ID Flashcards
1
Q
MC etiologies of meningitis?
A
- bacterial:
strep pneumo
N. meningitidis
H. flu - viral: enteroviruses, HSV, HIV, West Nile, VZV, mumps
- fungal: cryptococcus
- noninfectious: tumor, trauma, brain abscess, subdural empyema, pharm rxn
2
Q
Community acquired vs health care assoc etiologies of meningitis?
A
- community: Strep pneumo N. meninigitis H flu Listeria monocyotgenes (immune compromised)
- healthcare:
staph and aerobic gram neg bacilli
3
Q
Sxs of meningitis?
A
- abrupt onset
- classic triad: fever, nuchal rigidity, change in mental status
- intense HA
- photophobia, lethargy, nausea, vomiting, jt pain, seizures
- mediation duration of sxs b/f presentation: 25hrs (bacterial)
- petechial rash = N. Meningitidis
4
Q
Dx issues w/ CNS infections in elderly?
A
- hard to initially separate meningitis from encephalitis:
both present w/ mental status changes, elderly w/ meningitis less likely to have fever - any infection in elderly can cause delirium in elderly
- if personality change think encephalitis
5
Q
What are red flags in elderly pop when thinking about meningitis?
A
- behavioral changes/personality changes
- seizures
- lack of there source of infection
- HA, nuchal rigidity, exposure to infected persons
- low threshold to do LP
6
Q
Indications for head CT prior to LP?
A
- immunocompromised
- hx of seizure w/in 1 wk prior to presentation
- any of following neuro abnorm:
abnorm LOC
hx of CNS disease (lesion, stroke, focal infection)
PAPILLEDEMA
focal neuro deficit - mandatory in pts w/ possible focal infection
** any evidence of papilledema or focal neuro findings - don;t perform LP b/f getting STAT CT to r/o sig ICP - perform LP immediately in absence of papilledema or focal neuro findings
7
Q
W/U for meningitis? Tx?
A
- blood cultures, CBC, chem 7
- send CSF to lab for cell count, gram stain, culture, glucose, and total protein:
Any + gram stain is dx, WBC in CSF over 1000 if PMNs make up 85% is dx, CSF glucose less than 50% of serum glucose is suggestive - as soon as LP is completed (b/f labs are even back) give 2 gm rocephin IV
- all admitted and rocephin cont at 2 G IV q 12 hrs
- many even w/ proper, rapid tx will die or have permanent CNS deficits
8
Q
Normal CSF values?
A
- pressure: 70-180 mm H2O
- appearance: clear, colorless
- CSF total protein: 15-45 mg/100 ml
- CSF glucose: 50-80 mg/100 ml (or greater than 2/3 of blood sugar level)
- CSF cell count: 0-5 WBCs (all mononuclear) and no RBCs
- chloride: 110-125 mEq/L
9
Q
Bacterial meningitis clues in peds?
A
- occurs MC b/t 2 mo- 2 yrs
- uncomon to develop meningitis form OM and spread is not from direct extension but from systemic spread
- irritability and poor feeding may be only clues in infants
- paradoxical irritability: crying worsens when being held - suggestive of meningitis
10
Q
MC etiologic agents of meningitis in peds pts? How can we prevent this?
A
- strep pneumo
- N. meningitidis
- H flu
- in neonates: consider gram - causes, group B strep
- primary prevention of meningitis:
S. pneumo vaccine
H. flu vaccine
Meningococcal vaccine now available for teens and adults
11
Q
What is menigoencephalitis?
A
- overlap of meningitis + encephalitis
12
Q
What is encephalitis? MC etiology?
A
- inflammation of the brain
- MC caused by viral infections:
HSV-1, HSV-2 are rapidly progressing and life threatening - West Nile, CMV, mumps, EBV
13
Q
What is the diff b/t encephalitis and meningitis?
A
- encephalitis has alt brian fxn and neuro findings: personality changes, paralysis, hallucinations, alt smell, problems w/ speech
14
Q
Sxs of encephalitis?
A
- mild: flu like sxs
- severe:
severe HA, fever, alt consciousness, confusion, agitation, personality changes, seizures, loss of sensation, paralysis, muscle weakness, hallucinations, double vision, perception of foul smells, problems w/ speech or hearing, LOC - children: bulging of fontanels, N/V, body stiffness, inconsolable crying, crying that worsens when picked up, poor feeding
15
Q
W/U and tx of encephalitis?
A
- CT and/or MRI of head
- CBC, CMP
- LP: usual cultures, PCR for HSV1, serology: IgM ab for west nile virus, mumps, EBV
note if RBCs in CSF and nontraumatic tap it is HSV until proven otherwise - tx: Acyclovir 10 mg/kg IV q 8 hrs (empiric tx for HSV b/c it is most deadly)
16
Q
Septic arthritis progression? What jts are most commonly affected?
A
- It is an emergency!!
- when left untx - can destroy a jt in 12-24 hrs
- usually affects only one or few asymmetrical jts
- more commoly affects large jts, esp knee
17
Q
S/S of septic arthritis?
A
- acute or subacute onset of pain
- erythema, swelling and limiting jt motion
- systemic sx (fever, malaise) may be present or absent
- Must do arthrocentesis on any: red, hot, swollen jt
18
Q
What will jt fluid analysis show in septic jt tap?
A
- over 40,000 WBCs in most cases
- send jt fluid for crystals, glucose, cell count, culture
- have to specific culture + sensitivity + r/o gonorrhea
- gram stain of jt fluid will show causative organism in most cases except gonoccal arthritis (80% false negative)
- if GC arthritis is suspected in sexually active pt: do cervical, urethral, or rectal GC cultures as approp for over 90% sensitivity
19
Q
Tx for septic arthritis?
A
- High dose IV abx
- no indication for intra-articular abx
- Rocephin good choice
20
Q
Sxs of bacteremia? Source of infection?
A
- fever, +/- chills, rigors may suggest bacteremia, disorientation, hypotension, resp failure, sepsis, septic shock, skin lesions
- source of infection: resp tract, central venous cath, urinary tract, GI tract, biliary tract, skin, soft tissues
21
Q
Tx for gram - bacteremia?
A
- 25-50% of all blood stream infections (worse off than gram +)
- tx for severe sepsis +/- shock:
gentamicin or tobramycin or amikacin + antipseudomonal cephalosporin like cefepime +/- vanco until cultures come back
22
Q
Tx for gram + bacteremia?
A
- staph aureus leading cause
- empiric tx: vanco
- MSSA: PCN, nafcillin, oxacillin, vanco
- MRSA: vanco or daptomycin
- w/u should include TEE to r/o infectious endocarditis (IV drug use hx)
23
Q
What is sepsis?
A
- clinical syndrome from dysreg inflammatory response to an infection
- infection + some of the following:
temp greater than 38.3, or less than 36C
HR over 90
RR over 20
AMS
sig edema
hyperglycemia w/o hx of DM (glucose over 140)
or - infection + some of the following:
inflammatory: WBC over 12K, or below 4K, WBC w/ over 10% of bands, elevated CRP, elevated procalcitonin - hemodynamic:
hypotension often w/ wide pulse pressure - poor urine output, elevated creatinine, elevated INR, and PTT, low platelets
