Infection - Bacterial Meningitis

Question 1

…….. is the most common cause of fever associated with CNS manifestations.

Answer 1

CNS infection

Question 2

Infection of the CNS is mostly caused by ……. followed by bacteria, fungi, and parasites.

Answer 2

viruses

Question 3

Regardless of etiology, most patients with CNS infections have similar clinical syndrome.

Answer 3

….

Question 4

• Meningitis implies primary involvement of the meninges
• whereas encephalitis indicates brain parenchymal involvement.

Answer 4

….

Question 5

Many patients have evidence of both meningeal and parenchymal involvement and should be considered as meningoencephalitis

Answer 5

…..

Question 6

Causative Organisms of Bacterial Meninigitis

Question 7

Causative Organisms of Bacterial Meninigitis

• First 2 Months

Question 8

Causative Organisms of Bacterial Meninigitis

• 2 Months - 12 Years

Question 9

MOI by Bacterial Meninigitis

Answer 9

Direct droplet through respiratory secretions

Question 10

Pathogenesis of Bacterial Meninigitis

Question 11

Pathology in Bacterial Meninigitis

Question 12

Pathology in Bacterial Meninigitis

• Site

Question 13

Pathology in Bacterial Meninigitis

• Increased ICP

Question 14

Pathology in Bacterial Meninigitis

• hydrocephalus

Answer 14

• Uncommon acute complication
• Mostly due to decreased CSF absorption and less commonly obstructive

Question 15

CP of Bacterial Meninigitis

Answer 15

1. Fulminant course
2. Acute onset

Question 16

CP of Bacterial Meninigitis

• Fulminant Course

Answer 16

Sudden onset of shock, DIC, coma and death

Question 17

CP of Bacterial Meninigitis

• Acute Onset

Question 18

CP of Acute Onset Bacterial Meningitis

Question 19

CP of Acute Onset Bacterial Meningitis

• Prodorme

Answer 19

• FAHM - ANVC
• Tachycardia, hypotension
• Rash (Macules - Petechiae)

Question 20

CP of Acute Onset Bacterial Meningitis

• Increased ICP

Question 21

CP of Acute Onset Bacterial Meningitis

• decrease LVL of consciousness

Answer 21

Due to increased ICP - Cerebritis - Hypotension

Question 22

CP of Acute Onset Bacterial Meningitis

• Focal Neurological Signs

Question 23

CP of Acute Onset Bacterial Meningitis

• convulsions

Question 24

CP of Acute Onset Bacterial Meningitis

• Meningeal Irritation

Question 25

INVx for **Bacterial Meningitis**

Question 26

INVx for **Bacterial Meningitis** - CSF

Question 27

CSF in **Bacterial Meningitis** - Traumatic CSF

Answer 27

- Traumatic CSF will affect CSF protein, WBCs count but not glucose, gram stain, or culture

Question 28

CSF in **Bacterial Meningitis** - If LP is Delayed

Answer 28

Immediate empirical therapy should be initiated

Question 29

CSF in **Bacterial Meningitis** - Findings

Question 30

CSF in **Bacterial Meningitis** - CI to LP

Question 31

CSF in **Bacterial Meningitis** - CSF Ag Detection Tests

Answer 31

Should be reserved for patients - Who were receiving antibiotics when cultures were obtained

Question 32

INVx for **Bacterial Meningitis** - Blood Culture

Answer 32

- Should be performed in all patients with suspected meningitis - + ve in 80 - 90%

Question 33

INVx for **Bacterial Meningitis** - Brain CT

Question 34

DDx of **Bacterial Meningitis**

Question 35

DDx of **Bacterial Meningitis** - Atypical Bacteria

Question 36

DDx of **Bacterial Meningitis** - Fungal

Question 37

DDx of **Bacterial Meningitis** - Parasitic

Question 38

DDx of **Bacterial Meningitis** - Non-Infectious

Question 39

Complications of **Bacterial Meningitis**

Question 40

Complications of **Bacterial Meningitis** - Neurological

Question 41

Complications of **Bacterial Meningitis** - Prolonged Fever

Question 42

Complications of **Bacterial Meningitis** - Endocrinal

Answer 42

- Diabetes insipidus & SIADH - Pituitary dysfunction

Question 43

Complications of **Bacterial Meningitis** - hematological

Answer 43

- Anemia - DIC - Thrombocytosis

Question 44

Prevention of **Bacterial Meningitis**

Question 45

Prevention of **Bacterial Meningitis** - Active

Answer 45

Against Meningococcal - H. influenza b - Pneumococci - especially for high-risk children e.g., patients with asplenia.

Question 46

Prevention of **Bacterial Meningitis** - Passive

Answer 46

Rifampicin - Ciprofloxacin - Ceftriaxone "in close contact"

Question 47

TTT of **Bacterial Meningitis**

Question 48

TTT of **Bacterial Meningitis** - Antibiotic Therapy

Question 49

Antibiotic Therapy in **Bacterial Meningitis** - Type of Antibiotics

Question 50

Antibiotic Therapy in **Bacterial Meningitis** - Duration of Antibiotic Therapy

Question 51

TTT of **Bacterial Meningitis** - corticosteroids

Question 52

TTT of **Bacterial Meningitis** - Supportive

Question 53

Supportive TTT of **Bacterial Meningitis** - medical and neurologic assessment

Answer 53

Frequent medical and neurologic assessment in the 1st 72 hours

Question 54

Supportive TTT of **Bacterial Meningitis** - Check for ....

Answer 54

Check for BUN, HCO3, electrolytes, CBC, coagulation studies "in DIC"

Question 55

Supportive TTT of **Bacterial Meningitis** - Fluid Restriction

Answer 55

Fluid restriction to 1/2: 2/3 maintenance except in cases of hypotension

Question 56

Supportive TTT of **Bacterial Meningitis** - Management of Increased ICP

Question 57

Supportive TTT of **Bacterial Meningitis** - Control of Seizures

Answer 57

- IV diazepam - Phenytoin 15-20 mg loading followed by 5mg/kg maintenance