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PHRM 865 > Exam 5: CNS Infections > Flashcards

Exam 5: CNS Infections Flashcards

1
Q

Types of CNS infections

A

meningitis, encephalitis, brain abscess, ventriculitis, subdural empyema, CSF shunt infections

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2
Q

Function of skull, vertbrae

A

act as a shock absorber for brain and spinal cord

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3
Q

what produces CSF

A

choroid plexus

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4
Q

Normal CSF composition

A
  1. clear
  2. protein concentration <50
  3. Glucose concentration 50-66%
  4. pH of 7.4
  5. Wbc <5
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5
Q

what are the meninges

A

protective covering of the brain and spinal cord

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6
Q

3 layers of meninges

A

dura matter
arachnoid
pia mater

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7
Q

what is meningitis

A

infection of the subarachnoid space (b/w pia and arachnoid

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8
Q

BBB composition

A

tightly join capillary endothelial cells that produce tight junctions similar to a lipid bilayer

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9
Q

BBB function

A

separate blood from brain tissue

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10
Q

BBB and drugs relationship

A

drugs enter brain tissue by direct passage through capillary endothelial cells

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11
Q

BCSFB composition

A

consists of tightly fused ependymal cells, which line the ventricular side of the choroid plexus

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12
Q

BCSFB function

A

separated blood from CSF

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13
Q

ependymal cell function

A

restrict diffusion of drugs and chemicals into CSF to serve as a barrier to antimicrobial penetration into the CSF

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14
Q

Lipid Solubility and CSF penetration

A

lipid soluble drugs penetrate brain tissue more readily than hydrophilic drugs

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15
Q

Ionization and CSF penetration

A

only unionized drugs can diffuse

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16
Q

protein binding and CSF penetration

A

only free drug can penetrate

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17
Q

molecular weight and CSF penetration

A

agents with low molecular weight penetrate barrier

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18
Q

degree of meningeal inflammation and CSF penetration

A

penetration of some drugs into CSF is enhances with inflammation; decreased penetration as healing progresses

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19
Q

Therapeutic CSF concentrations with or without meningeal inflammation (8)

A
  1. acyclovir
  2. chloramphenicol
  3. fluconazole
  4. ganciclovir
  5. linezolid
  6. metronidazole
  7. rifampin
  8. ? FQ
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20
Q

Therapeutic CSF concentrations WITH meningeal inflammation (6)

A
  1. penicillins
  2. 3rd and 4th gen cephs
  3. aztreonam
  4. meropenem
  5. colistin
  6. vanc
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21
Q

Therapeutic CSF concentrations NOT achieved with or without meningeal inflammation

A
  1. AG
  2. Amp B
  3. Beta lactamase inhibitors
  4. 1st and 2nd gen ceph
  5. Clindamycin
  6. Tetracycline
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22
Q

Pathogenesis of meningitis

A

Bacteria gain access into CSF through contiguous spread from a parameningeal focus so pathogens penetrate CSF while draining via CNS veins or eroding through bony structures

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23
Q

bacterial meningitis likely causative pathogen: neonates <1 month

A

group b strep
e. coli
listeria

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24
Q

bacterial meningitis likely causative pathogen: children 1 mo-4yr

A

h. flu
s. pneumo
n. meningitidis

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25
bacterial meningitis likely causative pathogen: children, adults >4-29 yrs
n. meningitidis | s. pneumoniae
26
bacterial meningitis likely causative pathogen: adults 30-50 years
s pneumoniae | n. meningitidis
27
bacterial meningitis likely causative pathogen: older adult >50 yrs
s pneumo n mening gnr listeria
28
bacterial meningitis likely causative pathogen: post neurosurgery
s. aureus gnr s. epidermidis
29
bacterial meningitis likely causative pathogen: head trauma
s. aureus | GNR
30
bacterial meningitis likely causative pathogen: immunocompromised
s pnuemo n mening listeria GNR
31
what bacteria account for >80% of cases
h. influenzae n. meningitidis s. pnuemonae
32
Bacterial menigitidis clinical signs and symptoms: adult
fever headache stiff neck photophobia
33
Bacterial menigitidis clinical signs and symptoms: young infants
fever | SZ
34
Bacterial menigitidis clinical signs and symptoms: elderly
low grade fever | stiff neck
35
Bacterial menigitidis clinical signs and symptoms: older children
changes in activity level lethargy confusion
36
common clinical presentation of meningococcemia
rash
37
chemistry of CSF examination in meningitis
< 50% serum | High protein 100-500
38
hematology of CSF examination in meningitis
WBC >400-5000 | Differential >80% neutrophils
39
When to begin empiric therapy for bacterial meningitis
immediately after LP is performed
40
Basis of empiric therapy for bacterial meningitis
1. . most probable organism 2. antibiotic characteristics 3. patient characteristics
41
antibiotic characteristics needed for bacterial meningitis
1. high dose 2. penetration into csf 3. bactericidal activity
42
goal of treating bacterial meningitis
rapid sterilization of CSF, resolution of signs and symptoms, decrease mortality, and prevention of neurologic sequelae
43
bacterial meningitis recommended therapy: neonates
ampicillin + cefotaxime
44
bacterial meningitis recommended therapy: infants, children
3rd gen ceph + vanc
45
bacterial meningitis recommended therapy: children, adults
3rd gen ceph + vanc
46
bacterial meningitis recommended therapy: adults
3rd gen ceph + vanc
47
bacterial meningitis recommended therapy: older adults, immunocompromised
amp + 3rd gen ceph (4th gen if immuno/elderly) + vanc
48
bacterial meningitis recommended therapy: post neurosurgery
vanc + 3rd or 4th gen ceph
49
bacterial meningitis recommended therapy: head trauma
vanc + 3rd or 4th gen ceph
50
bacterial meningitis directed therapy and duration: PSSP
gen G or ampicillin for 10-14 days
51
bacterial meningitis recommended therapy: PRSP
van + ceftriaxone for 14-21 dqays
52
bacterial meningitis recommended therapy: group B strep
ampicillin +/- gentamicin for 14 to 21 days
53
bacterial meningitis recommended therapy: MSSA
naficillin for 14 to 21 days
54
bacterial meningitis recommended therapy: MRSA
14 to 21 days
55
bacterial meningitis recommended therapy: l. monocytogenes
ampicillin +/- gentamicin for 21 days
56
bacterial meningitis recommended therapy: n. meningitidis
penicillin or ceftriaxone for 7-10 days
57
bacterial meningitis recommended therapy: h. influenzae
BL- ampicillin, BL + ceftriaxone for 7 to 10 days
58
bacterial meningitis recommended therapy: gram negative
ceftriaxone or cefepime for 21 days
59
role of steroids in bacterial meningitis for children
adjunctive therapy in h. influenzae in pediatrics b/c it decreases the incidence of neurologic sequelae and hearing impairment
60
role of steroids in bacterial meningitis for adults
useful in adults with pneumococcal meningitis b/c decrease in mortality and unfavorable outcomes
61
when to administer steroids in bacterial meningitis
before or with 1st dose of the antibiotic
62
prophylaxis of bacterial meningitis
prophylaxis should be administered to close contacts of index case to eliminate nasopharyngeal colonization, decrease transmission of the organism, and prevent the development of meningitis
63
what is considered a close contact for bacterial meningitis
household member, someone sharing sleeping quarters, daycare attendee, NH resident, anyone in crowded confined area with index case
64
Prophylaxis regimens adults: neisseria meningitidis
rifampin 600mg q12h x4 doses
65
Prophylaxis regimens adults: h. influenzae
600mg qd x4 days
66
Prophylaxis regimens children: neisseria meningitidis
rifampin 5-10 mg/kg PO Q12H x4 doses
67
Prophylaxis regimens adults: h. influenzae
rifampin 10-20 mg/kg PO QD x4 days
68
most common cause of fungal meningitis
cryptococcus neoformans
69
Cryptococcal meningitis treatment: non-HIV
AmB 0.7-1 mg/kg/day or Lip AmB 3-4 mg/kg/day or Abelcet 5mg/kg/day + flucytosine 25mg/kg PO QID x14 followed by fluconazole 400mg PO or IV QD x10-12 weeks
70
Cryptococcal meningitis treatment: HIV
Lip AmB 3-4mg/kg IV + flucytosine mg/kg PO QID x2 weeks then fluconazole 400mg PO or IV qd for 8-10 weeks then fluconazole maintenance therapy for at least one year
71
what is encephalitis
inflammatory process of the brain parenchyma in association with clinical and lab evidence of neurologic dysfunction
72
CSF analysis in encephalitis
mildly decreased glucose elevated protein high WBC
73
treatment of herpes simplex of varicella zoster encephalitis
acyclovir 10mg/kg IV q8h x 2-3 weeks
74
treatment of CMV encephalitis
ganciclovir + foscarnet IV for 2 to 3 weeks (HIV infected patients)
75
ways bacteria can gain access into and invade tissue
1. contiguous spread 2. hematogenous spread 3. direct inoculation
76
bacterial etiology of brain abscess: otitis media or mastoiditis
streptococci bacteroides prevotella GNR
77
treatment of brain abscess: otitis media or mastoiditis
3rd gen ceph + metronidazole
78
bacterial etiology of brain abscess: sinusitis
``` streptococci bacteroides GNR s. aureus h. influenzae ```
79
treatment of brain abscess: sinusitis
3rd gen ceph + metronidazole
80
bacterial etiology of brain abscess: dental sepsis
fusobacterium bacteroides prevotella viridans streptococci
81
treatment of brain abscess: dental sepsis
penicillin + metronidazole
82
bacterial etiology of brain abscess: post neurosurgery, penetrating head trauma
s. aureus streptococci GNR clostridium
83
treatment of brain abscess: post neurosurgery, penetrating head trauma
vanc + 3rd of 4th gen ceph
84
bacterial etiology of brain abscess: bacterial endocarditis
s. aureus | viridans streptcocci
85
treatment of brain abscess: bacterial endocarditis
vanc + gentamicin
86
bacterial etiology of brain abscess: lung abscess, empyema
``` fusobacterium actinomyces bacteroides prevotella viridans streptococci ```
87
treatment of brain abscess: lung abscess, empyema
penicillin + metronidazole (+ sulfonamide for nocardia)
88
bacterial etiology of brain abscess: HIV infected
toxoplasma nocardia cryptococcus
89
third gen cephs to use for brain abscess
ceftriaxone or cefotaxime
90
what four gen ceph to use if pseudomonas suspected
cefepime
91
adjunct therapy for brain abscess
corticosteroids for patients with surrounding edema

PHRM 865 (59 decks)

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