Infectious Disease

Question 1

What are the recommendations for administration of the pneumococcal vaccine?

Answer 1

Age >65, 13-valent pneumococcal conjugate vaccine (PCV13), followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in 6-12 months

Age <65 with CHF, lung, liver disease, or DM, current smokers, alcoholics -> PPSV23

Age <65 with CSF leak, cochlear implants, Sickle cell, asplenia, immunocompromised, CKD -> PPSV13 then PPSV23 6 mo later

Question 2

Advanced imaging findings of TB meningitis?

Answer 2

Basilar meningeal enhancement and choroidal tubercles likely has tuberculous meningitis.
CSF will have decreased glucose and increased protein with elevated WBCs (however, WBCs wont be >1000 like many other bacterial meningitis infx)

Question 3

Treatment of TB meningitis?

Answer 3

Tuberculous meningitis should be initiated on treatment prior to bacteriologic confirmation. Treatment involves 2 months of 4-drug therapy with isoniazid, rifampin, pyrazinamide, and either a fluoroquinolone or injectable aminoglycoside, followed by 9-12 months of continuation therapy with isoniazid plus rifampin. Patients should also receive adjuvant glucocorticoids to reduce treatment-associated central nervous system inflammation.