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CNS infections Flashcards

1
Q

Define meningitis

A

Inflammation of the subarachnoid space or spinal fluid

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2
Q

What are the two types of meningitis?

A
  • Bacterial

- Aseptic

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3
Q

What is the cause of aseptic meningitis?

A
  • TMP/SMX
  • OKT3 antirejection monoclonal Ab
  • Azathioprine
  • NSAIDs
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4
Q

Define encephalitis

A

Inflammation of the brain

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5
Q

What are the predisposing risk factors for CNS infections?

A
  • Immunosuppression
  • Head trauma
  • Neurosurgical patients
  • Local infection
  • Exposure to someone with meningitis
  • Anatomical or functional asplenia
  • Complement deficiency
  • Recent travel to area with endemic meningococcal disease
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6
Q

What are the early classical signs/Sx of meningitis?

A
  • Fever
  • Nuchal rigidity
  • Altered mental status
  • Severe HA
  • Positive Brudzinski’s and Kernig’s sign
  • Photophobia
  • Petechial rash
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7
Q

Which early sign/Sx is only found when patient is exposed to N. meningitidis organism?

A

Petechial rash

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8
Q

What are the late classical signs/Sx of meningitis?

A
  • Irritability
  • Drowsiness
  • Seizures
  • Coma
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9
Q

What are the diagnostic tests or procedures for meningitis?

A
  • History and physical exam
  • Lumbar puncture
  • CSF gram stain and culture
  • Rapid identification latex-agglutination
  • Polymerase chain reaction (PCR)
  • CT scan
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10
Q

Rapid identification latex agglutination is helpful to detect which organism antigens in the CSF?

A
  • H. influenzae
  • S. pneumoniae
  • N. meningitidis
  • E. coli
  • Group B streptococci
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11
Q

(T/F) - Rapid identification latex agglutination is not useful if the gram stain comes out negative

A

FALSE - it is useful

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12
Q

When doing a lumbar puncture there are 5 things that need to be checked in order to diagnose a bacterial or viral meningitis. What are they?

A
  • Opening pressure (mmHg)
  • WBC count (cells/mm^3)
  • Differential (%)
  • Proteins (mg/dL)
  • Glucose (mg/dL)
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13
Q

What is a normal opening pressure in a patient?

A

75-175

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14
Q

What is a normal WBC count in a patient?

A

< 5

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15
Q

What is a normal differential in a patient?

A

> 90 monos

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16
Q

What is a normal protein in a patient?

A

< 50

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17
Q

What is a normal glucose in a patient?

A

50-66% simultaneous serum value

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18
Q

What is the bacterial opening pressure value in a patient?

A

Elevated

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19
Q

What is the bacterial WBC value in a patient?

A

1000-5000

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20
Q

What is the bacterial differential value in a patient?

A

> 80 PMNs

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21
Q

What is the bacterial protein value in a patient?

A

100-500

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22
Q

What is the bacterial glucose value in a patient?

A

< 40-60

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23
Q

What is the viral opening pressure value in a patient?

A

Elevated

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24
Q

What is the viral WBC count value in a patient?

25
Q

What is the viral differential value in a patient?

26
Q

What is the viral proteins value in a patient?

27
Q

what is the viral glucose value in a patient?

28
Q

Bacterial meningitis is treated depending on the age group and bacterial organism that is contributing to it. What are the divided age groups?

A

< 1 month
1-23 months
2-50 yo
> 50 yo

29
Q

Which is the only age group that is not affected by N. meningitidis?

30
Q

Which is the only age group that is not affected by S. pneumoniae?

31
Q

Which age groups can be affected by L. monocytogenes?

A

< 1 month

> 50 yo

32
Q

Which age groups can be affected by Streptococcus. agalactiae?

A

< 1 month

1-23 months

33
Q

Which age group is affected by H. influenzae?

A

1-23 months

34
Q

Which age group is affected by Klebsiella spp?

35
Q

Which age group is affected by aerobic gram (-) bacilli?

36
Q

Which age groups are affected by E. coli?

A

< 1 month

1-23 months

37
Q

What are the favorable characteristics of antibiotics that penetrate the CSF well?

A
  • LMW
  • Non-ionized at physiologic pH
  • Non-protein bound
  • Lipid soluble
38
Q

What is the empiric treatment for < 1-month patients with bacterial meningitis?

A
  • Ampicillin + cefotaxime OR

- Ampicillin + aminoglycoside

39
Q

What is the empiric treatment for 1-23 months patients with bacterial meningitis?

A

Ceftriaxone (or cefotaxime) + vancomycin

40
Q

What is the empiric treatment for 2-50 yo patients with bacterial meningitis?

A

Ceftriaxone (or cefotaxime) + vancomycin

41
Q

What is the empiric treatment for > 50 yo patients with bacterial meningitis?

A

Ceftriaxone (or cefotaxime) + vancomycin + ampicillin

42
Q

(T/F) - The duration of empiric treatments for bacterial meningitis depends on the pathogen in the patient

43
Q

How long should an empiric treatment be given for H. influenzae?

44
Q

How long should an empiric treatment be given for N. meningitidis?

45
Q

How long should an empiric treatment be given for S. pneumoniae?

A

10-14 days

46
Q

How long should an empiric treatment be given for S. agalactiae?

A

14-21 days

47
Q

How long should an empiric treatment be given for aerobic gram-negative bacilli?

48
Q

How long should an empiric treatment be given for L. monocytogenes?

A

At least 21 days

49
Q

(T/F) - Adjunctive dexamethasone is highly controversial for the use in meningitis

50
Q

(T/F) - Dexamethasone can decrease the neurologic sequelae in some patients

51
Q

Which patients can dexamethasone decrease neurologic sequelae?

A
  • Infants and children with H. influenzae type B meningitis

- Adults with suspected S. pneumoniae meningitis

52
Q

How is dexamethasone administered and for how long?

A

Either 10-20 mins before the 1st dose of the antibiotic OR at the same time as the 1st dose of the antibiotic for 2-4 days

53
Q

(T/F) - There is a disadvantage to the use of dexamethasone with antibiotics because it could reduce the amount of drug penetrating the CSF

54
Q

How can H. influenzae type B meningitis be prevented?

A

Vaccination - Hib conjugate vaccine (starts at 2 months)

55
Q

How can N. meningitidis meningitis be prevented?

A
  • Chemoprophylaxis: Use of rifampin for 2 days

- Vaccination: Hib-MenCY, Menactra, Menveo

56
Q

Which meningococcal vaccine is given to infants?

57
Q

How can S. pneumoniae meningitis be prevented?

A

Vaccination - PPSV23 or PCV13

58
Q

(T/F) - PPSV23 is given to patients ages 55 and older

A

FALSE - given to 65 and older

59
Q

(T/F) - PCV13 is given to patients starting at 2 months old

Infectious Disease (41 decks)

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