Encephalitis, meningitis Flashcards
How do pts w/ encephalitis present?
- Fever
- Altered mental status
- Seizures
- Focal neuro sx
What do you see on PE for encephalitis?
- Papilledema
- Rash
- Autonomic & hypothalamic disturbances
- Arthritis
- Retinitis
What imaging do you use for dx of encephalitis?
- MRI > CT
- Start w/ CT w/out contrast if pt is SICK (faster, r/o mass lesion)
- MRI: hyperintensity in areas of edema
What are contraindications to doing a lumbar puncture?
- Si/sx of increased ICP
- Severe coagulopathy
- Skin infection
- Mass lesion
- If pt has any of the above, CT > LP
What makes up cushing’s triad?
- Respiratory depression
- Bradycardia
- HTN
* Seen in encephalitis
What is cloudy CSF indicative of?
Bacterial meningitis
What are other causes of elevated WBCs in lumbar puncture sample?
- Vasculitis
- Leukemic infiltration
- Traumatic tap*
What is the gold standard for dx of encephalitis?
Brain biopsy
- Invasive, not the initial test performed
How do you tx encephalitis?
- Stabilize (ET tube, vent, circulatory support)
- Antiviral therapy*
- Tx offending agent
- Prevent secondary bacterial infections, DVT, GI prophylaxis.
How can you tx increased ICP?
- Elevate head to 30-45˚
- Avoid compression to jugular veins
- Hyperventilate
- Corticosteroids & mannitol
What is empiric therapy for encephalitis? What is the % of survival?
Start Acyclovir (early): decreases morbidity/ mortality - Up to 90% survival
How do you prevent encephalitis?
Avoid vectors!
- Bug spray, barriers, avoid areas/times when mosquitos are active
What are classic sx of meningitis?
- HA
- Photophobia
- N/V
- Neck stiffness
- Fever
What are complications of bacterial meningitis?
If not fatal, can cause:
- neurological sequelae
- brain damage
- hearing loss
- learning disabilities
What are characteristics of “viral” meningitis?
- Aseptic
- Often indistinguishable from bacterial meningitis based on presentation alone
- Course usually self-limited
- # 1 cause = entero
What is the typical CSF analysis for “viral” meningitis?
- Colorless
- Can be cloudy
What is the typical CSF for encephalitis?
Straw-colored
How do neonates acquire “bacterial” meningitis?
From birth canal
Suspected bacterial meningitis = ________
EMERGENCY
What is the #1 pathogen causing “bacterial” meningitis in neonates?
Group B streptococcus
1 cause of bacterial meningitis in babies/children?
strep pneumoniae
1 cause of bacterial meningitis in teens & young adults?
Neisseria meningitidis
1 cause of bacterial meningitis in adults?
streptococcus pneumoniae
What organism do you need to test for in pregnant women? At how many weeks should you perform?
GBS
35-37 wks gestation
How do you tx pregnant women who are positive for GBS?
prophylactic abx during labor
How does “bacterial” meningitis present?
may be slow or rapid onset
Classic sxs: fever, meningismus, AMS, severe HA
+/- N/V, photophobia, back pain
How does “bacterial” meningitis present in neonates?
classic sxs
+ irritability, poor feeding, lethargy, high-pitched cry, “floppy”, rash, +/- seizures
How do you dx/manage “bacterial” meningitis?
- IV access
- Blood cx x 2 (diff sites, diff times)
- Abx
- CBC, CMP, coag
- +/- CT
- LP
Can you delay abx?
NO!
if LP is delayed bc of CT scan, start abx after obtaining blood cultures
What meds do you use to tx “bacterial” meningitis?
Ceftriaxone or cefotaxime
+ Vanco
+ Ampicillin (if over age 50)
How do you tx pts w/ “bacterial” meningitis who are allergic to PCN?
Vanco + moxifloxacin
- If over 50yo, tx w/ TMP-SMX
Who should you give chemoprophylaxis for “bacterial” meningitis?
- Prolonged contact while in close proximity
- Direct exposure to pt’s oral secretions during 7 days prior to sx onset & until 24 hrs after initiation of abx therapy
What vaccines are available for meningitis?
Quadrivalent conjugate vaccines against A, C, W, & Y:
- Menactra
- Menveo
Vaccines against serogroup B:
- Trumemba
- Bexsero
What “clues” indicate viral meningitis?
- HSV w/ genital lesions (usually precede meningitis sx)
- Mumps
Common organism responsible for bacterial meningitis in pts over 65 y/o or immunocompromised?
Listeria monocytogenes
Which will always have AMS: bacterial meningitis or encephalitis?
ENCEPHALITIS
What kind of rash is highly associated with neisseria meningitis?
petechia/purpura
