IC17 BM

Question 1

What drugs can cause BM?

Answer 1

Co-trimoxazole
Ibuprofen

Question 2

What are the risk factors for BM? (8)

Answer 2

1. head trauma
2. CNS shunts
3. neurosurgical patients
4. CSF leak or fistula
5. Local infections like sinusitis, OM and pharyngitis
6. Immunosuppressed
7. Splenectomy
8. Congenital effects

Question 3

What is the classic triad for BM?

Answer 3

Headache, Neck-ache, Nuchal rigidity (neck)

Question 4

What are symptoms for BM other than the classic triad?

Answer 4

Fever, chills, mental status changes (irritability), photophobia, n&v, anorexia, poor feeding habits in infants, petechiae, purpura (purple patches)

Question 5

What are the physical signs of BM? (3)

Answer 5

Kernig’s sign, Brudzinski’s sign, bulging fontane

Question 6

What is the key investigation for BM?

Answer 6

Lumbar puncture

Question 7

What are the three components tested for in a lumbar puncture?

Answer 7

glucose, protein, WBC

Question 8

How does glucose differ between normal CSF, bacterial meningitis and viral meningitis?

Answer 8

Normal - CSF:blood > 0.66
Bacterial - low ,< 0.4
Viral - a bit low

Question 9

How does protein differ between normal CSF, bacterial meningitis and viral meningitis?

Answer 9

Normal - < 0.4 g/L
Bacterial - raised, > 1.5 g/L
Viral - a bit high

Question 10

How does WBC differ between normal CSF, bacterial meningitis and viral meningitis?

Answer 10

Normal - WBC < 5 cells/mm3
Bacterial - slightly raised
Viral - very raised 5-1000 cells/mm3

Question 11

What are the pathogens for neonates < 1 month?

Answer 11

Strep agalactiae
E. coli
Listeria monocytogenes

Question 12

What are the pathogens for infants 1-23 months?

Answer 12

Strep agalactiae
E. coli
Strep pneumo
Neisseria meningititis

Question 13

What are the pathogens for those aged 2-50 yo?

Answer 13

Strep pneumo
Neisseria meningititis

Question 14

What are the pathogens for those above 50?

Answer 14

]Strep pneumo
Neisseria meningititis
E. coli
Klebsiella
Listeria monocytogenes

Question 15

What is empiric treatment for neonates < 1 month?

Answer 15

IV ceftriaxone and ampicillin

Question 16

What is empiric treatment for infants 1-23 months?

Answer 16

IV ceftrriaxone and vancomycin

Question 17

What is empiric treatment for those aged 2-50 yo?

Answer 17

IV ceftrriaxone and vancomycin

Question 18

What is empiric treatment for those above 50?

Answer 18

IV ceftrriaxone and vancomycin and ampicillin

Question 19

What is culture directed therapy for Neisseria meningitidis and how long should it be treated?

Answer 19

IV Penicillin G 4MU q4h
IV Ampicillin 2g q4h
IV Ceftriaxone 2g q12h

Treatment for 5-7 days

Question 20

What is culture directed therapy for Strep pneumoniae and how long should it be treated?

Answer 20

IV Penicillin G 4MU q4h
IV Ampicillin 2g q4h
IV Ceftriaxone 2g q12h
IV Vancomycin 15mg/kg q8h with Rifampicin 300mg q12h

Treatment for 10-14 days for all

Question 21

What is culture directed therapy for Strep agalactiae and how long should it be treated?

Answer 21

IV Benazthine Penicillin G 4MU q4h
IV Ampicillin 2g q4h
IV Ceftriaxone 2g q12h

Treatment for 14-21 days for all

Question 22

What is culture directed therapy for Listeria monocytogenes and how long should it be treated?

(hint: MonoCytogenes = MC)

Answer 22

IV Penicillin G 4MU q4h
IV Ampicillin 2g q4h
IV Meropenem 2g q12h
IV Co-trimoxazole

Treatment for ≥ 21 days

Question 23

What adjunctive treatment can be given for BM?

Answer 23

PO Dexamethasone 10mg q6h for up to 4 days, 10-20 minutes before or at the same time as antibiotics

Question 24

What drugs can be given for chemoprophylaxis for household exposure to BM?

Answer 24

PO Rifampicin 4 doses
adults: 600mg q12h
children: 10mg/kg q12h
neonates < 1 month: 5mg/kg q12h

PO Ciprofloxacin 500mg single dose for adults

IM Ceftriaxone 125-250mg single dose