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Infectious Diseases > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is the pathogenesis of meningitis

A

Bact gain entry into body via
- Invasion of mucosal surface –> hematogenous spread to brain
- Penetrating head trauma
- Anatomic defects in meninges
- Prev neurosurgical procedures

Colonisation of bact in meninges of a susceptible host
Overgrowth –> meningitis

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2
Q

What is the general aetiology of meningitis?

A

Septic menigitis: Bact
Aseptic meningitis:
Viral
Other microorg: fungal, parasitic, mycobact, syphilis
Drugs (e.g. cotrimoxazole, ibuprofen - irritate meninges, inflamm)
Autoimmune diseases

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3
Q

What are the symptoms of meningitis?

A

Fever, chills, rigors
Alt mental status
Classic triad: Headache, Backache, Nuchal (neck) rigidity
NV
Anorexia
Poor feeding habits
Photophobia
Petechiae or purpura (Neisseria meningitidis)

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4
Q

What are the signs of meningitis?

A

WBC, CRP, procalcitonin

Kernig’s sign = hamstring extended, thigh perpendicular to trunk leads to severe back pain

Brudzinski sign = when head held up, natural reflex of flexion of hip and knee

Bulging fontane = CSF accum

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5
Q

Differentiate CSF in normal vs bact meningitis vs viral meningitis.

A

Glucose:
Normal - glucose:plasma > 0.66
Bact meningitis - glucose:plasma low <0.4
Viral meningitis - glucose:plasma normal to low

Proteins:
Normal - Low <0.4 g/L
Bact meningitis - Elevated >1.5g/L
Viral meningitis - Normal to mildly raised

Wbc:
Normal - <5 cells/mm^3
Bact meningitis - elevated, mostly neutrophils >100 cells/mm^3
Viral meningitis - elevated, mostly lymphocytes 5-1000 cells/mm^3

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6
Q

How do we diagnose meningitis?

A

Hx & physical exams
Blood cultures
Lumbar puncture: elevated opening P, CSF composition, gram stain & culture
Radiology

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7
Q

When do we do radiology for meningitis?

A

To evaluate for complications or disease progression, differential diagnosis.
If pt is unconscious or low alertness
Do prior to lumbar puncture where there is concern for brain shift

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8
Q

What are the bugs to cover for meningitis in neonates (<1mo)?

A

Group B streptococcus (S. aagalactiae)
E. coli
Listeria monocytogenes

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9
Q

What are the bugs to cover for meningitis in infants and children (1-23 mo)?

A

Group B streptococcus (S. agalactiae)
E. coli
S. pneumoniae
Neisseria meningitidis

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10
Q

What are the bugs to cover for children and adults (2-50y)?

A

S. pneumoniae, Neisseria meningitidis

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11
Q

What are the bugs to cover for elderly?

A

S. pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Aerobic gram -ve

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12
Q

What is the recommended regimen for neonates (<1mo)?

A

IV ceftriaxone AND IV ampicillin (for listeria)

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13
Q

What is the recommended regimen for infants and children (1-23mo)?

A

IV ceftriaxone AND IV vancomycin

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14
Q

What is the recommended regimen for children and adults (2-50y)?

A

IV ceftriazone AND IV vancomycin

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15
Q

What is the recommended regimen for elderly?

A

IV ceftriaxone AND IV vancomycin AND IV ampicillin (for listeria)

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16
Q

What is the recommended regimen for culture directed Listeria monocytogenes?

A

IV ampicillin or penicillin
Penicillin allergy: IV cotrimoxazole, meropenem

17
Q

What is the recommended regimen for culture directed S. pneumoniae?

A

Penicillin susceptible: IV Pen G or ampicillin
Penicillin resistant, cephalosporin susceptible: Ceftriaxone
Penicillin, cephalosporin resistant: IV vancomycin AND rifampicin

18
Q

What is the recommended regimen for culture directed Neisseria meningitidis?

A

Penicillin susceptible: IV Penicillin G or ampicillin
Penicillin resistant or mild allergy: IV Ceftriaxone

19
Q

What is the recommended regimen for culture directed Group B Streptococcus (S. agalactiae)?

A

Penicillin susceptible: IV Pen G or ampicillin
Penicillin resistant or mild allergy: IV Ceftriaxone

20
Q

What is the recommendation for adjunctive corticosteroid therapy?

A

10 mg Q6H for up to 4d, 10-20min before first dose of abx.
Only for H. influenzae and S. pneumoniae meningitis

21
Q

What are the benefits of adjunctive corticosteroid thera in H. influenzae and S. pneumoniae meningitis?

A

Less hearing loss & other neurologic sequelae
Decreased mortality (S. pneumoniae)

22
Q

What are the concerns for adjunctive corticosteroid therapy in H. influenzae and S. pneumoniae meningitis?

A

May decrease abx penetration.
ADR: mental status changes, hyperglycemia, HTN

23
Q

What is the recommendation for antibiotic chemoprophylaxis with respect to meningococcal meningitis?

A

Rifampicin
Adults: 600 mg Q12H, four doses
Children: 10 mg/kg Q12H, four doses
Infants: 5 mg/kg Q12H, four doses

Ciprofloxacin 500 mg once daily, one dose
Ceftriaxone 140-250 mg IM, one dose

24
Q

What are the risk factors for meningitis?

A

Head trauma
Neurosurgery
CSF shunts
CSF fistula or leaks
Abnormalities in meninges (Congenital defects)
Drugs
Splenectomised pts
Immunosuppression

25
Q

What is the duration of treatment for Listeria monocytogenes?

A

> =21d

26
Q

What is the duration of treatment for Neisseria meningitidis?

A

5-7d

27
Q

What is the duration of treatment for Group B Streptococcus (S. agalactiae)?

A

14-21d

28
Q

What is the duration of treatment for S. pneumoniae?

A

10-14d

29
Q

How do we de-escalate if there is -ve culture?

A

Treat with empiric abx for at least 14d. May be extended dep on condition of pt

Infectious Diseases (9 decks)

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