May1 M3-CNS Infections Flashcards

1
Q

classification of meningitis

A
  • bacterial (community acquired OR healthcare-associated/post-neurosurgical)
  • viral
  • fungal
  • mycobacterial
  • parasitic
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2
Q

(imp?) most common bacterial pathogen for meningitis in neonates IN THE COMMUNITY (<1 month of age)

A

GEL

    1. GBS (agalactiae), transmitted vertically intrapartum*
  • enterobacteriaceae
  • listeria (rare now)
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3
Q

(imp?) most common bacterial pathogen for meningitis in 1-23 months old babies (>1, <24) IN THE COMMUNITY

A

strep pneumoniae

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4
Q

(imp?) most common bacterial pathogen for meningitis in 2-50 year old people IN THE COMMUNITY

A

strep pneumo (also Neisseria)

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5
Q

(imp?) most common bacterial pathogen for meningitis in people over 50 years of age

A
    1. strep pneumo *
      1. Neisseria
      2. Listeria* (comes back)
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6
Q

pathogen with important mortality in meningitis

A

Neisseria meningitidis

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7
Q

who’s especially susceptible for Neisseria meningitidis infections

A

C5-C9 (MAC) complement deficiencies patients. vulnerable to encapsulated organisms in general (S pneumo, N mening, haemophilus influenza)

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8
Q

classical organisms that are encapsulated

A
  • Strep pneumo
  • N mening
  • Haemophilus influenza
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9
Q

(important) spleen removed = at risk for what infections (what type of meningitis) #1 and #2

A

encapsulated organisms

  • strep pneumo (#1)
  • neisseria meningitidis (#2)
  • haemophilus influenza
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10
Q

(important) how bacterial meningitis organisms are transmitted

A

by droplets

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11
Q

how do you get listeria monocytogenes infection (and meningitis)

A

from contaminated foods

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12
Q

(imp?) conditions that increase risk of listeriosis (listeria infection and meningitis)

A
  • iron overload conditions (like hemochromatosis)

- immunodeficiency conditions (neonates, old, pregnant, etc.)

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13
Q

(imp?) listeriosis affects what group especially

A

pregnant women because of immunodeficiency

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14
Q

pathogens in HOSPITAL associated bacterial meningitis

A
  • aerobic gram- bacilli like pseudomonas is 40% of cases
  • staph aureus and CoNS (epidermidis, etc.)
  • propionibacterium acnes (on plastic devices)
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15
Q

what viruses cause the majority of viral meningitis

A

enteroviruses (echoviruses, coxsackie viruses)

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16
Q

signs of meningitis in children

A
  • fever
  • poor feeding
  • vomiting
  • irritability
17
Q

signs of meningitis in adults

A

headache, fever, meningismus = mucorigidity, altered mental status + Brudzinki’s sign, Kernig’s sign, Jolt accentuation

18
Q

skin manifestations in meningitis

A

-purpura fulminans (hemorrhagic necrotic bullae) = Neisseria meningitidis (and also Strep pneumo and enterovirus)

19
Q

bacterial vs viral meningitis

A
  • opening P in CSF: B = 200-500. viral = normal, max 200
  • WBC >1000 = B
  • PMNs > 80% = B
  • protein > 1g/L = B
  • positive gram stain=B
20
Q

(imp?) neonatal (0-1 mo) bacterial meningitis: Abx given and organisms covered

A

ampicillin IV + cefotaxime (3rd gen cephalo) IV

GBS, gram- enteric rods, listeria

21
Q

(imp?) infant (1-3 mo) bacterial meningitis: Abx given and organisms covered

A

ampicillin IV + (Cefotaxime or Ceftriaxone IV) + Vancomycin IV
(GBS, gram- enteric rods, listeria, S. pneumo)

22
Q

(imp?) 3 months to 50 yrs of age bacterial meningitis: Abx given and organisms covered

A

(Cefotaxime or Ceftriaxone IV) + Vancomycin IV

S. pneumo, N mening, H infl type B

23
Q

(imp?) 50 years+ and immunocompromised bacterial meningitis: Abx given and organisms covered

A

ampicillin IV + (ceftriaxone or cefotaxime IV) + Vancomycin IV
(S pneumo, N mening, listeria)

24
Q

(imp?) healthcare associated bacterial meningitis: Abx given and organisms covered

A

-Vanco + (ceftazidime or cefepime or meropenem)

(cover gram- rods like pseudomonas, CoNS and staph aureus

25
Q

(imp?) Abx for S pneumo OR N meningitis OR H infl meningitis susceptible to penicillin

A

penicillin G or ampicillin (for H infl, only ampicillin) (cross BBB)

26
Q

(imp?) Abx for S pneumo OR N meningitidis OR H infl meningitis resistant to penicillin

A

Cefotaxime or Ceftriaxone IV (cross BBB)

27
Q

(imp?) Abx for GBS or listeria meningitis

A

beta-lactam IV + aminoglycoside IV

28
Q

adjunctive therapy to the Abx that is given in certain conditions in meningitis and when

A
adjunctive steroids (IV dexamethasone) for H infl meningitis in all ages and S pneumo meningitis in adults
(decrease neuro damage *hearing loss* and cytokine influx)
29
Q

encephalitis def

A

inflam process of brain parenchyma associated with lab or clinical evidence of brain dysfunction

30
Q

usual causes of encephalitis and list some examples

A

viruses (HSV-1 most common, rabies, nipah, LCV, SLE, WNF, JEF, etc.)

31
Q

(important) most common cause (specifically) of viral encephalitis

A

HSV-1

32
Q

bacterial vs viral differentiation in meningitis vs encephalitis

A

CSF analysis can help make the difference in meningitis but not in encephalitis (CSF is same in viral vs bacterial encephalitis)

33
Q

(imp?) tx of encephalitis

A
  • no therapy except for herpes

- herpes: acyclovir IV for 21 days, check kidneys and baseline renal fct

34
Q

(imp?) important principle in HSV encephalitis treatment

A

start to treat early: results in significantly decreased morbidity and mortality

35
Q

(imp?) classic triad of bacterial meningitis

A
  • fever
  • headache (that is worse with light)
  • nuchal rigidity
36
Q

investigation step that is done for every patient with encephalitis

A

send CSF for HSV and enterovirus PCR for every patient

37
Q

considerations of cause of encephalitis in immunocompromised patient

A

think of the following herpesviruses: EBV, CMV, VZV, HHV-6