CNS infection

Question 1

Meningitis presentation

Answer 1

Predominantly starts with headache, neck stiffness and fever and can get altered LOC later into course.

Question 2

encephalitis course

Answer 2

Predominantly starts with altered LOC/mental status and fever and can get seizures, focal neurological changes associated.

Question 3

basal skull meninigtis
- consequences ?
- culprit bugs ?

Answer 3

– + CN palsies, long-tract signs
– Think TB, Listeria, Cryptococcus, Syphilis, Lyme in correct host

Question 4

18-50 meningitis
- cover what
- meds ?
- if PNC allergy ?

> 50 or immunsup , what do you add and what covering and alternative if PNC allergy ?

Answer 4

• s pneumonia, meningitis, haeomophilus
• vanco , ctx
• vanco moxy
• listeria monocytogenes
• add ampicillin
  -tmp smx

Question 5

benefit of dexamethasone 10 mg q6H x 4 days , when to give

Answer 5

• decrease mortality morbidity in pneumococcal meningitis
• give prior or with
• also may decrease hearing loss
• may also increase mortality in neurolisteriosis

Question 6

meningitis chemoprophylaxis ( neiseria meningitis

-when
- what to dgive

Answer 6

• 7 days before sx until 24H post initiation of tx
• within 10 days, ideally 24H contact

meds
– Ciprofloxacin 500 mg PO X 1 dose (increasing resistance concern) – OR ceftriaxone 250 mg IM X 1 dose
– OR rifampin 600 mg PO BID X 2d

Question 7

empirici tx for ventriculitis/meningitis in hospital ?

Answer 7

vanco + ceftazidime/mero