CNS infections Flashcards
LP vs CT scan in suspected meningitis?
- CT scan to r/o occult mass lesion (CI for spinal tap)
- look for papilledema, focal neuro signs
MOST patients do not need a CT
If you DO need a CT before LP, should you treat?
Do not delay blood cultures or treatment
CSF prof: acute bacterial meningitis
- HIGH OP
- HIGH WBC (PMNs)
- HIGH protein
- LOW glucose
- CSF glu/serum glu <0.4
CSF prof: viral meningitis
- nl/ increase OP
- HIGH WBC (lymphocytes)
- nl/ inc
- nl glucose
CSF prof: fungal/ TB meningitis
- HIGH OP
- HIGH WBC (lymphocytes)
- HIGH protein
- LOW sugar
most common bug causes of community acquired bac meningitis
- strep pneumo (50%)
- n. mening (25%) –> 2-18yo
- group b strep (15%)
- listeria (10%)
age group/ diagnostic clues of n meningiditis?
2-18 yo
petechial rash
H. flu rates are low now since Hib vax
antibiotic approach to acute bacterial meningitis?
- ceftriaxone to cover most likely bugs (s pneumo, n mening, h flu)
- Vanco to cover b-lactam resistant strep pneumo
- steroids ONLY effective if given 15 min prior to antibiotics
sx of meningitis? Are sx worse in bacterial or viral?
- fever, HA, neck pain, n/v, seizures
- meningismus, photophobia, phonophobia
generally worse in bacterial
4 most common viral etiologies of meningitis in children?
- enterovirus (summer) –> EV PCR
- arboviruses
- HSV –> always do proph acyclovir is suspected, viral PCR
- mumps
enteroviruses (check this one)
polio echo rhino coxackievirus HAV
(all picorno)
clinical syndromes of enteroviral dz
herpangina
hand-foot-mouth dz –> hand, foot, buttocks, tongue bucal mucosa, palate, gingiva
tx for viral meningitis?
acyclovir IV when HSV or VZV suspected
no tx for EV
how are EVs transmitted?
primary= fecal oral, resp
- vertical transmission
- fomites
CNS lesions with mass effect/ severe immunocompromise
1) toxoplasma gondii –> #! mass lesion in HIV1 pt. RING ENHANCING lesions
2) primary CNS lymphoma –> EBV. Single lesions
3) cryptococcus neoformans
4) aspergillus
