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
Treatment for post-exposure rabies prophylaxis
Rabies IG 20IU/kg half in site and half IM
HDCV days 0,3,7,`14
+clean and debride wound, tetanus prophylaxis
When is Clostridium tetani in a toxic form?
=vegatative
spore in wound becomes toxin producing vegetative form
Treatment for active tetanus infection includes
ABCs (may need intubated or neuromuscular blockade)
TIG, metronidazole, midazolam, magnesium
labetalol or esmolol
morphine
clonidine
what is opisthotonos?
severe hyperextension and spasticity in which an individual’s head, neck and spinal column enter into a complete “bridging” or “arching” position
- seen in tetanus
- not exclusive to
