Management of Meningitis Flashcards
How are bacteria able to enter the central nervous system?
- Invasion of mucosal surface, then hematogenous spread to brain
- Spread from para-meningeal focus
- Penetrating head trauma
- Anatomical defects in the meninges
- Previous neurosurgical procedures
What are the triad of symptoms for meningitis?
Headache, backache, neck rigidity
What is a sign of meningitis caused by Neisseria meningitidis?
Petechiae or purpura
What are the physical signs of meningitis?
- Kernig sign
- Brudzinski sign
- bulging fontane
What is normal CSF like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: clear
- Glucose: 2.6-4.5mmol/L (CSF:blood >0.66)
- Protein: <0.4g/L
- WBC: <5 cells/mm3
What is CSF from bacterial meningitis like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: turbid
- Glucose: v low, CSF:blood <0.4
- Protein: raised (>1.5g/L)
- WBC: raised (>100 cells/mm3), mainly neutrophils
What is CSF from viral meningitis like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: clear
- Glucose: Normal to slightly low
- Protein: Normal to mildly raised
- WBC: raised (5-1000 cells/mm3), mainly lymphocytes
What are the organisms that need to be covered for meningitis in neonates?
Group B Streptococcus (S. agalactiae), E.coli, Listeria monocytogenes
What is the empiric regimen for neonatal meningitis?
Ceftriaxone + Ampicillin
What are the organisms that need to be covered for meningitis in kids <2yo?
S.pneumoniae, Neisseria meningitidis, S.agalactiae, E.coli
What is the empiric regimen for meningitis in kids<2yo?
Ceftriaxone + Vancomycin
What are the organisms that need to be covered for meningitis in 2-50yo?
S.pneumoniae, Neisseria meningitidis
What is the empiric regimen for meningitis in 2-50yo?
Ceftriaxone + Vancomycin
What are the organisms the need to be covered for meningitis in >50yo?
S.pneumoniae, N.meningitidis, Listeria monocytogenes, aerobic gram-negatives bacilli (eg E.coli, Klebsiella spp)
What is the empiric regimen for meningitis in >50yo?
Ceftriaxone + Ampicillin + Vancomycin
How long should culture directed regimen for Streptococcus pneumoniae be?
10-14 days
How long should culture directed regimen for Neisseria meningitidis be?
5-7 days
How long should culture directed regimen for Listeria monocytogenes be?
Min 21 days
How long should culture directed regimen for Streptococcus agalactiae be?
14-21 days
What are the alternative options for S.pneumoniae Tx in meningitis?
Ceftriaxone if cephalosporin susceptible
Vancomycin + Rifampicin if beta-lactam resistant
What are the alternative options for Neisseria meningitidis Tx in meningitis?
Ceftriaxone
What are the alternative options for Listeria monocytogenes Tx in meningitis?
Co-trimoxazole or meropenem
What are the alternative options for Streptococcus agalactiae Tx in meningitis?
Ceftriaxone
What kinds of patients can adjunctive steroid be used in meningitis treatment for?
> 6 weeks old
What is the steroid dosing for meningitis?
IV dexamethasone 10mg Q6H for up to 4 days
When should steroids be started for meningitis?
10-20min before or at the same time as the first dose of meningitis Abx
What are the options for Neisseria meningitidis meningitis chemoprophylaxis?
Rifampicin, Ciprofloxacin, Ceftriaxone
What are the rifampicin doses for Neisseria meningitidis meningitis chemoprophylaxis?
→ Adults: 600mg Q12H, 4 doses
→ Children: 10mg/kg Q12H, 4 doses
→ Infants (younger than 1 month): 5mg/kg Q12H, 4 doses
What is the ciprofloxacin dose for Neisseria meningitidis meningitis chemoprophylaxis?
Adults: 500mg PO, 1 dose
What is the ceftriaxone dose for Neisseria meningitidis meningitis chemoprophylaxis?
125-250mg IM, 1 dose
