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CNS Infections (Exam #3) Flashcards

1
Q

What two pathogens are most often seen with delivery exposure in Bacterial Meningitis?

A
  • GBS

- E. Coli

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2
Q

What pathogen is most commonly seen with nasopharynx transmission of Bacterial Meningitis?

A

Strep pneumoniae

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3
Q

What pathogen is most commonly associated with crowded conditions (military, college) and Bacterial Meningitis?

A

N. Meningitides

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4
Q

What pathogen is most commonly associated with head trauma in Bacterial Meningitis?

A

Staph spp.

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5
Q

What is the triad of sxs associated with Bacterial Meningitis? What other two sxs may also be seen?

A
  • Fever
  • Nuchal rigidity
  • AMS

Can also see meningococcal rash and HA

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6
Q

What skin manifestation is pathognomonic for Bacterial Meningitis?

A

Meningococcal rash?

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7
Q

What two specialized exams are likely positive with Bacterial Meningitis?

A
  • +Kernig’s

- +Brudzinski’s

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8
Q

Generally, what three things will be elevated, what will be reduced and what will be positive or negative with a CSF culture in Bacterial Meningitis?

A
  • Elevated WBCs, proteins, neutrophils
  • Reduced glucose
    • gram stain/culture
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9
Q

G+ diplococci on gram stain is indicative of what pathogen?

A

Strep pneumoniae (pneumococcal)

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10
Q

G- diplococci on gram stain is indicative of what pathogen?

A

N. Meningitides (meningococcal)

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11
Q

G- coccobacilli on gram stain is indicative of what pathogen?

A

H. Influenzae

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12
Q

G+ rods/coccobacilli on gram stain is indicative of what pathogen?

A

L. Monocytogenes

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13
Q

Generally for dx of Bacterial Meningitis, IF 1+ criteria for CT before LP are met, what is the stepwise process of tests (5 steps)?

A
  1. Cultures STAT
  2. Start Dex + empirical abx
  3. CT head
  4. LP
  5. Send CSF cultures
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14
Q

Generally for dx of Bacterial Meningitis, if NO criteria for CT before LP are met, what is the stepwise process of tests (4 steps)?

A
  1. Cultures STAT
  2. LP
  3. Start Dex + empirical abx
  4. Send CSF cultures
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15
Q

What is the general initial tx for all types of Meningitis (2)?

A

Dexamethasone + empirical abx

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16
Q

For Bacterial Meningitis, what is the recommended tx for NEWBORNS (2)?

A

Ampicillin + Cefotaxime/Gentamycin

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17
Q

For Bacterial Meningitis, what is the recommended tx for 1 MONTH to 50 YEARS (3)?

A

Vancomycin + Ceftriaxone/Cefotaxime + Dex

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18
Q

For Bacterial Meningitis, what is the recommended tx for 50+ YEARS (4)?

A

Ampicillin + Vancomycin + Ceftriaxone/Cefotaxime + Dex

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19
Q

For Bacterial Meningitis, what is the recommended tx for an IC PATIENT (4)?

A

Ampicillin + Vancomycin + Cefepime/Meropenem + Dex

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20
Q

For Bacterial Meningitis due to Basillar Skull Fracture, what is the recommended tx (3)?

A

Vancomycin + Cefotaxime/Gentamycin + Dex

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21
Q

For Bacterial Meningitis due to penetrating trauma or post-neurosurgery, what is the recommended tx (3)?

A

Vancomycin + Ceftazidime/Cefepime/Meropenem + Dex

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22
Q

If the CSF gram stain/culture is POSITIVE for Bacterial Meningitis, and it shows G+ diplococci (S. pneumoniae), what is the recommended tx (3)?

A

Targeted abx therapy + Dex + Rifampin

23
Q

If the CSF gram stain/culture is POSITIVE for Bacterial Meningitis, and it shows any NON-G+ diplococci pathogen, what is the recommended tx (1)?

A

Targeted abx therapy ONLY

24
Q

If the CSF gram stain/culture is NEGATIVE for Bacterial Meningitis but appears like Bacterial Meningitis, what is the recommended tx (2)?

A

Continue Dex + empirical abx

25
Q

What two viruses are most often seen with Aseptic Meningitis, and which is more common?

A
  • Enterovirus = MORE common

- HSV-2

26
Q

Generally, what will be elevated and what will be positive or negative with a CSF culture in Aseptic Meningitis?

A
  • Elevated lymphocytes

- - gram stain/culture

27
Q

What is the recommended tx for Aseptic Meningitis if bacterial cause is R/O and likely viral? What medication may be considered and under what two conditions?

A

D/C abx and begin supportive tx (often self-limiting)

- Can consider Acyclovir if severe or IC

28
Q

What condition involves brain/cerebral function abnormalities?

A

Encephalitis

29
Q

What is the most common cause of fatal encephalitis?

30
Q

What is the most common cause of viral encephalitis in U.S.?

A

West Nile Virus (WNV)

31
Q

Generally, what do the sxs of Encephalitis involve? What are five example sxs?

A

Brain dysfunction

  • HA
  • Fever
  • AMS
  • Seizures
  • Focal neuro deficits
32
Q

What is the dx test of choice for Encephalitis?

A

MRI WITH contrast

33
Q

For both Meningitis and Encephalitis, what three dx tests are included in both?

A
  • Blood cultures x2 (pre-abx)
  • LP (based on IDSA criteria +/- CT/MRI)
  • CSF culture
34
Q

Generally, what will be elevated and what will be positive or negative with a CSF culture in Encephalitis?

What other two findings will be seen if the Encephalitis is due to HSV-1 specifically?

A
  • Elevated lymphocytes
    • gram stain/culture

If HSV-1, RBCs will be present and glucose will be LOW (glucose is normal if NOT HSV-1)

35
Q

What are the five most common viruses associated with Meningitis?

A
  • Coxsackie (enterovirus)
  • HSV-2
  • HIV
  • Mumps
  • Measles
36
Q

What are the four most common viruses associated with Encephalitis?

A
  • West Nile Virus (WNV)
  • HSV-1
  • CMV
  • Influenza
37
Q

What is the recommended tx for Encephalitis? What other two considerations should be made?

A

Acyclovir

  • Anti-seizure meds
  • Decrease ICP (diuretics like Mannitol)
38
Q

What is the most common sxs associated with Cerebral Abscess? What other two sxs may be seen?

A

Unilateral HA (severe, intractable)

  • Focal neuro deficits
  • Fever
39
Q

What is the dx test of choice for Cerebral Abscess? What will it show?

A

MRI WITH contrast

- Shows “ring-enhancing” lesion

40
Q

What dx test is CI for Cerebral Abscess, and with what specific sxs present? Why?

A

LP is CI if focal neuro deficits

- Can cause possible brainstem herniation

41
Q

What are the three types of CNS Abscess, and what is the recommended tx for all three (2)?

A

Tx = Neurosurg consult for CT-guided aspiration (+ excision if Cerebral Abscess) AND IV empirical abx

  • Cerebral Abscess
  • Intracranial Epidural Abscess (IEA)
  • Spinal Epidural Abscess (SEA)
42
Q

If the source of a Cerebral Abscess is oral, what is the recommended abx (2)?

A

Metro + Pen G

43
Q

If the source of a Cerebral Abscess is otogenic/sinus, what is the recommended abx (2)?

A

Metro + Ceftriaxone/Cefotaxime

44
Q

If the source of a Cerebral Abscess is hematogenous, what is the recommended abx (2)?

A

Metro + Vanco

45
Q

What four sxs are commonly seen with Intracranial Epidural Abscess (IEA)?

A
  • Fever
  • HA
  • Lethargy
  • N/V
46
Q

If the source of an Intracranial Epidural Abscess (IEA) is contiguous spread, what is the recommended abx (2)?

A

Metro + Ceftriaxone/Cefotaxime

47
Q

If the source of an Intracranial Epidural Abscess (IEA) is not due to contiguous spread but anything else (post neurosurgery or skull trauma), what is the recommended abx (3)?

A

Metro + Vanco + Ceftriaxone/Cefotaxime/Ceftazidime

48
Q

For Spinal Epidural Abscess (SEA), what is the recommended abx (2)?

A

Vanco + Ceftriaxone/Cefotaxime/Ceftazidime/Cefepime

49
Q

What is the triad of sxs associated with Spinal Epidural Abscess (SEA)?

A
  • Fever
  • Spinal pain
  • Neuro deficits
50
Q

What condition involves the triad of fever, nuchal rigidity and AMS?

A

Meningitis

51
Q

What condition involves the triad of fever, spinal pain and neuro deficits?

A

Spinal Epidural Abscess (SEA)

52
Q

What is the dx test of choice for Spinal Epidural Abscess (SEA)?

A

MRI WITH contrast

53
Q

What are three RF associated with Spinal Epidural Abscess (SEA)?

A
  • IC (DM, alcoholism, HIV)
  • Direct inoculation (epidural cath, paraspinal injection, trauma)
  • Hematogenous (tattoo, acupuncture, bacteremia, IVDU, hemodialysis)

EM/Surg (16 decks)

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