Infections of the central nervous system Flashcards
Widespread rash, can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease. Non-blanching
Exanthum
Most common community acquired bacterial meningitis bugs in adults
S. pneumo, N. meningitidis, H. flu
Most common community acquired bacterial meningitis bug in newborns
group B strep
Most common bugs responsible for nosocomial bacterial meningitis
e. coli, k. pneumoniae, p. auruginosa
Triad of meningitis
high fever, nuchal rigidity, change in mental status (lethargy)
Typical LP findings for this disease include: Elevated opening pressure, Leukocytosis, increased protein, decreased glucose
meningitis
Gram stain that suggests S. pneumo
gram-positive diplococci
gram stain that suggest N. meningitidis
gram-negative diplococci
Gram stain that suggests H. flu
Small pleomorphic gram-negative coccobacilli
Empiric tx for community acquired meningitis aimed at s. pneumo and meningococcal
Cefotaxime IV (Claforan) or ceftriaxone IV (Rochephin) + vancomycin
Empiric tx for nosocomial acquired meningitis
Ceftazidime + vancomycin
Pharm tx that reduces mortality and neurologic disability in pts w/ Glasgow Coma Scale (GCS) scores of 8-11 and pneumococcal diagnosis
IV dexamethasone before or w/start of abx
Childhood vaccines for the prevention of meningitis
HIB vaccine starting at 2 months and Pneumococcal conjugate vaccine (PCV13) for children under 2 yrs
Most common cause of aseptic meningitis
enterovirus
Type of meningeal inflammation w/ neg bacterial cultures,
aseptic meningitis
Difference between bacterial and aseptic meningitis
Aseptic meningitis is a self-limited course that resolves without specific therapy
Sx include: Fever, HA, stiff neck and photophobia
aseptic meningitis
Tx for aseptic meningitis
If CSF with LP is fairly clear, you can observe pt without antibiotics. If uncertain, start on antibiotics and wait 24-48 hrs for culture results
Most important distinguishing feature between encephalitis and meningitis?
Meningitis-cerebral fxn remains intact. Encephalitis- more severe mental status changes
Sx include: altered mental status, seizures, focal neuro deficits, exaggerated DTRs, behavior or personality changes
encephalitis
Most likely etiolgoy of encephalitis
Viral- west nile**
Disease with CSF findings that may include: increased WBCs with differential showing mostly lymphocytes, Elevated protein, but < 150 mg/dL, Normal glucose
viral encephalitis
Sx include: fever, stiff neck, sore throat, N/V. Eventually signs of UMN lesion (increased DTRs, spastic paralysis)
west nile virus
CSF: Protein and opening pressure increased and there will be lymphocytic leukocytosis
west nile virus
Most significant risk factor for developing severe neuro dz with West Nile Virus
advanced age
Tx for West nile
supportive and ribavirin
Sx include: fever, HA, blanching maculopapular rash on palms/soles that spreads centrally
rocky mtn spotted fever
CSF: inc lymphocytes/PMN’s, inc protein; neg gram stain
rocky mtn spotted fever
Etiology of rocky mtn spotted fever
rickettsia rickettsii (gm neg bacteria)
Tx of Rocky Mtn Spotted fever
Doxycycline 100 BID x 7 days
Lab results for this disease include hyponatremia, low platelets, elevated LFTs
Rocky Mtn Spotted Fever
Etiology of Lyme Disease
Borrelia burgdorferi (deer tick)
Most common cause of tick-bourne disease
Borrelia burgdorferi
Sx include: erythema migrans rash initially, EM lesions and/or neurologic and/or cardiac findings, intermittent or persistent arthritis later stages
lyme disease
First line early tx for lyme disease
Doxycycline - 100 mg BID for 21 to 28 days
Tx for late or severe lyme disease
Cefotaxime (Claforan) or Penicillin G
Describe as pus-filled cavity ringed by granulation tissue & outer fibrous capsule surrounded by edematous brain tissue
brain abscess
Classic triad of brain abscess
HA, fever, focal deficit
Sx of frontal lobe abscess
hemiparesis
Sx of temporal lobe abscess
homonymous superior quadrant visual field deficit or aphasia
Sx of cerebellar abscess
limb incoordination or nystagmus
Contraindicated for brain abscess
LP
