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CDM > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Meningitis is inflammation of membranes of the ____ and ____ (in particular the ____)

A

Spinal cord, brain, leptomeninges

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2
Q

Encephalitis is inflammation of the ____

A

brain

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3
Q

Encephalitis is usually caused by

A

viruses and bacteria

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4
Q

Meningitis is caused by

A

bacteria, viruses, medications (aseptic), fungus

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5
Q

What are top 5 most common infectious pathogens that cause meningitis

A

Strep pneumo, Group B strep, neisseria meningitidis, H. influe, listeria monocytogenes

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6
Q

What common pathogen of meningitidis goes down the list as patients grow older? (Becomes less common cause)

A

Group B strep

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7
Q

Describe the pathophysiology of meningitis- what property of the invading organism is advantageous in getting through the bloodstream?

A

Inflammation of the BBB causes tight junctions to widen which allows bacteria to enter. CSF lacks immune cells/chemicals that prevent replication so bacteria begins to multiply. Organisms can go through the bloodstream unscathed if they are encapsulated.

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8
Q

What are the CSF markers related to pathophysiology of meningitis?

A

Increased CSF protein, decreased CSF glucose increased CSF lactate

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9
Q

What are the components of the classic “triad” of meningitis (clinical presentation)?

A

Fever, nuchal rigidity, AMS, headache

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10
Q

Empiric meningitis therapy for Age Group <1 month

A

Ampicillin + cefotaxime OR ampicillin + AG (gent/tobra)

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11
Q

Why should you not use ceftriaxone on infants < 1 month?

A

Kernicterus

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12
Q

Empiric meningitis therapy for Age Group 1-23 months

A

Vancomycin + 3GC (ceftriaxone or cefotaxime)

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13
Q

Why do you not use ceftriaxone alone as empiric treatment for children with meningitis?

A

There is a chance that S. pneumo has resistance to ceftriaxone

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14
Q

Empiric meningitis therapy for Age Group 2-50 years

A

Vancomycin + 3GC

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15
Q

Empiric meningitis therapy for Age Group 2-50 years

A

Vancomycin + 3GC +

Ampicillin is needed for listeria which shows up in this age group

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16
Q

Definitive treatment for S. pneumoniae (penicillin susceptible)

A

PCN G 4 million units IV q4H OR ampicillin 2 g IV q4h

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17
Q

Definitive treatment for N. meningitidis (penicillin susceptible)

A

PCN G 4 million units IV q4h OR ampicillin 2 g IV q4h

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18
Q

Definitive treatment for S. pneumoniae (penicillin resistant)

A

Vanco + ceftriaxone or cefotaxime

19
Q

Definitive treatment for N. meningitidis (penicillin resistant)

A

ceftriaxone or cefotaxime

20
Q

Definitive treatment for N. meningitidis (penicillin resistant) in pregnancy

A

ceftriaxone

21
Q

Definitive treatment for H. flu (b-lactam negative)

A

ampicillin 2 g IV q 4h

22
Q

Definitive treatment for H. flu (b-lactam positive)

A

cefotaxime or ceftriaxone

23
Q

Definitive treatment for listeria monocytogenes)

A

PCN G +/- gentamicin

24
Q

Definitive treatment for group B strep

A

PCN OR ampicillin

25
Q

Definitive treatment for enterobacteriaceae, e. coli, k. pneumoniae, enterobacter spp.

A

ceftriaxone or cefotaxime

26
Q

Definitive treatment for pseudomonas aeruginosa

A

ceftaxidime or cefepime

27
Q

Definitive treatment for acinetobacter baumanii

A

ampicillin/sulbactam, meropenem, amikacin, or colistin/polymixin

28
Q

Definitive treatment for enterococcus sp (AMP susceptible)

A

ampicillin + gentamicin

29
Q

Definitive treatment for enterococcus sp (AMP resistant)

A

vancomycin + gentamicin

30
Q

Definitive treatment for enterococcus sp (VRE)

A

linezolid, daptomycin, quinupristin/dalfopristin

31
Q

Length of therapy for treating S. pneumoniae

32
Q

Length of therapy for treating N. meningitidis, H. influenzae

33
Q

Length of therapy for treating Group B streptococcus, S. aureus

34
Q

Length of therapy for treating Enterobacteraceae, P. aeruginosa

35
Q

Length of therapy for treating listeria monocytogenes

36
Q

Advantages of corticosteroid therapy in patient with meningitis

A

Reduces inflammation, may decrease consequences, decreases mortality more in adults vs. children

37
Q

Disadvantages of corticosteroid therapy in patient with meningitis

A

May decrease antibiotic penetration, no benefit if given after antibiotics

38
Q

When should corticosteroids be used relative to abx therapy?

A

10-20 minutes before

39
Q

Drug of choice and dosing for corticosteroid therapy adjunct to meningitis abx therapy

A

Dexamethasone 0.15 mg/kg q6h for 2-4 days

40
Q

When should corticosteroid therapy NOT be discontinued

A

growing H. influ or S. pneumoniae

41
Q

What severe adverse effect is associated with acyclovir for encephalitis?

A

Nephrotoxicity

42
Q

What treatment is given to treat encephalitis and how does dosing work?

A

Acyclovir, dose based on IBW and renal function

43
Q

What is the target organism / benefit of corticosteroids for adults?

A

Strep pneumo / mortality

44
Q

What is the target organism / benefit of corticosteroids for children?

A

H. influ / hearing loss

CDM (2 decks)

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