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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
What two viruses are most often seen with Aseptic Meningitis, and which is more common?
- Enterovirus = MORE common | - HSV-2
26
Generally, what will be elevated and what will be positive or negative with a CSF culture in Aseptic Meningitis?
- Elevated lymphocytes | - - gram stain/culture
27
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?
D/C abx and begin supportive tx (often self-limiting) | - Can consider Acyclovir if severe or IC
28
What condition involves brain/cerebral function abnormalities?
Encephalitis
29
What is the most common cause of fatal encephalitis?
HSV-1
30
What is the most common cause of viral encephalitis in U.S.?
West Nile Virus (WNV)
31
Generally, what do the sxs of Encephalitis involve? What are five example sxs?
Brain dysfunction - HA - Fever - AMS - Seizures - Focal neuro deficits
32
What is the dx test of choice for Encephalitis?
MRI WITH contrast
33
For both Meningitis and Encephalitis, what three dx tests are included in both?
- Blood cultures x2 (pre-abx) - LP (based on IDSA criteria +/- CT/MRI) - CSF culture
34
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?
- 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
What are the five most common viruses associated with Meningitis?
- Coxsackie (enterovirus) - HSV-2 - HIV - Mumps - Measles
36
What are the four most common viruses associated with Encephalitis?
- West Nile Virus (WNV) - HSV-1 - CMV - Influenza
37
What is the recommended tx for Encephalitis? What other two considerations should be made?
Acyclovir - Anti-seizure meds - Decrease ICP (diuretics like Mannitol)
38
What is the most common sxs associated with Cerebral Abscess? What other two sxs may be seen?
Unilateral HA (severe, intractable) - Focal neuro deficits - Fever
39
What is the dx test of choice for Cerebral Abscess? What will it show?
MRI WITH contrast | - Shows "ring-enhancing" lesion
40
What dx test is CI for Cerebral Abscess, and with what specific sxs present? Why?
LP is CI if focal neuro deficits | - Can cause possible brainstem herniation
41
What are the three types of CNS Abscess, and what is the recommended tx for all three (2)?
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
If the source of a Cerebral Abscess is oral, what is the recommended abx (2)?
Metro + Pen G
43
If the source of a Cerebral Abscess is otogenic/sinus, what is the recommended abx (2)?
Metro + Ceftriaxone/Cefotaxime
44
If the source of a Cerebral Abscess is hematogenous, what is the recommended abx (2)?
Metro + Vanco
45
What four sxs are commonly seen with Intracranial Epidural Abscess (IEA)?
- Fever - HA - Lethargy - N/V
46
If the source of an Intracranial Epidural Abscess (IEA) is contiguous spread, what is the recommended abx (2)?
Metro + Ceftriaxone/Cefotaxime
47
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)?
Metro + Vanco + Ceftriaxone/Cefotaxime/Ceftazidime
48
For Spinal Epidural Abscess (SEA), what is the recommended abx (2)?
Vanco + Ceftriaxone/Cefotaxime/Ceftazidime/Cefepime
49
What is the triad of sxs associated with Spinal Epidural Abscess (SEA)?
- Fever - Spinal pain - Neuro deficits
50
What condition involves the triad of fever, nuchal rigidity and AMS?
Meningitis
51
What condition involves the triad of fever, spinal pain and neuro deficits?
Spinal Epidural Abscess (SEA)
52
What is the dx test of choice for Spinal Epidural Abscess (SEA)?
MRI WITH contrast
53
What are three RF associated with Spinal Epidural Abscess (SEA)?
- 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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