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Pharmacology II > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What are the five pathogens that can cause meningitis? aka the types?

A 
Viral
Mycobacteria
Parasitic
Bacteria
Fungal
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2
Q

What are the most common causes of bacterial meningitis?

A

Streptococcus Pneumoniae is the most common cause (reason for PCV 13 vaccine)
Neiseria Meningitidis is another leading cause that affects young adults and teens
Haemophilus Influenzae- decreased since HIB vaccine
Listeria Monocytogenes- found in soft cheeses, hot dogs, luncheon meats. Pregnant women, newborns, and older adults and those with weakened immune systems are at highest risk

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3
Q

What is the most common cause of meningitis?

A

Viral- usually mild and often clears on its own

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4
Q

What are the two most common causes of bacterial meningitis?

A

80% causes by S. Pneumoniae and N. Meningitidis

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5
Q

What do patients surviving a gram (-) bacillary meningitis have a risk of developing?

A

A neurocomplication

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6
Q

What was the cause of the 2012 fungal meningitis outbreak?

A

Contaminated corticosteroid injections from a compounding pharmacy.
160 cases w/ 49 deaths

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7
Q

What is the pathophysiology for bacterial meningitis?

A 
Mucosal colonization
Intravascular survival
Meningeal invasion
Subarachnoid space invasion
Blood brain barrier disruption
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8
Q

What is the clinic presentation for adult bacterial meningitis?

A

Headache, fever, stiff neck (nuchal rigidity), photophobia

Altered mental status (Glascoma scale <14), obtundation, seizures, vomiting

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9
Q

What is the clinic presentation for infants bacterial meningitis?

A

Irritability, altered sleep, vomiting, high pitched cry, decreased oral intake

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10
Q

What is the clinic presentation for children bacterial meningitis?

A

Lethargy, confusion, somnolence

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11
Q

What is the inability to straighten the leg when the hip is flexed to 90 degrees?

A

The kernig’s sign

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12
Q

What is when flexion of the neck causes hips and knee flexion?

A

The brudzinski neck sign

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13
Q

What is the differential for the increase in WBC in bacterial meningitis?

A

Neutrophilic

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14
Q

What is the differential for the increase in WBC in bacterial and viral meningitis?

A

Lymphocytes

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15
Q

What is the lab test done to diagnose meningitis?

A

CSF- cerebrospinal fluid

Flows unidirectional down the spinal cord

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16
Q

What does a CSF evaluation involve?

A

Gram stain and culture

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17
Q

What is the empiric therapy for CSF gram stain (+) for a gram (-) bacilli H influenzae?

A

ceftaz or cefepime +/- gent

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18
Q

What organisms is using PCR effective as a diagnostic method?

A

Viruses
Mycobacteria
Fungi

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19
Q

What is the management for bacterial meningitis?

A 
Empiric antibiotics
Anti-inflammatory agents
Fluids
Electrolytes
Antipyretics
Analgesia
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20
Q

When should empiric therapy be initiated?

A

Until the pathogen is identified

Within 30 minutes of presentation even if LP is not obtained

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21
Q

When should empiric therapy be stopped?

A

Continued for 48-72 hours or until dx of meningitis can be ruled out.
Once identity of infecting organism and sensitivities are obtained, tailor therapy to infecting organism.

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22
Q

What is the empiric ABX for a CSF gram stain that is negative for an infant less than 1 month?

A

Ampicillin + cefotaxime or gentamicin

Increased incidence of LIsteria monocytogenes

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23
Q

What is the empiric ABX for a CSF gram stain that is negative for a 1 month-50 y/o?

A

Cefataxime or ceftriaxone + vancomycin (+ dexamethasone)

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24
Q

What is the empiric ABX for a CSF gram stain that is negative for a patient >50 y/o or alcoholic-increased incidience of L. monocytogenes?

A

Ampicillin + Ceftriaxone or Cefotaxime + Vancomycin (+dexamethasone)

25
Q

What do you add for empiric ABX if you suspect Listeria?

A

Ampicillin

26
Q

What is the empiric therapy for CSF gram stain (+) for a gram (+) diplococci strep?

A

ceftriax or cefotaxime + vanco + dexa

27
Q

What is the empiric therapy for CSF gram stain (+) for a gram (-) diplococci strep N meningitidis?

A

cefotax or ceftriax

28
Q

What is the empiric therapy for CSF gram stain (+) for a gram (+) bacilli or coccobacili?

A

amp + gent

29
Q

What is the empiric therapy for CSF gram stain (+) for a gram (-) bacilli H influenzae?

A

ceftaz or cefepime +/- gent

30
Q

Dexamethasone

A

Anti-inflammatory, corticosteroid
Inhibits the production of pro-inflammatory cytokines (TNF, IL-1)
Improves CSF parameters (bacterial meningitis)
Needs to be administered before antibiotics
Concern of increased GI bleeding
Concern of decreased antibiotic penetration
Vancomycin penetration not affected by dexamethasone

31
Q

What does dexamethasone decreased in pediatric patients (>2 mo. of age)?

A

Hearing loss

32
Q

What is dexamethasone beneficial against in adults?

A

S. Pneumoniae, meningitis, reduced mortality

33
Q

Dexamethasone- uses in adult patients

A

Cloudy CSF, bacteria on CSF gram stain, CSF >1000 WBCs
Risk of unfavorable outcome reduced from 25% to 15%
Greatest benefit occurred in patients with a GCS score of 8-11
Mortality in patients with S. pneumoniae related meningitis decreased from 34% to 14%
Patients with meningitis and septic shock could have a worse outcome with dexamethasone use and should be avoided for now

34
Q

What is the evaluation of a response to tx in meningitis?

A

Signs and symptoms
Vital signs and cerebral dysfunction Q4H for 72 hours
CSF for re-culture, PCR if not responding
Identification and susceptibility testing usually takes 72 hours
Individualize therapy based on results

35
Q

Neisseria Meningitidis

A

Gram-negative diplococci
Children and young adults
Winter and Spring
Immunologic reaction (fever, arthritis, pericarditis)- Consider NSAIDS
Behavioral change, seizures, coma
Up to 50%: DIC (disseminated intravascular coagulation- both bleeding and clotting inappropriately. They have purple spots all over their limbs.), purpuric lesions

36
Q

Neisseria Meningitidis- treatment

A

Drug of choice is high dose IV PCN G

Alternatives include cefotaxime, ceftriaxone, chloramphenicol

37
Q

What is the prophylaxis of contacts?

A

Recommended for close contacts defined as household contacts, day care members, and anyone directly exposed to the patient’s oral secretions (kissing, mouth-to-mouth resuscitation, endotracheal management)

38
Q

When should prophylaxis of contacts be administered?

A

Should be administered ASAP (ideally 24hrs), administration 14 days post-contact is probably not useful

39
Q

What is the prophylaxis regimen?

A

Adults: Rifampin
Children 1 month to 12 years: Rifampin
Children < 1 month: Rifampin

Alternatives include IM ceftriaxone (i.e. for pregnancy

40
Q

Streptococcus pneumoniae (Pneumococus)

A

Gram-positive cocci in pairs
Most common cause of meningitis in adults
Seen commonly in children
Predisposition with pneumonia, endocarditis, splenectomy, head trauma, alcoholism, sickle cell disease, bone marrow transplant

41
Q

Who has an increased risk for pneumococal meningitis?

A

Persons with cochlear implants

42
Q

What is common among survivors of pneumococcal meningitis?

A

Neurological Sequelae

43
Q

Streptococcus pneumoniae (Pneumococus)- treatment

A

Treat with IV 3rd generation cephalosporin for 10-14 days
Cefotaxime
or
Ceftriaxone

If PCN susceptible may switch to penicillin
Vancomycin if resistant to beta-lactams

44
Q

Streptococcus pneumoniae (Pneumococus)- prevention

A
  • Vaccinate persons > 65 years old, immunocompromised patients and asplenic patients
  • Prevnar® (heptavalent conjugate vaccine- PCR13) at 2, 4, 6, and 12 to 15 months (don’t memorize the vaccine schedule)
  • Vaccination and chemoprophylaxis with penicillin reduce the incidence of pneumococcal disease in sickle cell disease
45
Q

Haemophilus Influenzae

A

Gram-negative bacilli
Introduction of Hib vaccine has decreased incidence by 76-90%
Sterile, subdural effusions seen frequently
May have morbiliform or petechial rash similar to menigicoccal rash (rare)

46
Q

Haemophilus Influenzae- treatment

A

30-40% isolates are now ampicillin resistant

Treatment of chouce is cetriaxone or cefotaxime

47
Q

What is given as a prophylaxis for H.influenzae?

A

Rifampin

48
Q

Who does not benefit from the prophylaxis for H. influenzae?

A

Individuals fully vaccination (> 2 years of age)

49
Q

Listeria Monocytogens

A

Gram-positive bacilli or coccobacilli
Primarily affects neonates, immunocompromised adults, and the elderly
Peaks in summer and early fall
Colonizes GI tract then penetrates gut lumen

50
Q

Listeria Monocytogens- treatment

A

DOC is IV ampicillin x 14-21 days, plus an aminoglycoside x 10 days
(PCN may be used in place of ampicillin)

Alternative is TMP/SMX (bactrim)

51
Q

What are the risk factors for Gram-negative Bacilli?

A

Cranial trauma, neurosurgery
Immunosuppression
Hospitalization
Elderly Patients

52
Q

What gram-negative bacilli infections are neonates at risk for developing?

A

E. Coli and klebsiella pneumoniae

53
Q

Gram negative bacilli- treatment

A

Treat with IV ceftazidime (more specific cephalosporin) plus gentamicin x 3 weeks if Pseudomonas aeruginosa

Other organisms treat with 3rd generation cephalosporins x 3 weeks

54
Q

Meningitis is a serious infection associated with significant?

A

Morbidity and mortablity

55
Q

Recognition of the clinical signs and symptoms of meningitis is?

A

Critical

56
Q

Empiric antibiotic and adjunctive therapy for meningitis should be?

A

Initiated promptly

57
Q

Ceftriaxone or Cefotaxime and Vancomycin should be the initial choice for?

A

Community-acquired meningitis

58
Q

Ampicillin should be added to meningitis treatment if what?

A

Listeria is suspected

Usually in old people, babies, and pregnancy

59
Q

When is chemoprophylaxis necessary?

A

Niesseria Meningitidis
and
H. Influenzae

Pharmacology II (23 decks)

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