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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
What do you add for empiric ABX if you suspect Listeria?
Ampicillin
26
What is the empiric therapy for CSF gram stain (+) for a gram (+) diplococci strep?
ceftriax or cefotaxime + vanco + dexa
27
What is the empiric therapy for CSF gram stain (+) for a gram (-) diplococci strep N meningitidis?
cefotax or ceftriax
28
What is the empiric therapy for CSF gram stain (+) for a gram (+) bacilli or coccobacili?
amp + gent
29
What is the empiric therapy for CSF gram stain (+) for a gram (-) bacilli H influenzae?
ceftaz or cefepime +/- gent
30
Dexamethasone
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
What does dexamethasone decreased in pediatric patients (>2 mo. of age)?
Hearing loss
32
What is dexamethasone beneficial against in adults?
S. Pneumoniae, meningitis, reduced mortality
33
Dexamethasone- uses in adult patients
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
What is the evaluation of a response to tx in meningitis?
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
Neisseria Meningitidis
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
Neisseria Meningitidis- treatment
Drug of choice is high dose IV PCN G | Alternatives include cefotaxime, ceftriaxone, chloramphenicol
37
What is the prophylaxis of contacts?
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
When should prophylaxis of contacts be administered?
Should be administered ASAP (ideally 24hrs), administration 14 days post-contact is probably not useful
39
What is the prophylaxis regimen?
Adults: Rifampin Children 1 month to 12 years: Rifampin Children < 1 month: Rifampin Alternatives include IM ceftriaxone (i.e. for pregnancy
40
Streptococcus pneumoniae (Pneumococus)
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
Who has an increased risk for pneumococal meningitis?
Persons with cochlear implants
42
What is common among survivors of pneumococcal meningitis?
Neurological Sequelae
43
Streptococcus pneumoniae (Pneumococus)- treatment
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
Streptococcus pneumoniae (Pneumococus)- prevention
- 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
Haemophilus Influenzae
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
Haemophilus Influenzae- treatment
30-40% isolates are now ampicillin resistant | Treatment of chouce is cetriaxone or cefotaxime
47
What is given as a prophylaxis for H.influenzae?
Rifampin
48
Who does not benefit from the prophylaxis for H. influenzae?
Individuals fully vaccination (> 2 years of age)
49
Listeria Monocytogens
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
Listeria Monocytogens- treatment
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
What are the risk factors for Gram-negative Bacilli?
Cranial trauma, neurosurgery Immunosuppression Hospitalization Elderly Patients
52
What gram-negative bacilli infections are neonates at risk for developing?
E. Coli and klebsiella pneumoniae
53
Gram negative bacilli- treatment
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
Meningitis is a serious infection associated with significant?
Morbidity and mortablity
55
Recognition of the clinical signs and symptoms of meningitis is?
Critical
56
Empiric antibiotic and adjunctive therapy for meningitis should be?
Initiated promptly
57
Ceftriaxone or Cefotaxime and Vancomycin should be the initial choice for?
Community-acquired meningitis
58
Ampicillin should be added to meningitis treatment if what?
Listeria is suspected | Usually in old people, babies, and pregnancy
59
When is chemoprophylaxis necessary?
Niesseria Meningitidis and H. Influenzae

Pharmacology II (23 decks)

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