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OU Module ID Fall 2018 > CNS Exam 4 > Flashcards

CNS Exam 4 Flashcards

1
Q

For a pt < 1 month of age, what are the likely pathogens for community acquired CNS infection?

A
  • Group B Streptococcus
  • Escherichia coli
  • Klebsiella pneumoniae
  • Listeria monocytogenes
  • Gram-negative bacilli
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2
Q

For a pt 1 month of age and less than 18 y/o, what are the likely pathogens for community acquired CNS infection?

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haemophilus influenzae
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3
Q

For a pt between 18 and 50 y/o, what are the likely pathogens for community acquired CNS infection?

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Gram-negative bacilli (in immunocompromised individuals)
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4
Q

For a pt > 50 y/o, what are the likely pathogens for community acquired CNS infection?

A
  • Streptococcus pneumoniae
  • Listeria monocytogenes
  • Gram-negative bacilli
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5
Q

community acquired CNS infection: Listeria

A

common in the very old and very young

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6
Q

What are the common pathogens for healthcare associated CNS infections?

A
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Gram-negative bacilli (including Pseudomonas aeruginosa)
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7
Q

What are worldwide causes of CNS infections?

A
  • Measles and mumps—viral or aseptic meningitis
  • Japanese B encephalitis virus
  • Enterovirus, arboviruses, and varicella zoster
  • Herpes simplex virus (HSV)
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8
Q

Normal CSF values

A
  • Opening Pressure: 60-200 mm H2O
  • WBC count (cells/mm3): Up to 5
  • Dominant Cell Type: Lymphocytes
  • Protein: 20-60 mg/dL
  • Glucose: Two-thirds of serum levels
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9
Q

Bacterial Meningitis CSF values

A
  • Opening Pressure: Increased (>250 mm H2O)
  • WBC count (cells/mm3): 1,000-5,000
  • Dominant Cell Type: Neutrophils
  • Protein: Usually increased (100-500 mg/dL)
  • Glucose: Low (< 40 mg/dL or 40% of concurrent serum) bacteria organisms are eating up the glucose
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10
Q

Viral Meningitis/ Encephalitis CSF values

A
  • Opening Pressure: Rarely increased
  • WBC count (cells/mm3): 100-500
  • Dominant Cell Type: Lymphocytes
  • Protein: Normal / slightly increased
  • Glucose: Rarely low
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11
Q

What are the factors that affect antibiotic penetration?

A
  • Inflammation
  • Molecular Weight
  • Lipid solubility
  • Protein binding
  • Ionization
  • Dosing
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12
Q

Factors that affect antibiotic penetration: Inflammation

A

increased inflammation = increased penetration; inflammation decreases the activity of efflux pumps in the choroid plexus

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13
Q

Factors that affect antibiotic penetration: Molecular Weight

A

low molecular weight will penetrate better

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14
Q

Factors that affect antibiotic penetration: Lipid solubility

A

high lipid solubility will penetrate better

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15
Q

Factors that affect antibiotic penetration: Protein binding

A

low protein binding will penetrate better

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16
Q

Factors that affect antibiotic penetration: Ionization

A

only non-ionized drugs will penetrate

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17
Q

Factors that affect antibiotic penetration: Dosing

A

often times dosing is higher

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18
Q

For a neonate (less than 28 days), what is appropriate empiric therapy?

A

Ampicillin plus cefotaxime or gentamicin

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19
Q

For a pt >1 month- 50 years, what is appropriate empiric therapy?

A

Vancomycin plus cefotaxime or ceftriaxone

20
Q

For a pt >50 years, what is appropriate empiric therapy?

A

Vancomycin plus cefotaxime or ceftriaxone plus ampicillin

21
Q

For a pt that has penetrating head trauma, post-neurosurgery, or CSF shunt in place, what is appropriate empiric therapy?

A

Vancomycin plus cefepime or meropenem

22
Q

Duration of therapy for antibiotics for CNS infections

A
  • At least 48-72 hours or until diagnosis can be ruled out

- Continue therapy based on clinical signs, cultures, susceptibility results

23
Q

What is the most common cause in children > 2 months?

A

S. pneumoniae

24
Q

What is the most common cause of neonatal meningitis?

A
  • Group B Streptococcus

- also common in neonatal sepsis, pneumonia, and meningitis

25
Q

What is appropriate empiric therapy for neonatal meningitis? (same as definitive treatment)

A
  • Ampicillin or Penicillin

- Alternative: cefotaxime

26
Q

What is the leading cause of children and adults? (occurs in spring or winter)

A

N. meningitidis

27
Q

Who should have prophylaxis for meningococcus?

A
  • young children
  • household
  • daycare
  • military contacts
28
Q

Adult prophylaxis for meningococcus

A
  • Rifampin 600 mg q12h x 4 doses

- Alternative: IM Ceftriaxone 250 mg x 1 OR Ciprofloxacin 500 mg po x 1 OR Meningococcal vaccine

29
Q

Children > 1 month prophylaxis for meningococcus

A
  • Rifampin 10 mg/kg q12h x 4 doses
  • Alternative: Ceftriaxone 125 mg x 1 for children < 12 OR Ciprofloxacin 500 mg po x 1 for children > 12 OR Meningococcal vaccine (ages 10-25)
30
Q

Children < 1 month prophylaxis for meningococcus

A

Rifampin 5 mg/kg q12h x 4 doses

31
Q

Who should receive the Meningococcal vaccine?

A
  • all pts age 10-25 that have some risk factors
  • all pts who has had their spleen removed or spleen dysfunction
  • Meningococcal polysaccharide vaccine (MPSV4): adults 56 and older
  • Meningococcal conjugate vaccine quadrivalent (MCV4): age less than 55
32
Q

Prophylaxis of close contacts

A
  • If fully vaccinated then no need to use prophylaxis
  • Children: rifampin 20 mg/kg/day x 4 days
  • Adults: rifampin 600 mg/day x 4 days
  • Unvaccinated 12-48 mo: 1 dose
  • Unvaccinated 2-11 mo: 3 doses
33
Q

Listeria monocytogenes

A
  • 8% of all cases of meningitis
  • Neonates, alcoholics, immuno-compromised, elderly
  • Peaks in summer and early fall
34
Q

What are predisposing factors for Gram-Negative Meningitis?

A
  • Congenital defects involving the CNS
  • Cranial trauma
  • Neurosurgery
  • Diabetes
  • Malignancy
  • UTI in neonates
35
Q

Causes of Herpes Simplex

A
  • HSV-1 associated with adults

- HSV-2 with newborns

36
Q

Therapy for HSV viral encephalitis

A
  • Limited in most cases to supportive care with fluids, seizure control, antipyretics, and analgesics
  • Adults: Acyclovir 10 mg/kg IV q8h for 2-3 weeks
  • Neonates: Acyclovir 20 mg/kg IV q8h for 2-3 weeks
  • Resistance reported especially in immuno-compromised patients
  • Alternative is foscarnet; watch for renal toxicity; make sure pt is adequately hydrated
37
Q

Empiric treatment for Streptococcus pneumoniae (Pneumococcus or Diplococcus)

A
  • Vancomycin plus ceftriaxone
  • Vancomycin plus cefotaxime
  • Alternatives: meropenem or moxifloxacin
38
Q

Who should receive Pneumovax 23®?

A
  • Persons older than 65
  • Persons 2-64 who have chronic illness, who live in high-risk environments (residents of long-term care facilities), who lack a functioning spleen
  • Immunocompromised persons older than 2 (including HIV)
  • Questionable recommendation for college students living in dormitories
39
Q

Who should receive Prevnar 13®?

A
  • Children 2 months and older and adults over the age of 65

- Children with cochlear implant

40
Q

Empiric treatment for N. meningitidis

A
  • Ceftriaxone or cefotaxime

- Alternatives: Penicillin G, Ampicillin, Fluoroquinolone, Aztreonam

41
Q

Empiric treatment for Haemophilus influenzae

A
  • Ceftriaxone or Cefotaxime

- Alternatives: Cefepime, Meropenem, Fluoroquinolone

42
Q

Empiric treatment for Listeria monocytogenes

A
  • Ampicillin or penicillin G

- Alternatives: trimethoprim-sulfamethoxazole or meropenem

43
Q

Gram-Negative Meningitis

A
  • Enteric gram-negatives are the fourth leading cause of meningitis
  • includes Klebsiella, E. coli, Serratia marcescens, Pseudomonas, Salmonella
44
Q

Adult dosing for ampicillin

A
  • Total daily dose (dosing interval in hours): 12g (4)

- 2g q4h

45
Q

Adult dosing for ceftriaxone

A
  • Total daily dose (dosing interval in hours): 4g (12-24)

- 4g q24h OR 2g q12h

46
Q

Adult dosing for meropenem

A
  • Total daily dose (dosing interval in hours): 6g (8)

- 2g q8h

47
Q

Adult dosing for vancomycin

A
  • Total daily dose (dosing interval in hours): 30-45mg/kg (8-12)

OU Module ID Fall 2018 (18 decks)

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