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MKSAP Facts > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Most common cause of viral meningitis

A

-Enterovirus from May to November, HSV-2 all year round.

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2
Q

Viral Meningitis CSF parameters

A
  • Opening pressure: =<250 mm H2O
  • Leukocyte count: 50-1000
  • Mostly lymphocytes
  • Glucose: >45
  • Protein: <200
  • Gram stain and cx negative
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3
Q

Bacterial Meningitis CSF parameters

A
  • Opening pressure: 200-500 mm H2O
  • Leukocyte count 1000-5000
  • Mostly neutrophils
  • Glucose: <40
  • Protein 100-500
  • Gram stain + in 60-90%
  • Culture + in 70-85%
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4
Q

Viral CNS Infections with mild hypoglycorrhachia (30-45)

A

HSV and West Nile

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5
Q

Mollaret Meningitis

A
  • Recurrent benign lymphocytic meningitis

- HSV-2 is the most common to cause recurrent.

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6
Q

Zoster sine herpete

A

-Zoster w/o the vesicular lesions

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7
Q

West Nile VIrus symptoms and diagnosis

A
  • PCR is insensitive.
  • CSF similar to enteroviral meningitis.
  • Acute flaccid paralysis if neuroinvasive.
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8
Q

HSV -2 meningitis treatement

A

-Usually supportive w/o need for acyclovir.

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9
Q

Bacterial meningitis causes

A
  • Streptococcus pneumoniae is most common community acquired cause.
  • Neisseria meningitides serogroup B accounts for 40% in US. Quadrivalent conjugate vaccine doesn’t cover it.
  • Strep agalactiae is now 3rd.
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10
Q

Rule of 7’s

A
  • To identify pt’s at low risk of Lyme meningitis.
  • headache <7 days
  • <70% CSF mononuclear cells
  • absence of a 7th facial nerve palsy
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11
Q

Lyme Disease meningitis

A
  • 2-10 weeks after erythema migrans.
  • can have unilateral or bilateral facial paralysis.
  • Resembles enteroviral meningitis w/ lymphocytic predominance.
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12
Q

Bacterial endocarditis presenting as purulent endocarditis

A
  • Staph aureus and S pneumo
  • New murmur, embolic phenomena or other stigmata of endocarditis in addition to CNS findings.
  • May have stroke like findings 2/2 embolic infarctino.
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13
Q

Treponema pallidum meningitis

A
  • Can occur in secondary or tertiary syphilis.
  • Lymphocytic pleocytosis w/ elevated protein.
  • Tertiary syphilis can have asymptomatic neurosyphilis.
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14
Q

Two presentations of neurosyphilis

A
  • Primary meningovascular (stroke)

- Parenchymatous (tabes dorsalis, general paresis) features.

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15
Q

Leptospiral meningitis

A
  • Develops in the immune or second phase of illness.
  • Associated w/ uveitis, rash, conjunctival suffusion, lymphadenopathy, and hepatosplenomegaly.
  • Looks like enteroviral CSF. Diagnose w/ CSF, urine, or serology.
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16
Q

Imaging prior to LP?

A
  • Immunocompromise.
  • Hx of CNS disease
  • New onset seizure
  • Papilledema
  • AMS
  • FND
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17
Q

Immunocompentent host <50 yo w/ suspected meningitis empiric therapy

A

IV ceftriaxone or cefotaxime plus IV vancomycin.

18
Q

Patient >50 yo or w/ altered cell mediated immunity meningitis empiric therapy

A

-IV ampicillin (listeria coverage) plus IV ceftriaxone or cefotaxime plus IV vancomycin.

19
Q

Emperic coverage for meningitis w/ B lactam allergies

A
  • IV moxifloxacin in place of cephalosporin.

- IV bactrim in place of ampicillin.

20
Q

Empiric coverage for hospital acquired bacterial meningitis or after neurosurgical procedures.

A

IV vancomycin plus IV ceftazidime, cefepime, or meropenem.

21
Q

Adjunctive dexamethasone in bacterial meningitis

A
  • Reduces morbidity and mortality in adults w/ pneumococcal meningitis.
  • Reduces risk of neurological sequelae.
  • 10 mg Q6 hours for 4 days.
22
Q

Subacute and chronic meningitis symptom duration

A
  • 5-30 days
  • > 30 days
  • Most commonly fungi and M tuberculosis.
23
Q

Tuberculous Meningitis

A
  • Basilar meningitis w/ cranial neuropathies (usually CN 6), mental status changes, and SIADH.
  • CSF w/ lymphocytic pleocytosis, elevated protein, and hypolycorrhachia.
  • CSF acid fast bacilli smear is insensitive and cx are not reliable.
  • NAAT and serial LPs for 3 days increase sensitivity.
  • Anti TB treatment for a year w/ initial steroids.
24
Q

Neurobrucellosis

A

Occurs in 4-11% of pts w/ brucellosis.

  • Endemic in mediterranean, middle east, and central america.
  • Meningitis, meningoencephalitis, cranial neuropathies, myelopathy, radiculopathy, or stroke/brain abscess.
25
Q

Treatment of neurobrucellosis

A
  • Combination of therapy for 6 months.

- Ceftriaxone, rifampin, and doxycycline.

26
Q

Acute primary amebic meningoencephalitis

A
  • Naegleria, balamuthia, and acanthamoeba.
  • Often fatal, resembles bacterial meningitis.
  • Freshwater exposure is key.
  • Fresh CSF shows motile trophozoites and CDC to perform confirmatory PCR.
27
Q

Acute primary amebic meningoencephalitis treatment

A

-Miltefosine should be included in treatement.

28
Q

Eosinophilic meningitis

A

-Helminth infections including neurocysticercosis, schistosomiasis, etc.

29
Q

Neurocysticercosis

A
  • Endemic in Mexico, south america, Asia.

- Presents w/ seizures, hydrocephalus, and CT scan shows multiple brain cysts or calcified lesions.

30
Q

Common causes of aseptic meningitis

A

NSAIDS, antibiotics, IVIG, leukemia, lymphoma, metastatic carcinoma, SLE, behcet disease, neurosarcoidosis, Vogt-Koyanagi,-Harada syndrome.

31
Q

Health Care Associated Meningitis and Ventriculitis Causes

A

-Most commonly staph and enteric gram negative bacteria

32
Q

HCA meningitis and Ventriculitis

A
  • head trauma, neurosurgery, or device like CSF shunt, intrathecal pump, deep brain stimulator.
  • CSF cell counts, glucose, protein unreliable and up to 50% of infections have negative cultures.
  • Remove device if present.
33
Q

Brain Abscess predisposing factors

A
  • Contiguous foci of infection (sinusitis = frontal lobe, otitis media = cerebellum) 50% of cases.
  • Hematogenous (odontogenic, endocarditis, IVDU) 25% of cases.
  • Cryptogenic (usually odontogenic)
  • Neurosurgery or penetrating head trauma
34
Q

Brain abscess treatment

A

->2.5 cm requires drainage w/ antibiotics for 4-8 weeks.

35
Q

Brain abscess 2/2 otitis media/mastoiditis empiric coverage

A
  • strep, bacteroides sp, prevotella sp, enterobacteriaceae.

- Metronidazole plus ceftriaxone

36
Q

Brain abscess treatment

A
  • > 2.5 cm requires drainage w/ antibiotics for 4-8 weeks.

- Follow up imaging

37
Q

Brain abscess 2/2 dental abscess empiric coverage

A
  • Mixed fusobacterium, prevotella, bacteroides sp, strep

- Penicillin plus metronidazole

38
Q

Brain abscess 2/2 penetrating trauma or neurosurgery empiric coverage

A

-vancomycin and a third gen cephalosporin

39
Q

brain abscess 2/2 lung abscess, empyema, and bronchiectasis empiric coverage

A

-Penicillin plus metronidazole plus a sulfonamide

40
Q

Brain abscess 2/2 endocarditis empiric coverage

A

-vancomycin plus gentamicin

41
Q

Brain abscess in HIV or immunocompromised pts empiric coverage

A

-metronidazole plus third gen cephalosporin, and antifungal or antiparasitic agent.

MKSAP Facts (1 decks)

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