IC17 Bacterial Meningitis and Cdiff Flashcards
Examples of Septic and Aseptic Meningitis
Septic: Bacteria
Aseptic:
Virus
Fungal
Parasitic
Mycobacterium
Syphilis
What is the classic triad of bacterial meningitis symptoms?
Headache
Backache
Neck rigidity
3 physical signs of bacterial meningitis
Kernig sign
Lift one leg while lying, back pain
Brudzinski sign
Flexing neck will cause reflex of hip and knee
Bulging fontane (in infants)
Special symptoms for Neisseria meningitis
Petechiae: Widespread red spots on body
or Purpura: Bigger red, purple spots
What can be inferred from Lumbar puncture? (4 points)
- Elevated opening pressure
- CSF composition
- CSF gram stain and culture
- CSF PCR
What are the components tested in CSF?
Glucose
Protein
WBC
What is the normal CSF glucose level?
What is the level in bacterial and viral meningitis?
2.6-4.5
Bacterial: Very low
Viral: Slightly low
What is the protein in normal CSF?
VS Bacterial, viral
Should be low, <0.4g/L
Bacterial: Raised, >1.5g/L
Viral: Mildly raised
Normal WBC level in CSF?
Amount in bacterial and viral, mainly which type of wbc?
< 5 cells/mm3
Bacterial: >100, mainly neutrophils
Viral: up to 1000, mainly lymphocytes
What are the 2 likely pathogens for BM? Which patient population is different?
Strep Pneumo
Neisseria meningitidis
These not present in Neonates (<1 month)
Which patients need to be covered by Listeria and E.coli
Listeria: Adults > 50yo, Neonates
E.coli: everybody except Children and Adults (2 - 50yo)
What is grp B strep?
Which patients need to be covered by Group B Strep?
Strep Agalactiae
Neonates to Children
What is the main drug for empiric treatment of bacterial meningitis?
Ceftriaxone
What is Ampicillin used for?
Listeria
What is Vancomycin used for in Bacterial Meningitis?
Cover Strep Pneumo that is resistant to Ceftriaxone
Duration of Culture directed therapy for Bacterial Meningitidis (what is the acronym?)
NSBL
Neisseria - 5-7 days
Strep Pneumo - 10-14 days
Grp B Strep (Strep Agalactiae) - 14-21 days
Listeria - >21 days
Culture directed therapy principles of Bacterial Meningitidis (if culture shows NSBL)
For NSBL, use Ampicillin or Penicillin G
If Penicillin resistant or mild allergy, go back to Ceftriaxone (as used in empiric)
(special cases)
for Listeria (if penicillin allergy)
BUT Ceftriaxone cannot cover Listeria, (cos only Ampicillin can), so use Co-trimox OR Meropenem
for strep pneumo
If bug is penicillin and cephalosporin resistant, use Vancomycin + Rifampicin
What infection is adjunctive corticosteroid indicated for?
What corticosteroid is used + dose?
Strep Pneumo and Haem Influenzae bacterial meningitis
Dexamethasone 10mg Q6 x 4 days
Why does Dexamethasone interact with drugs?
Decrease antibiotic penetration due to decreased meninges inflammation
Chemoprophylaxis is suitable for which infection by which bug?
Neisseria Meningitidis infection
What can adults take for chemoprophylaxis?
What can children take?
Rifampicin (4 doses)
Adults: 600mg Q12
Children: 10mg/kg Q12
Neonates: 5mg/kg Q12
Ciprofloxacin (1 dose)
Adult only: 500mg
IM Ceftriaxone (1 dose)
125 - 250mg
Antibiotics that have highest risk for C.diff (3 points)
Clindamycin
3rd, 4th gen cephalosporins
Fluoroquinolones
Antibiotics with lowest risk of C.diff (2 points)
(protective) Doxycycline or Tigecycline
IV Vancomycin
Does not reach gut
But some IV drugs may still reach gut due to enterohepatic circulation eg. IV Metronidazole
Symptoms of moderate C.diff infection (3 points)
Abdominal cramps and distension
Leukocytosis (high WBC count)
Hypovolemia
