CNS Infections

Question 1

Virus family causing majority of viral meningitis

Answer 1

Enterovirus (Coxsackievirus, Echovirus, non-Polio Enterovirus)

Question 2

HSV 1 is more likely to cause meningitis or encephalitis?

Answer 2

Encephalitis

Question 3

HSV 2 is more likely to cause meningitis or encephalitis

Answer 3

Meningitis

Question 4

What is Mollaret Meningitis?

Answer 4

Recurrent form of lymphocytic meningitis; classic symptoms of meningitis with weeks to years of asymptomatic periods in-between recurrences

Question 5

What infection is associated with Mollaret Meningitis?

Answer 5

HSV-2

Question 6

CSF findings in viral meningitis

Answer 6

Pressure: <250mmH2O
WBC: 50-1000/uL
Leukocyte Predominance: Lymphocytes
Glucose: >45 (normal)
Protein <200 (high)
Culture: Negative

Question 7

CSF findings in bacterial meningitis

Answer 7

Pressure: 200-500mmH2O
WBC: 1000-5000/uL
Leukocyte  Predominance: Neutrophils
Glucose: <40 (low)
Protein: 100-500 (high)
Gram Stain: +60-90%
Culture: +70-85%

Question 8

After how many hours can empiric ABX be stopped in a person w/ likely viral meningitis

Answer 8

48-72hours of negative CSF cultures

Question 9

Endemic meningococcal disease is present where?

Answer 9

Sub-Saharan Africa

Question 10

Two most common organisms causing bacterial meningitis

Answer 10

1. Streptococcus pneumoniae

2. Neisseria meningitidis

Question 11

CT should be obtained before LP only in which circumstances?

Answer 11

Essentially evidence of increased ICP
1. Papilledema
2. Focal Neuro Deficits
3. AMS
4* Immunocompromised
5* H/O CNS disease (stroke, tumor)

Question 12

Asplenia increases risk of which three bacterial causes of meningitis

Answer 12

Strep pneumo, Neisseria, H. flu

Question 13

How is Neisseria transmitted?

Answer 13

Droplets

Question 14

4 conditions that put a pt at risk for GBS meningitis

Answer 14

Diabetes, Alcoholism, Malignancy, Liver Disease

Question 15

How is dexamethasone dosed for bacterial meningitis?

Answer 15

0.15mg/kg q6 hrs x 4 days (ideally give 15mins before ABX)

Question 16

When is dexamethasone recommended?

Answer 16

In all cases of suspected bacterial meningitis in developed countries

Question 17

Antibiotics for community acquired meningitis in otherwise healthy <50y/o patient

Answer 17

IV Ceftriaxone + IV Vancomycin

Question 18

Antibiotics for community acquired meningitis in >50y/o

Answer 18

IV Ceftriaxone + Vancomycin + Ampicillin

Question 19

What would you give a patient w/ beta lacatam allergy who has meningitis?

Answer 19

IV Moxifloxacin (instead of Ceftriaxone)
IV Trimethoprim-Sulfamethoxazole (instead of ampicillin)

Question 20

Treatment for hospital acquired meningitis

Answer 20

IV Vancomycin + either Cefepime / Meropenem / Ceftazidime

Question 21

Treatment for meningitis from neurosurgical procedures

Answer 21

IV Vancomycin + either Cefepime / Meropenem / Ceftazidime

Question 22

What size brain abscess warrants surgical drainage or excision?

Answer 22

> 2.5cm

Question 23

When are glucocorticoids recommended with brain abscesses?

Answer 23

Only with significant cerebral edema

Question 24

What organisms are most likely causing a brain abscess and what is the treatment in a patient with Otitis Media or Mastoiditis

Answer 24

Strep, Bacteroides, Prevotella, Enterobacteriaceae

Tx: Metronidazole + 3rd Gen Cephalosporin

Question 25

What organisms are most likely causing a brain abscess and what is the treatment in a patient with Sinusitis

Answer 25

Strep, Bacteroides, Enterobacteriaceae, Staph Aureus, Haemophilus

Tx: Metronidazole + 3rd Gen Cephalosporin +/- Vanco if MRSA suspected

Question 26

What organisms are most likely causing a brain abscess and what is the treatment in a patient with Dental Sepsis

Answer 26

Mixed Fusobacterium, Prevotella, Bacteroides, Strep

Tx: Penicillin + Metronidazole

Question 27

What organisms are most likely causing a brain abscess and what is the treatment in a patient w/ penetrating trauma or NSGY

Answer 27

Staph Aureus, Strep, Enterobacteriaceae, Clostridium

Tx: Vancomycin + 3rd Gen Cephalosporin (may give Pseudomonal coverage if suspected)

Question 28

What organisms are most likely causing a brain abscess and what is the treatment in a patient with a lung abscess, empyema or bronchiectasis

Answer 28

Fusobacterium, Actinomyces, Bacteroides, Prevotella, Strep and Nocardia

Tx: Penicillin + Metronidazole + TMP/SMX

Question 29

If predisposition for a brain abscess is unknown, what is the empiric therapy?

Answer 29

Vancomycin + Metronidazole + 3rd Gen Cephalosporin

Question 30

What organisms are most likely causing a brain abscess and what is the treatment in a patient with Endocarditis

Answer 30

Staph aureus, Strep

Tx: Vancomycin + Gentamicin

Question 31

What organisms are most likely causing a brain abscess and what is the treatment in a patient w/ hematogenous spread from pelvic or intra-abdominal source

Answer 31

Enteric Gram Negative Bacteria, anaerobic bacteria

Tx: Metronidazole + 3rd Gen Cephalosporin

Question 32

What organisms are most likely causing a brain abscess and what is the treatment in a patient w/ HIV or otherwise immunocompromised

Answer 32

Listeria, Fungi (Crypto), Parasitc/Protozoal (Toxo); Aspergillus, Coccidioides, Nocardia

Tx: Metronidazole + 3rd Gen Cephalosporin +/- Antifungal and Antiparasitic