Infection of the CNS

Question 1

Bacterial Meningitis: Neonatal 6 weeks- Group B Strep, E. coli and other, tx?

Answer 1

Empirical treatment. Ampicillin + Gentamicin or Ampicillin + Ceftriaxone

Question 2

Bacterial Meningitis: Children (>3 months) and adults: S. pneumonia, N. meningitis, H. influenza type B (can be prevented by vaccination)

Answer 2

Empirical treatment. Cefataxime, Ceftriaxone or ampicillin or vancomycin

Question 3

BM: Elderly (>50 yrs), alcoholics, immunocompromised, head injuries: E. coli, S. pneumonia, L. monocytogenes

Answer 3

Empirical treatment: Ceftriaxone or ampicillin or vancomycin.

Question 4

Meningococcal infection- Spread by respiratory route, pharyngeal colonization in 5 to 10% of population.
causative agent,

Answer 4

Neisseria meningitidis

Question 5

Affects 6 months to 5 year old children (can be prevented by Hib vaccine). Spread through respiratory route (→blood→meninges)

Answer 5

Haemophilus influenza type B

Question 6

Pneumococcus causes

Answer 6

Elderly patients: pneumonia, immunosuppressed, haematological malignancy. 
Very young (<3 months): Head injury with skull fracture. High mortality (up to 30%).

Question 7

Enchepalitis causative agents.

Answer 7

Virus infection of brain and CNS cells.

HSV-1 (most common), CMV, rabies, mumps, measles, eschovirus, coxsackievirus

Question 8

Enterovirus, faecal-oral spread; 90-95% well; 5% viral meningitis, 1% paralytic disease destroys motor neurons of anterior lumen

Answer 8

Polio

Question 9

Direct spread from middle ear, sinuses or mastoid

Usually mixed infection, anaerobes + streptococcus + haemophilus, coliform

Answer 9

Brain abscess— Haematogenous

Strep and Staph

Question 10

TB meningitis causative agents

site of infection:

Answer 10

Meningococcus; Pneumococcus; H. influenza

—CNS

Question 11

TX for each causative agents:

Answer 11

Meningococcus: benzyl penicillin
Pneumococcus: benzyl penicillin/cefotaxime or vancomycin if resistant
H. influenzae – cefotaxime (start with penicillin and cefotaxime)

Question 12

Prophylaxis for Meningitis

Answer 12

Prophylaxis: meningococcus – Rifampicin or ciprofloxacin (whole family/close contacts)

Question 13

Community acquired pheumonia, most commonly caused by S. pneumonia but for ambulatory and requiring hosp. admission?

Answer 13

Amb: M. pneumonia 24%, S. pneumonia 5%

Req. hosp: S. pneumonia 17%, M. pneumonia 14%

Question 14

Emergency tx for S. pneumonia and high level resistant

Answer 14

S. pneumonia: Amoxi or Macrolides

High lvl: Cefotaxime, Ceftria, PO or IV Fluoroquinolones

Question 15

Emergency tx for pneumonia caused by H. influenza

Answer 15

2nd and 3rd gen. Cepha or Amoxi + clavalunate

Question 16

Emergency tx for Methicillin S/R S. aureus

Answer 16

MSSA: Cloxacillin
MRSA: Vancomycin

Question 17

Emergency tx for M. and C. pneumonia

Answer 17

Doxy or Macrolide

Question 18

Tx for Legionella sp.

Answer 18

Fluoroquinolones, macrolide + rifampicin

Question 19

Tx and initial tx for E. coli- aerobic gram -ve bacilli and proteus sp.

Answer 19

2nd and 3rd Gen cephalosporins (initial therapy should be with Cefoxitin or piperacillin + tazobactam)