Infectious disease Flashcards
Meningitis less than 3 month clinical presentation
1) slow or inactive
2) vomiting
3) poor feeding
4) irritable
Meningitis 3month - 50 yr
clinical presentation
1) high fever
2) nuchal rigidity
3) atered mental status
4) HA
meningitis > 50 yr
clinical presentation
1) high fever
2) nuchal rigidity
3) atered mental status
4) HA
Meningitis less than 2 month
most common organisms
group b strep gram neg rod (e coli, enterobacter) strep pneumo n meningitidis listeria (only 1st 30 days)
amp + cefotaxime OR ampicillin + aminoglycoside
Meningitis 2month - 23 mo
most common orgnaism
treatment
1) strep pnumo
2) neisseria meningitis
3) group b strep
4) GNR (e coli)
5) h influenzae
ceftriaxone AND vancomycin
meningitis 2-35
more than 35yrs
most common organism
treatment
1) neisseria meningitidis
2) strep pneumo
1) strep pneumo
2) neisseria meningitidis
3) listeria monocytogenes (more immunocompromised and older patients esp 65+)
ceftriaxone + vanco + ampicillin (for listeria)
Meningitis less than 3 month
CSF profile
low WBC
low protein
2/3 serum glucose
lMeningitis 3month - 50 yr
CSF profile
low wbc
18-50 protein
2/3 serum glucose
meningitis > 50 yr
CSF profile
same as 3month-50 yr
meningitis > 60
most common organisms
treatment
1) strep pneumo
2) n meningitidis
3) listeria
ceftraixone OR cefotaxime + vanco + ampicillin
when do you give steroids for meningitis
if immunocompetnet prior to and with first dose of antibiotics to decr inflamm
how soon do u start antibiotics in ER for meningitis
within 60 min
what drug specific for listeria
ampicillin
meropenem has activity against
pseudomonas
resistant gram negative rods
vanco for
penicillin and cephalosporin resistant pneumococci and coag neg MRSA
and enterococcus
define meningitis
has decr since
infection of subarach space
decr since creation of encapsul organism vaccines (HiB, pneumo, meningo)
cellular effects of bact meningitis after enter blood
enters blood
or adjacent intracranial infection (otitis, sinusitis) = kids
or spinal/skull defect (congenital/trauma)
______
incr BBB permeability (vasogenic edemia, incr ICP)
infarction from vasculitis
hydrocephalus and incr IL-1, TNFa causing further BBB perm and worsening vasogenic/cytotoxic edema
classic triad of bact meningitis
CN effects and other signs
stiff neck
fever
decr consciousness
CN 3, 6, 7, 8
seizure, vomiting
myalgia,
hemiparesis, gaze pref
complications of bact meningitis
1) infarcts due to septic arteritis or endarteritis obliterans (MRI)
2) meningoencephalitis (effaced sulci) (CT or MRII)
3) CN palsy esp 8, seizures (EEG)
4) subdural empyema esp s. aureus (LP or ventriculostomy)
5) acute hydrocephalus
CSF of bact meningitis shows
1) CSF pleocytosis (WBC in fluid)
2) mainly PMNs
3) high protein, low glucose, low CSF to glucose ratio
4) gram stain and culture
do not do LP on bact meningitis if
1) focal deficits/altered conscious/new seziures
2) incr ICP/papilledema
3) focal CNS abscess, empyema
4) immunocompromise
get ct and cultures and empiric therapy first (never delay antibiotics)
viral meningitis
most due to what organism
transmission
> 80% enterovirus (fecal, oral, resp)
HSV-2
arbovirus (WNV)
transmit oral/fecal
viral meningitis
symptoms
compare severity to bact meningitis
1) HA
2) fever
3) nuchal rigidity
less severe
viral meningitis
csf signs
1) lymphocytic pleocytosis
WBC 10-2000
of lymphocytes
2) normal glucose
3) normal or slight incr protein
PCR best except for WNV
viral meningitis
treatment
empiric HIV CMV flu entero WNV
empiric IV acyclovir ART for HIV, foscarnet/ganciclo/cidofovir for CMV rimantidine for flu pleconaril for entero supportive for WNV
viral encephalitis
major causes organisms
HSV-1 (1/3 primary, 2/3 reactiv) (very young or very old)
WNV
most unknown and could be autoimm encepahlitis
viral encephalitis
symptoms
HSV-1 vs WNV
more altered consciousness because of parenchyma affected (seizures, personality change, CN, aphasia, hemiparesis)
+ HA, fever, nuchal rigidity
wnv = tremors, myoclonus, parkinsonian
viral encephalitis
HSV-1 dx
PCR diagnostic
MRI with temporal lobe involvement
EEG abnormal in 60-90%
viral encephalitis
WNV dx
serology for IgM
LP may have PMNs up to 1 week before lymphocytes
incr protein
normal glucose
viral encephalitis
treatment
empiric IV acyclovir
for wnv,
supportive
define brain abscess
define subdural empyema
define epidural abscess
brain abscess = focal infection within brain tissue
subdural empyema = infection btwn arachnoid and dura
epidural abscess = infection btwn dura and bone
where do suppurative CNS infections arise from
originate from blood, adjacent intracranial infection (otitis, sinusitis, mastoid, dental, cellulitis), from distant infection (MCA territory or primary pulm infection) or direct intro of micororg
microbes causing
brain abscess
vs empidural abscess or subdural empyema
brain abscess = polymicrobial = anaerobic + s aureus, strep, GNR
SDE or EA = s aureus or strep
symptoms of brain abscess
sx of primary infection (sinusitis)
sx of high ICP (HA, vomiting, obtunded)
classic triad with focal neuro sx
symptoms of subdural empyema
acutely ill with fever, HA, altered consciousness, focal sx, also contralateral hemiparesis
symptoms of epidural abscess
less ill than subdural with fever, HA, hemiparesis, seizures
diagnostic tests for brain abscess, subdural, epidural abscess (all same)
MRI
also brain biopsy or aspiration
NO LP may cause herniation
treatment for for brain abscess, subdural, epidural abscess (all same)
antibiotics + surgical aspiration/drain
metronidazole and cefotaxime OR ceftraixone IV for 4-6 weeks
most common cause of brain abscess in HIV +
toxoplasma gondii
kernig’s sign
supine patient, flex thigh to abd then passive extension of leg but PATIENT RESISTS DUE TO PAIN
brudzinski’s sign
passive flexion of neck causes flexion of hip and knee (stretching meningeal)
work up for bact meningitis
1) blood culture
2) lumbar puncture
3) empiric antibiotics
4) imaging CT vs mri
lumbar puncture for acute bacterial meningitis
opening pressure = slight elev
CSF pleocytosis = WBC, PMNs
Low glucose
Protein slight elev
CSF to serum glucose less than 0.4 for diabetics
drugs to use for immunocompromised/nosocomial/recent head trauma/surgery
meropenem or cefepime AND vanco +/- ampicillin
when to give steroids for bact meningitis
must give PRIOR OR WITH dose of antibiotics
repeat lumbar punctures for
no response in 48 hrs
penicillin resistant pneumococcus
meningitis due to GNR and listeria
enterovirus clues
rash (echo = macular rash)
pharyngitis/herpangina (coxsackie A)
GI
myocarditis/pericarditis
treatment of HSV meningitis
valacyclovir
acyclovir
autoimmune encpehalitis
anti-NMDA receptor encephalitis
CSF profile
dx via
treatment
prominent psych
cognitive
seizures
CSF profile looks like viral encephalitis
dx via antibody
treatment = immune suppression
procedure for viral encephalitis
1) start antibitoics
2) steroids
3) acyclovir for HSV encephalitis
4) neuroimaging
5) lumbar puncture
can delay LP for 1 week if necessary
