CNS Infections Flashcards

1
Q

Common organisms

A

Haemophilus
Meningococcus
Pneumococcus

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2
Q

Diagnosis

A
  • LP: if good then probably not bacterial
  • CT
  • MRI
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3
Q

Risk factors

A

Sickle cell
Asplenic
Complement deficiency

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4
Q

Manifestations

A

Fever & Neurologic signs (mostly infectious)
Neurologic:
headache, meningitis, convulsion, focal signs, kernig & brudzinski, confusion, agitation,…

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5
Q

Non-specific signs

A
  • Fever
  • Low appetite
  • Poor feeding
  • Headaches
  • Myalgia
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6
Q

Specific signs

A
  • Nuchal rigidity + backache
  • Kernig
  • Brudzinski
  • Mental state change (Bacterial=progressive, viral=swings)
  • Convulsion
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7
Q

CNS infection other specific signs

A
  • Cranial neuropathy (6,4,3)
  • Mental change, CSF glucose decrease
  • Photophobia
  • Mostly positive B/C
  • Mottling (mostly sign of organ failure)
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8
Q

LP & CSF results

A
  • Pleocytosis > 1000 or 250
    <20 normal if lymphocyte or monocyte
    Bacterial: first 12h lymphocytic, then maybe neutrophils
  • Low Glucose & High Protein
    Viral: neutrophil then lymphocyte
  • Normal Glucose & Bit high protein
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9
Q

LP Contraindications

A
  • High ICP
  • Altered Consciousness
  • Focal Signs
  • Lesions and Abscesses
  • Neutropenia
  • Coagulation disorder
  • Thrombocytopenia
  • History of CNS diseases
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10
Q

Meningitis Treatment

A

ICU if altered consciousness
- Empiric: Ceftriaxone (100mg/kg) in 2dose or Cefotaxime + Vancomycin (60mg/kg) in 4dose
- If Gram-Negative, Imipenem instead of cephalosporine
- Listeria: Ampicillin 300

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11
Q

Treatment Duration

A
  • Meningococcus: 5-7d
  • Haemophilus: 7-10d
  • Pneumococcus: 10-14d
  • Gr (-): 2-3w after sterilization
  • Staph: 4-6w
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12
Q

Dexamethasone

A

Decreases side effects specially ototoxicity
- 1-2h before Ab
- 0.15 mg/kg QID / 4d

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13
Q

Other doses: amikacin, ampicillin, Ceftriaxone, meropenem, vanco

A

Amikacin 15mg/kg/d TDS
Ampicillin 150mg/kg/d
Ceftriaxone 100mg/kg
Meropenem 40mg/kg/dose
Vancomycin 60mg/kg/d in 4dose

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14
Q

Meningitis causes:

A

1- Hearing loss
2- Convulsions
3- Focal signs
4- Obstructive thrombosis
5- Hyponatremia

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15
Q

Hearing Loss

A
  • Sensorineural
  • Test in every meningitis
  • ABR test
  • Pneumococcus has worse hearing loss
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16
Q

Focal Signs

A
  • Increased ICP
  • Hernia
  • Hydrocephalus (stays in under 2yr olds)
17
Q

Obstructive thrombosis etiology

A

Less if treated fast or not meningococcus
Meningococcus: fast thrombosis & gangrene

18
Q

Hyponatremia

A
  • Late treatment because of SIADH
  • Can cause convulsions
  • ~20%
19
Q

Meningococcal Prophylaxis

A
  • Rifampin
    Children 10mg/kg BID / 2d
    Adults 600mg BD / 2d
  • Ciprofloxacin
    Adults only 500mg single
  • Ceftriaxone
    Children 125mg IM single
    Adults 250mg IM single
20
Q

Haemophilus Prophylaxis

A

Rifampin
Children 20mg/kg daily
Adults 600mg daily
4 days

21
Q

Vaccines

A
  • Meningococcus: 11-12y & 16-18y
    For those in danger
  • Haemophilus: 2-4-6m
22
Q

Viral

A
  • Seasonal
  • More common:
    Enterovirus, Varicella, Herpes
  • Rash specially in Enteroviruses & Herpes Viruses
    Fever + Neurologic + Rash: check viral meningoencephalitis
  • Cerebellar ataxia
23
Q

Viral Treatment

A

Only for Herpes encephalitis:
Acyclovir 10-20mg/kg TID