Infectious disease Flashcards by A B

Meningitis less than 3 month clinical presentation

1) slow or inactive
2) vomiting
3) poor feeding
4) irritable

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Meningitis 3month - 50 yr

clinical presentation

1) high fever
2) nuchal rigidity
3) atered mental status
4) HA

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meningitis > 50 yr

clinical presentation

1) high fever
2) nuchal rigidity
3) atered mental status
4) HA

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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

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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

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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)

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Meningitis less than 3 month

CSF profile

low WBC
low protein
2/3 serum glucose

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lMeningitis 3month - 50 yr

CSF profile

low wbc
18-50 protein
2/3 serum glucose

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meningitis > 50 yr

CSF profile

same as 3month-50 yr

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meningitis > 60
most common organisms
treatment

1) strep pneumo
2) n meningitidis
3) listeria

ceftraixone OR cefotaxime + vanco + ampicillin

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when do you give steroids for meningitis

if immunocompetnet prior to and with first dose of antibiotics to decr inflamm

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how soon do u start antibiotics in ER for meningitis

within 60 min

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what drug specific for listeria

ampicillin

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meropenem has activity against

pseudomonas

resistant gram negative rods

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vanco for

penicillin and cephalosporin resistant pneumococci and coag neg MRSA
and enterococcus

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define meningitis

has decr since

infection of subarach space

decr since creation of encapsul organism vaccines (HiB, pneumo, meningo)

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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

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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

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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

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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

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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