Infectious Diseases Flashcards
What is the clinical presentation for acute bacterial meningitis?
~45% of pts present with the “classic triad” of fever, headache and neck stiffness, but nearly all patient have at least 2 of 4 symptoms (fever, headache, nuchal rigidity and altered mental status).
Other symptoms may include vomiting, seizures, focal neurological findings and papiledema
What are the most common organisms for different age groups for acute bacterial meningitis?
35 years: Pneumococcus, Meningococcus, Hemophilus, Listeria (25% of cases in pts over 60)
What is the basic CSF profile (cell number and type, glucose, protein) for acute bacterial meningitis?
High (100-10,000) WBC Cell type of PMN Low glucose Elevated Protein \+Bacterial cultures Gram stain is useful
What is the basic medical management for bacterial
meningitis in different age groups?
Neonates (1-3mos.): Ampicillin and Cefotaxime
3mos-50years: Ceftriaxone OR Cefotaxime AND vancomycin
> 50years: Ceftriaxone or Cefotaxime, Vancomycin, Ampillin
Any age for hospital acquired, recent head trauma/neurosurgery, immunocompromised, alcoholics: Vancomycin and Meropenem +/-Ampicillin
Steroid shown to be beneficial for Pnuemococcus
How do you distinguish the clinical features and most
common viruses in cases of viral meningitis and viral
encephalitis?
For diagnosis, look at CSF for lympthocytic pleocytosis (seen in TB, fungi, syphilis, inflammatory and neoplastic disease). Look at glucose levels (Low glucose can be seen in Mumps, LCMV and HSV 2).
PCR amplification of viral genomic material from CSF is most important diagnosis for viral meningitis
Viral cultures of CSF, throat swab, blood, urine, stool less frequently used
Serology of CSF IgM
What are the clinical features for viral meningitis?
Clinical features are more mild than bacterial meningitis, include headache, fever, meningeal irritation
What are the most common organisms for viral meningitis?
Enteroviruses
HSV-2
West Nile virus
What is the basic CSF profile and key diagnostics for viral meningitis
10-2,000 WBC Mononuclear cells (lymphocytes) present Normal glucose Normal or slightly elevated Protein \+Viral culture (neg. Bacterial) PCR is useful
What are the clinical features for viral encephalitis?
Altered consciousness, fever, headache. Seizures and focal neurological symptoms common, such as personality changes, alteration in mental status/consciousness, aphasia, hemiparesis, ataxia, cranial nerve palsies
What are the most common organisms that cause viral encephalitis?
First of all, up to 60% of encephalitis cases do not have an identified cause.
HSV EBV CMV West Nile Virus Enterovirus Mumps
What is the basic CSF profile and key diagnostics for viral encephalitis?
10-2,000 WBCs Mononuclear cells (lymphocytes) present Normal glucose Elevated Protein \+Viral culture, +/- Bacterial culture PCR and MRI most useful
