ID - Meningitis Flashcards
Consider neisseria meningitis if what PE finding?
Signs of meningitis with purpuric skin rash
Patient suspected meningitis: diagnostic test to confirm?
Lumbar puncture
Papilledema? Funduscopic examination would reveal?
Swelling of the optic nerve caused by increased the cranial pressure
See hazy optic disc margin
Most common causes of meningitis?
- Strep pneumonia
- Neisseria meningitis
- Group B strep (Streptococcus agalactiae).
- Listeria
- H influenza
Suspect group B strep Meningitis in?
#Neonates # older than 50 with diabetes or liver disease
Suspect Listeria meningitis in?
Pregnant women, neonates, elderly, AIDS patients, alcoholics
How do bacteria usually get to meninges?
Seed the oropharynx, then move hematogenously
Causes of meningitis after neurologic procedures?
Staph aureus and staff epidermidis
Complications of inflammation due to meningitis?
Seizures, increased intracranial pressure, stroke
Nuchal rigidity?
When passive or active flexion of the neck results in inability to touch the chin to chest
Kernig vs Brudzibski sign?
Flex hip and knee and then passively extend. Positive if you elicits pain
Versus
Patient flexes knees and hips when their neck is passively flexed
Pt with severe headache with symptoms of gastroenteritis. Cause of meningitis?
Enterovurus
Causes meningitis in HIV patients?
Cryptococcus, TB
If patient has focal neurologic findings consider?
Intracranial empyema or brain/epidural abscess
Signs of subarachnoid hemorrhage?
- Photophobia
- Gossly bloody CSFs
- Xanthochromic chromic supernatant
CSF findings in bacterial meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?
High, elevated and neutrophilic, <40, elevated, none, Gram
CSF findings viral meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?
Normal, elevated/lymphocytic, normal, normal, none, culture/PCR
CSF findings in herpes simplex meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?
Normal/high, elevated/lymphocytic, normal, normal/high, high, PCR
CSF findings in tuberculosis meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?
Normal/high, elevated/monocytes, very low, very high, none, PCR/AFB
Bacteria and treatment of meningitis in neonates?
- E. coli/group B strep
- Listeria
Ampicillin plus cefotaxime
Bacteria and treatment of meningitis in 1 month to 2 years old?
- Strep pneumonia
- Nisseria meningitis
- H. flu
Cefotaxime/ceftriaxone plus vancomycin
Bacteria and treatment of meningitis in 2 to 18-year-olds?
- Nisseria meningitis
- Strep pneumonia
- H influenza
vancomycin plus ceftriaxone
Bacteria and treatment of meningitis in 19 to 60 age group?
- Strep pneumonia
- Nisseria meningitis
- H influenza
vancomycin plus ceftriaxone
Bacteria and treatment of meningitis in 60 and older age group?
- Strip pneumonia
- Listeria
3.
Ampicillin plus vancomycin plus ceftriaxone
If suspect a patient of having meningitis, next steps?
Do LP
If radiological studies must be done before LP, send blood cultures and begin administering antibiotics while awaiting radiologic results
If antibiotics are started, she an LP still be done?
Yes, LP still should be done if performed within two hours of antibiotic administration
If patient is suspected of having HSV meningitis, radiological test of choice?
MRI
MRI findings in HSV meningitis? Tuberculosis meningitis?
Enhancement of temporal lobes
Enhancement of basal region
EEG findings in HSV meningitis?
2 to 3 second intervals of periodic sharp and slow wave complexes originating within temporal lobes
Empiric treatment of meningitis?
Ceftriaxone plus vancomycin
Add ampicillin suspect the studio
Add acyclovir if suspect HSV
Studies suggest giving glucocorticoids to decrease CNS inflammation if?
Patient is a child with H influenza or strep pneumonia meningitis
Close contact prophylaxis for meningococcal meningitis?
Rifampin twice daily for two days or single-dose of ciprofloxacin
Patient presents with nerve palsy, CSF findings (low glucose, high protein, low WBC count). Positive PPD but negative bacteria cultures at 48 hours. How to confirm diagnosis?
Repeat LP – if glucose falls at 48 hours, highly suggestive of TB
Treatment for patient with Listeria meningitis?
Ampicillin
When to get a CT before LP if suspect meningitis?
#papilledema #seizures #focal neurological deficits #confusion
If suspected meningitis pt cannot get immediate LP, next step?
Start antibiotics BEFORE LP
Most common deficit in untreated bacterial meningitis?
Deafness
