CNS Infection Flashcards
When should you order a head CT prior to lumbar puncture (6)?
Focal neurological deficits Altered mental status Immunocompromised Hx of CNS mass New seizures Papilledema
What is Kernig’s sign?
The patient’s thigh is flexed so that it is at a right angle to the trunk, and the physician attempts to extend the leg at the knee. If it cannot be completely extended due to pain, it is a positive test (Kernig’s sign).
What is Brudzinski’s sign?
A positive sign is flexion of the hips and knees when the neck is flexed by the physician.
What are the common bacterial pathogens of meningitis in individuals 18-50 years of age?
S. Pneumoniae
N. Meningitidis
H. Influenzae
What are the common pathogens for meningitis in patients who are immunocompromised or > 50 years old?
S. Pneumoniae
N. Meningitidis
H. Influenzae
Listeria monocytogenes
What is the empiric treatment for meningitis in patients 18-50 WITHOUT risk factors for Listeria? Include dosing and frequency.
- Vancomycin 15-20 mg/kg Q12H, maximums 2 grams per dose
2. Ceftriaxone 2g IV Q12H
What is the agent (frequency and dosing) used to cover for Listeria meningitis?
Ampicillin 2 g Q4H
What is the duration of treatment for N. meningitidis meningitis?
7 days
What is the duration of treatment for S. pneumoniae meningitis?
10-14 days
What is the duration of treatment for Listeria meningitis?
21 days
What is the dose of dexamethasone that should be administered for meningitis?
10 mg IV q6h x 4 days PRIOR to or WITH the first dose of antibiotics.
What is the evidence for dexamethasone in meningitis?
- Reduced mortality for meningitis secondary to S. pneumoniae.
- Reduced hearing loss and neurological sequelae for all bacteria.
What are the chemoprophylaxis guidelines for N. meningitidis (6)?
Chemoprophylaxis required:
- Household contacts
- Sharing sleeping arrangements
- Direct nose/mouth contamination with oral/nasal secretions
- Children and staff in childcare or nursery
- HCW who have had intensive unprotected contact (no mask), such as intubation, resuscitation and close examination of oropharynx
- Airline passengers sitting immediately on either side of the case (but not across the aisle) when total time on aircraft > or = 8 hrs.
What is the timeline of chemoprophylaxis for the contacts of a patient with N. meningitidis?
10 days
What are the antibiotic options for chemoprophylaxis in N. meningitidis patient contacts?
- Ciprofloxacin 500 mg PO x 1 dose
- Ceftriaxone 250 mg IM x 1 dose
- Rifampin 600 mg PO BID x 2 days
Which contacts of a patient with N. meningitidis meningitis need immunoprophylaxis (4)?
- Household contacts
- Shared sleeping arrangements
- Direct nose/mouth contamination
- Children and staff in contact with a case of invasive meningococcal disease in childcare or nursery school facilities.
What is the treatment for HSV encephalitis?
Acyclovir 10 mg/kg Q8H
What would you use to empirically treat meningitis in a patient who is allergic to penicillin/beta-lactate?
Vancomycin + MOXIFLOXACIN
If ampicillin coverage also needed: Septra
How do you diagnose CNS lyme disease?
Serum antibody testing - no role for culture or PCR of the CSF
What are the clinical manifestations of CNS/peripheral nerve Lyme disease (5)?
(1) Meningitis
(2) Radiculoneuritis
(3) Mononeuritis Multiplex
(4) Cranial Nerve Palsies
(5) Spinal Cord Inflammation
How would you treat early neurological Lyme disease?
Doxycycline, ceftriaxone or pen G for 14-21 days
What is the empiric management for health-care associated ventriculitis or meningitis?
Vancomycin PLUS ceftazidime OR meropenem +/- rifampin (if suspected staphylococcus)
REMOVE HARDWARE
What are two pathopneumonic features for encephalitic rabies?
Hydrophobia
Aerophobia
