Infectious Flashcards
RF for Bacterial Meningitis (huge list)
Acute or chronic otitis media Sinusitis ImmunosuppressionEtOH, PNA, DM Cerebrospinal fluid leak Endocarditis Neurosurgical procedure/head injury Indwelling neurosurgical device/cochlear implant Advanced age Malignancies Liver disease Unvaccinated to Haemophilus influenzae type b, Neisseria meningitidis, or Streptococcus pneumoniae
2 MCC bacterial meningitis
Strep pneumo
Neisseria meningitis
Subacute meningitis (1-7 days) usually caused by
viral
fungal
Does absence of fever, stiff neck, or AMS exclude meningitis?
No
esp in TB
Brudzinski sign
hips and kness flex with neck flexion
-Meningitis
Kernig sign
hamstrings contract when knee is extended with the hip flexed
-Meningitis
Who needs CT in meningitis evaluation?
focal neuro deficits AMS papilledema seizure IC Malignancy/CA -concern CNS mass lesion Hx focal CNS disease -CVA, tumor
Pt presents to ED with sxs meningitis. Last week started antibiotic trial for complaints of otitis media. This is referred to as
“Partially treated meningitis”
-more careful with treatment selection
Treatment approach for bacterial meningitis
Abx ASAP
don’t delay dt imaging/LP
if delay LP get blood culture
Empiric= Ceftriaxone or Cefotaxime
> 50, IC + Ampicillin
staph or gram - concern use vanco + ceftazidime
~Dexamthasone
toxic pts, purulent CSF
Ddx of meningitis with signs of infection. CSF is normal, next step
repeat LP in 8-12 hrs with abx started before 2nd LP
treatment of encephalitis
Admit, and supportive
caused by HSV- Acyclovir
meningeal sings +
altered LOC, irritability, movement disorders
consider encephalitis
Come causative vectors of rabies in the US
skunks, bats, raccoons, foxes
in developing countries- Dogs
definitive diagnostic technique for rabies
Brain biopsy
The prodrome phase of rabies has what sxs
fever, malaise, HA, nausea, pain or paresthesias at bite site
