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CDM 3 Exam 1 > Lecture 8 - CNS Infections > Flashcards

Lecture 8 - CNS Infections Flashcards

1
Q

CSF Shunts

A

essentially tube with valve implanted in skull and you drain the fluid to control the pressure in brain to somewhere else in the body

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2
Q

Meningitis

A

Inflammation of members of the spinal cord and brain, particularly leptomeninges

based by bacteria, viruses, meds, fungus

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3
Q

Encephalitis

A

inflammation of the brain

caused by viruses and bacteria

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4
Q

Transmission & Risk Factors of Meningitis

A
  1. Spread through blood
  2. Direct entry leading to contiguous spread

RF: immunosuppression, cig smoking, inc risk in prisons/dorms/barracks

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5
Q

top 5 bacteria for Meningitis

A
  1. Strep pneum
  2. Group B Strep
  3. N. meningitis
  4. H. Influ
  5. Listeria monocytogenes
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6
Q

top 5 bacteria for Meningitis > 60yrs old

A
  1. S. pneu
  2. L. mono
  3. N.meningitis
  4. Group B strep
  5. H. influ
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7
Q

Things that can cause Aseptic Meningitis?

A

Viral = HSV2, Varicella, HIV, flu
Meds = NSAIDs, sulfamethoxazole, aminopenicillins, carbamazepine, lamotrigine, ranitidine
Fungal
Parasites
Tuberculosis
Syphilis

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8
Q

Aseptic Meningitis means that….

A

from sample of CSF we cant find where its from

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9
Q

Pathophysiology of Meningitis

A
  1. Strep pneumo makes a protease that lets it go undetected by immune system.
  2. Bacteria can live in bloodstream, and it binds to receptors that allows it to pass through.
  3. Strep Pneumo, prevents interaction w/ C3b bc its encapsulated**
  4. Due to inflammation, tight junctions in BBB start to break apart
  5. this allows bacteria to pass through and into brain & CSF
  6. CSF has little to defend against bacteria
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10
Q

CSF markers of Meningitis

A

Increase CSF protein
Decreased CSF glucose
Increase CSF Lactate

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11
Q

Classic “Triad” for Meningitis

A

Fever**
Nuchal Rigidity**
Altered Mental Status**

Headache

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12
Q

Physical exams findings for Meningitis

A

Brudzinski Sign
Kernig’s Sign

Jolt accentuation

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13
Q

CSF Analysis from Lumbar Puncture

A

Glucose, protein, WBC, and lactate
Gram stain, culture, susceptibility

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14
Q

What sorts of values are we looking for in Bacterial Meningitis

A

Opening pressure > 250
Glucose % < 40% (Dec)
Protein > 200 (elevated)
WBC > 1000 (80-90% Neutrophils)
Lactate > 3.5

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15
Q

two barriers for medications when dealing with Meningitis

A

BBB and Blood-CSF barrier

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16
Q

To cross BBB/ Blood-CSF barrier, we need….

A

High Lipophilicity
Low degree of ionization
Small molecule weight
Low protein binding

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17
Q

Meningitis Goals of Therpy

A

** Prevention / Vaccines
eradicate infeciton
improve signs/symptoms
reduce morbidity and mortality

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18
Q

Empiric therapy < 1 month old common pathogens

A

Group B strep
E.coli
Klebsiella
Enterobacter
L.monocytogenes

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19
Q

Empiric therapy < 1 month treatment

A

Ampicillin + cefotaxime**/Ceftazidime/cefepime = due to shortage

Ampicillin + AG (Genta/Tobra)

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20
Q

Empiric therapy 1-23 month old common pathogens

A

S. pneum
N. Meningitidis
H. influ
S. agalactiae
E. coli

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21
Q

Empiric therapy 1-23 month old treatment

A

Vanco + 3 Gen Ceph (Ceftriaxone or cefotaxime)

22
Q

Why give 2 things that cover gram +?

A

Ceftriaxone-nonsusceptible strains of S.pneum occur about 10% of the time

23
Q

Empiric therapy 2-50 yrs old common pathogens

A

S. pneumoniae
N. Meningitidis

24
Q

Empiric therapy 2-50 yrs old treatments

A

Vancomycin + 3 Gen ceph (Ceftriaxone or Cefotaxime)

25
Q

Empiric therapy > 50 yrs old common pathogens

A

S. pneum
N. meningitides
L. mono
Aerobic GNR

26
Q

Empiric therapy > 50yrs old treatments

A

Vancomycin + 3 Gen ceph (Ceftriaxone or Cefotaxime) + ampicillin

27
Q

Antibiotic Dosing considerations

A

tend to be dosed higher than usual

28
Q

Vancomycin Meningitis dosing

A

15-20mg/kg Q8-12hrs

monitoring doing troughs or AUC

29
Q

Big issue with Pneumococcal Meningitis?

A

Hearing loss

30
Q

Pneumococcal Meningitis (PCN susceptible) TXM

A

PCN G 4mil units IV q4h or Ampicillin 2g IV q4h

alternative: cefotaxime, ceftriaxone, cefepime, meropenem

31
Q

Pneumococcal Meningitis (PCN resistant) TXM

A

Vancomycin (15-20mg/L) + ceftriaxone 2g q12h/cefotaxime 2g IV q4-6h

Alternative: moxifloxacin

32
Q

Meningococcal Meningitis (PCN Susceptible) Txm

A

PCN G 4mil units IV q4h or Ampicillin 2g IV q4h

Alternative: 3rd Gen Ceph (Cefotaxime/ceftriaxone) chloramphenicol

33
Q

Meningococcal Meningitis (PCN resistant) Txm

A

Ceftriaxone 2g q12h or cefotaxime 2g IV q4-6h

Alternative: moxifloxacin, meropenem, chloramphenicol

34
Q

N. Meningitidis Chemoprophylaxis close contact definition

A

ppl within 3 feet of patient for >8hrs during 7 days before and 24hrs after starting ABX

35
Q

N. Meningitidis Chemoprohylaxis txm

A

Essential Rifampin for everyone in different doses

Ceftriaxone preferred in pregnant

36
Q

H. Flu type B (B-lactamages neg) Txm

A

Ampiclin 2g IV q4h

37
Q

H.Flu type B (B-lactamase pos) Txm

A

Cefotaxime 2g q4-6h or ceftriaxone 2g IV q12h

38
Q

H.Flu type B chemoprophylaxis

A

Rifampin in 4 doses

unvaccinated close contacts

39
Q

Listeria Monocytogenes TXM

A

PCN G 4mil units IV q4h + gent or Ampicillin 2g IV q4h + gent

40
Q

Group B strep TXM

A

PCN G 4mil units IV q4h or Ampicillin 2g IV q4h

41
Q

Group B Strep chemoprophylaxis

A

pregnant in labor should receive PCN or Ampicillin if…

GBS carrier
H/x of GBS bacteriuria
Prev delivery of infant w/ GBS

42
Q

S. pneumoniae length of therapy

A

10-14 days

43
Q

N. meningitides or H.influ length of therapy

A

7-10 day, may extend to 14 days

44
Q

GBS, S.aureus length of therapy

A

14-21 days

45
Q

Enterobacteraceae, P.aeruginosa length of therapy

A

21 days

46
Q

L. monocytogenes length of therapy

A

> 21 days

47
Q

when to consider outpatient ABX treatment for meningitis?

A

can do after 7 days if….

low risk of neurologic complications
able to adhere w/ close monitoring and follow-up

48
Q

Children advantages with steroid treatment

A

less hearing loss w/ H.influ infection

49
Q

Adult advantages with steroid treatment

A

dec mortality w/ S.pneum

50
Q

Disadvanages of steroid treatment

A

dec ABX pen, so give before or w/ 1st dose (within 10-20min)

guileless recommend starting for all adults w/ suspected bacterial meningitis

51
Q

Encephalitis symptoms

A

Altered mental status
Stupor
Seizures more common

52
Q

Common causes of Encephalitis

A

HSV1 in adults
HSV2 in neonates

CDM 3 Exam 1 (10 decks)

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