CNS Infections in Adults Flashcards
t/f empirical therapy should be initiated promptly if bacterial meningitis is a possibility
true
t/f you can do a lumbar tap before ct scan in all patients
false, mri/ct before lp
t/f altered mental status points to encephalitis
false, meningoencephalitis
cardinal features of acute bacterial meningitis
decreased consciousness
seizures
raised icp
stroke
common organisms in acute bacterial meningitis
s. penumoniae*
n. meningitides (younger age groups, petechiae/pupura, death)
group b streptococci (neonates, >50 yo)
enteric g(-) bacilli (post surgical)
s. aureus (post-op)
listeria monocytogenes
h. influenzae
clinical presentation of acute bac men
acute fulminant illness or subacute infection that progressively worsens
triad: fever, headache, nuchal rigidity
dx of acute bac men
csf exam!
gold standard: csf culture
blood culture, csf analysis (pcr), ct/mri
csf abnormalities in bacterial meningitis
high opening pressure
low glucose
high protein
tx of acute bac men
table 3
adjunct treatments to acute bac men
dexamethasone – pneumococcal meningitis
highest risk organism for mortality in acute bac men
s. pneumoniae
indicators of poor prognosis for acute bac men
decreased consciousness
seizures within 24 hrs onset
increased icp
>50 yo
comorbidities, shock, mechanical ventilation
delayed treatment
csf protein > 300 mg/dl, glucose <40 mg/dl
etiologic agents of acute viral meningitis
enteroviruses* hsv2 varicella zoster ebv arthropod borne viruses
csf abnormalities in acute viral men
table 6, page 4
tx for acute viral meningitis
supportive and symptomatic, no need for admission
antivirals: acyclovir, famciclovir, valacyclovir
clinical presentation of viral encephalitis
altered or depressed consciousness (mild lethargy to severe coma)
diffuse symptoms in viral encephalitis
HAPPy BEHrthday SEIyo
focal symptoms in viral encephalitis
AA WITChDi SIAdh
etiologic agents of viral encephalitis
herpesviruses (cmv, hsv 1/2, hhv 6, vzv, ebv)
arthropod borne virus
enterovirus
csf findings in viral encephalitis
table 9, page 5
tx of viral encephalitis
supportive, monitoring in ICU, ventilator, anticonvulsants, antivirals (iv acyclovir)
clinical manifestations of subacute meningitis
unrelenting headache, stiff neck, low grade fever, lethargy (days to weeks)
causative organisms for subacute meningitis
tb meningitis
fungal (cryptococcal) meningitis
syphilitic meningitis
characteristics of tb meningitis
inflammatory rxn with exudates in basilar cisterns and base of brain
abf culture is gold standard, csf pcr for faster results
csf findings in tb meningitis
table 10, page 5
tx for tb meningitis
HRZE for 12 mos
monitor for hydrocephalus
organism found in cryptococcal meningitis
c. neoformans
lab findings in cryptococcal men
csf lymphocytic pleocytosis with inc protein, low glucose
(+) india ink
polysaccharide antigen or latex agglutination
tx for cryptococcal men
amphotericin b iv + flucytosine x 2 wks followed by 8-10 wks of oral fluconazole
causative agent in syphilitic meningitis
t. pallidum, usually affects cn 7 and 8
lab findings in syphilitic meningitis
reactive serum treponemal test
(+) csf vdrl
treponemal + nontreponemal tests
tx for syphilitic meningitis
iv or im aqueous penicillin g x 2 wks followed by im benzathine penicillin weekly x 3 wks
cardinal features of chronic meningitis
>4 wks persistent headache stiff neck hydrocephalus cranial neuropathies radiculopathies cognitive or personality changes
common bacterial cause of chronic meningitis
partially treated suppurative meningitis, parameningeal infection, m. tuberculosis, syphilis
cerebritis vs brain abscess
cerebritis: focal presentation, no capsule
brain abscess: has vascularized capsule
common etiologies of brain abscess
streptococcus sp. (sinusitis) enertobacteriaceae (nosocomial) anaerobes (dental) staphy tuberculoma
clinical manifestations of brian abscess
expanding cranial mass, depend on location and level of icp
meningismus often absent
classic triad: headache, fever, focal neurologic deficit
dx for brain abscess
mri* (can see ring enhancement)
stereotactic needle aspiration
tx for brain abscess
immunocompetent: cefotaxime or ceftriaxone + metronidazole (for poly)
penetrating head trauma: ceftazidime + vanco OR meropenem + vanco
