CNS Infections Flashcards by Anthony Carli

What test is more sensitive for meningitis/CNS infx on PE than brudzinski/kernig?

Jolt Accentuation Test

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Procedure for Jolt Accentuation Test

rotate 2 times/sec

(+) if HA exacerbation

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Meningococcal/petechiael rash indicates which pathogen for meningitis?

N. meningitides

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IDSA Criteria for CT before LP…

1+ of what 6 RFs?

immunocompromise
Hx CNS dz
new onset seizure
papilledema
ALOC
Focal Neuro Deficit

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G+ diplococci in meningitis…

pneumococcal

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G- diplococci in meningitis

meningococcal

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G- coccobacilli in meningitis

H. flu

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G+ rods & coccobacilli in meningitis

L. monocytogenes

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Which pathogen?

Hx sinusitis, AOM, mastoiditis

Facial fx/cochlear implant

S. pneumo

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Which pathogen?

post- head trauma/neurosurg

staph

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Which 2 pathogens?

exposure during delivery

E. coli

GBS

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Workup for meningitis

blood Cx x 2

LP + CSF Analysis & Cx

CBC with diff
CMP
ESR + CRP
Serum Glucose
Coags

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CSF Analysis…

WBCs: > 1000, Neutrophils

Glucose: < 40

CSF:Blood Glucose: < 0.4

Prot: Elevated

G stain: POS

Bacterial

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CSF Analysis…

WBCs: < 250, lymphocytes

Glucose: WNL

CSF:Blood Glucose: WNL

Prot: Elevated

G stain: NEG

Viral

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Dexamethasone helps w. what pathogen?

pneumococcal

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Dexamethasone dose

0.15 mg/kg q 6 hrs x 4 days

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Meningitis Tx algorithm if 1+ RF for ICP

Stat blood cx

dexamethasone + empiric abx

Head CT

+/- LP + Cx (CT Dependent)

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Meningitis Tx algorithm if no ICP RFs

Stat blood cx

dexamethasone + empiric Abx

CSF analysis/Cx

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CSF Cx shows:

G+ Diplococci

What pathogen, what tx?

Strep Pneumo

Targeted Abx + Dexamethasone + Rifampin

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CSF Cx Shows:

Not S. Pneumo

What Tx?

Targeted Abx

d/c dexamethasone, no rifampin

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Empiric meningitis Tx for newborn …

L. monocytogenes coverage

Ampicillin + Cefotaxine/Gentamycin

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Empiric meningitis Tx for 1mo - 50 yrs …

Vanco + Ceftriaxone/Cefotaxime + Dexamethasone

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Empiric meningitis Tx for immunocompromised or > 50 yo…

L. monocytogenes coverage

Ampicillin + Vanco + Ceftriaxone/Cefotaxime + Dexamethasone

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Empiric meningitis Tx for adults w/ PCN allergy

Vanco + Moxifloxacin + Bactrim

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Empiric meningitis Tx for basilar skull Fx

Vancomycin + cefotaxime/gentamycin +Dexamethasone

Empiric meningitis Tx for penetrating trauma/neurosurg

Vanco + Ceftazidime/Cefepime/Meropenem + Dexamethasone

PEP for bacterial meningitis

Cipro 500mg PO x 1 dose Rifampin 600mg q 12hrs x 2 days

PEP for bacterial meningitis in pregnant clinician/family member

Ceftriaxone 250mg IM x 1

What occurs prior to onset of meningitis sxs if HSV-2?

genital lesions 7 days prior

What pathogen? Meningitis + unvaccinated

mumps

What pathogen? Meningitis + vesicular genital lesions

Primary HSV-2

What pathogen? (3) Meningitis + maculopapular exanthem, mildly ill

enteroviral, primary HIV, Syphilis

What pathogen? Meningitis + OP Thrush + Cervical LAD

Primary HIV

What pathogen? Meningitis + Asymmetric flaccid paralysis

West Nile

Aseptic meningitis CSF analysis = WNL except...

WBCs < 500 +/- lymphocytes

MC cause of fatal encephalitis

HSV 1

MC cause of viral encephalitis in US

west nile

Encephalitis sxs + ulcers/vesicles

HSV-1

Encephalitis sxs + parotitis

mumps

Encephalitis sxs + flaccid paralysis + rash

west nile

Encephalitis sxs + hydrophobia + hyperactivity + pharyngeal spasm

rabies

Encephalitis sxs + tremors tongue/lips/eyelids

St. Louis virus

RBCs in CSF indicates...

HSV-1

CSF Analysis shows: Elevated Protein WBCs: < 250 + lymphocytes

viral encephalitis

Study of choice in encephalitis

MRI (CT is faster tho)

temporal lobe changes on MRI =

HSV

Hydrocephalus on MRI =

bacterial/fungal/parasitic

Abscess in temporal lobe... etiology?

AOM, mastoiditis

Abscess in frontal lobe... etiology?

sinusitis | dental infx

Hematogenous spread presents with...

multiple abscesses

Severe unilateral HA not relieved w. OTC analgesics...

cerebral abscess

Ring enhancing lesion on MRI

cerebral abscess

Dx and Tx proceddure if no ICP sxs for brain abscess...

CT aspiration

Multiple abscesses indicates...

fungal/parasitic cysticercosis

Abx for abscess if oral source...

metro + PenG

abx for abscess if otogenic/sinus source

Metro + Ceftriaxone/Cefotaxime

Intracranial epidural abscess MC a complication of...

neurosurg

Pt. p/w: fever, headache, lethargy, N/V +/- signs of increased ICP

Intracranial epidural abscess (IEA)

IEA Dx...

think of it + Contrast MRI

IEA Tx if contiguous spread

Metro + ceftriaxone/cefotaxime

IEA Tx if no contiguous spread

vanco + metro + ceftriaxone/cefotaxime/ceftazidime

Pt. p/w: Spinal pain neuro deficits weakness/paralysis +/- fever

Spinal epidural abscess

Dx for SEA

Think of it + Contrast MRI | contrast CT 2nd line

Mgmt of SEA

blood cx x 2 + empiric abx decompression + drainage f/u MRI in 4 weeks

Empiric Abx for SEA

Vanco + cephalosporin