceftriaxone MIC is less than than one, greater than one

Answer 29

Ceftriaxone, vancomycin plus ceftriaxone

Question 30

If a patient is found to have N. meningitidis caused meningitis what should the antibiotic therapy be

Answer 30

Ceftraixone 1-4 grams per day

Question 31

T/F: Characterisitics of antibiotics for miningitis not only include high dose and rapidly bactericidal but they also penetrate the BBB

Answer 31

True

Question 32

What empiric antibiotic regimen should be given for meningitis if the patient has just had post-neurosurgery

Answer 32

Vancomycin PLUS cefepime or Ceftazidime or meropenem

Question 33

What organisms is vancomycin trying to target in a patient who has meningitis after neurosurgery

Answer 33

Gram-positive cocci, MRSA

Question 34

What is the most common organism that causes hospital-acquire meningitis, what antibiotics can be given to treat this

Answer 34

P.aeruginosa/ Ceftazidime, Cefepime, Cabrapenems, Aminoglycosides, Aztreonam

Question 35

T/F: Aeorobic GNB can also cause hospital-acquired meningitis and can have the same antibiotics used to treat P. aeruginosa plus ceftraixone as well

Answer 35

True