Howell 2 Flashcards
what organisms cause the purpura rash of meningitis
-N. Meningiditis (MC)
-Strep. Pneumoniae
H. Influenzae
the neurologic complications that may occur if this patient’s ICP is permitted to rise?
Seizures
Focal Neurologic Deficits
Papilledema
meningitis labs
CBC w/diff, CMP, Coag’s, Blood Cx’s x 2
when to CT meningitis before LP
Immunocompromised state
History of CNS disease (mass lesion, stroke, or focal infection)
New onset seizure (within one week of presentation)
Papilledema
Abnormal level of consciousness
Focal neurologic deficit
What does Rifampin protect against?
Meningicoccal
H. Influenzae
How are other organisms tx’d (prophylactically)?
There is no targeted tx
normal ct in meningitis… what do you do
you LP!!
LP what position
lateral recumbent position
meningitis tx
Dexamethasone (+/-), Vancomycin and Rocephin
What is important about the dexamethasone and the abx?
Give the Dexamethasone First!
Or at least the same time as the abx
symptoms that differentiate meningitis and encephalitis
AMS
focal deficits
most likely source of encephalitis in healthy pt
HSV
most likely source of encephalitis in unhealthy pt
VZV and CMV
What virus typically manifests with challenges in swallowing and hydrophobia?
Rabies virus
Why when considering Encephalitis do you concern yourself with the history and labs?
disttinguse acute arboviral encephalitides as the other acute viral encephalitides, especially HSV encephalitis (HSE) and varicella-zoster encephalitis
normal CSF
Pressure (mmH2O) Appearance Protein (mg/dL) Glucose (mg/dL) WBC
P: 50-200
A: Clear, colorless
P: 10-50
G: 50-80
<5 – all mononuclear
bacterial meningitis LP findings
cloudy (torpid grey)
increased protein and decreased glucose
most common bacterial etiology of community-acquired meningitis in adults of all ages
Streptococcus pneumonia
encapsulated organisms
Streptococcus pneumoniae N. meningitidis H. influenzae Group B streptococcus E.Coli Klebsiella Salmonella
this is important bc no spleen = increased
organism to suspect in pts with meningitis following vp shunt
gram - bacilli
What are the most common cause of neonatal meningitis?
Group B streptococcus andEscherichia coli
Where is the MC source of this for the baby, when less than 6 days?
Vertical Transmission
Maternal transmission, MC during delivery. Screening after: 35-37 weeks and providing abx during delivery.
What is the MC cause of disease in neonate after 7 days?
Nosocomial
age/organism
>1 month and < 3 month
Group B strep
age/organism
>3 month and < 3 years
> 3 years and 10 years
> 10 yrs and < 19 years
Group B strep
N. Meniningiditis
Infants 1-3 months old receive what regimen
Ampicillin and Cefotaxime
Children > 3 months old receive what regimen:
Ceftriaxone and Vancomycin
tx of Everyone up to 50 y/o
Ceftriaxone and Vancomycin + Ampicillin
Aseptic Meningitis
HA
subacute presentation
consider HIV
causes of Aseptic Meningitis
Viruses, Fungi, Spirochetes, and even Autoimmune/Vasculitic and Hypersensitivity reactions have been reported.
how do you determine potential cause of aseptic meningitis
epidemiologic setting
recent medication use
every pt with aseptic meningitis must be tested for
HIV
What viral infections occur in the Summer or Fall and is the MC cause of viral associated meningitis?
Enteroviruses (Coxsackie, Echovirus, and Non-polio Virus)
What is the treatment of choice for most viral meningitis patients?
Symptomatic management/supportive care.
What virus getting treated with targeted therapies (in meningitis)?
HSV, VZV, and CMV (Acyclovir and Gancyclovir)
What form of Meningitis presents as:
This CSF Normal appearance. Proteins were approximately 40 mg/dL and CSF: Serum ratio of glucose was > 0.6; < 1000 wbc’s…mostly Eosinophils
Coccidoidal (Aseptic Meninigitis with Eosinphils)
What medications are most commonly associated with aseptic meningitis?
NSAIDs, Sulfa Based, IVIG, Antiepileptics
why did the median age of meningitis switch?
H Flu and Strep pneumo vax
What vaccination is provided to those living in dorms, and generally provided to those 11-16 y/o? How many in series?
Answer: MCV-4
How many in series?
Answer: 2 shots
What vaccine is provided as routine childhood immunizations, four shot series (2,4,6, 12 months) and is not generally needed after the age of 5 y/o?
Hib (H. Influenzae Type B) + Prevnar 13
Which vaccination is for those who are > 65 y/o or for those with poor health?
PPSV
Why is Pneumovax so important for meningitis prevention?
It is the MOST COMMON Bacterial cause of meningitis “broadly”
risk factors for meningitis
Asplenia and sickle cell disease
Complement deficiency
Alcoholism, IV drug use
HIV infection — immunocompromised; opportunistic pathogens
Recent infection
Crowding
Recent head trauma
Immunosuppression, diabetes mellitus, renal or adrenal insufficiency, cystic fibrosis, glucocorticoid excess
Recent travel to areas with endemic meningococcal disease such as sub-Saharan Africa
N. Meninigitidis MC
crowding and recent travel to areas endemic
diskitis work up
Labs- ESR/CRP, CBC, CMP, Blood Cx.
lance that and obtain a wound cx
plain film and ultimately MRI
CT guided bx
academic difference of Diskitis and Osteomyelitis?
Disc vs. Bone
how is Diskitis tx?
Vancomycin and Rocephin
Pain mgt. IV therapies, as well as bed rest and brace. – In bed physical therapy
epidural abscess s/s+pathoge
Bladder, bowel dysfunction and paralysis + organisms
staph
LP and epidural abscess
no use in doing it
epidural abscess tx
Vancomycin + Metronidazole +
EitherCefotaxime,Ceftriaxone, (orCeftazidime if considering pseudomonas)
what is the difference between a spinal and intracranial abscess
Intracranial epidural abscesses (IEAs) are less common than spinal epidural abscess, and less acute in their evolution
IEAs tend to be slow-growing, rounded, and well-localized
how do IEAs look onCT
Biconvex
The most frequent intracranial locations
Frontal-temporal Frontal-parietal Parietal Cerebellar Occipital lobes
brain abscess on MRI
Ring Enhancing Lesion
mc organism of brain abscess
polymicrobial
early stage of brain abscess
cerebritis
tx for brain abscess
- Surgical Debridement with Neurosurgery (aspiration dx vs excision) pends on size
- Abx: Vancomycin and Rocephin, and Metronidaxole
steroids and brain abscess
decrease antibiotic penetration into the abscess
slow encapsulation of the abscess site
reduce contrast enhancement on CT
increase risk of ventricular rupture
What are the two variances of meningitis determined by the CSF?
Bacterial and Aseptic
Why is it that the host defenses are lacking in the CSF?
Lack of functional opsonic and bactericidal activity
meningitis based on timeline
What is Acute
Answer: Under 24 hours, MC this is bacterial
meningitis based on timeline
What is Subacute
1-7 days, MC this is viral
meningitis based on timeline
What is Chronic
More than 7 days, this lasts longer than 4 weeks
