Meningitis Flashcards
a collection of cells surrounding a group of capillaries in each ventricle that produces the CSF
choroid plexus
which 2 structures are infected and inflamed in meningitis?
meninges
subarachnoid space
what organism in most common in a patient between 18-50 years old?
strep pneumo.
what organism would we suspect in a patient between 18-50 yo who lives in a crowded area?
neisseria meningitis
what organism could be the cause of meningitis in a patient over 50 who was infected by a co-morbid infection?
strep pneumo.
what organism could be the cause of meningitis in a patient over 50 who lives in a crowded area?
Neisseria
what organism is a concern in a patient who is over 50 yo and has had suspicious food?
listeria mono.
what 3 organisms would we expect in a patient who is post-surgical or post-trauma?
gram negative
strep pneumo
staph aureus
what 3 organisms would we expect in a patient who is immunocompromised, HIV, has alcoholism, or uses steroids?
gram negative
strep pneumo
listeria mono.
what are the 3 etiologies of chronic meningitis?
mycobacterium TB
atypical bacteria
fungi
in a viral meningitis, what do we worry about?
HSV
what is the classic triad of symptoms in meningitis?
fever
headache
neck stiffness
what are 3 parts of the physical exam that would point to meningitis?
Kernig sign
Brudzinski sign
AMS
a patient presents within 2 days of symptom onset and has the classic presentation of fever, headache, and neck stiffness. what is the type of meningitis?
bacterial (acute)
a patient presents months after onset with focal neurological signs, strokes, seizures, and cranial nerve deficits. what is the type of meningitis?
chronic
a patient presents days-1week after onset with headache and fever. what is the type of meningitis?
viral
what 4 diagnostics should we order for meningitis?
Head CT
LP + CSF culture
blood culture
CBC
what should we order if we are concerned about contaminated injection as a source of infection?
MRI with contrast of injection site
CSF findings show increased neutrophils, low glucose, high protein, and markedly elevated opening pressure. what is the type of meningitis?
bacterial meningitis
CSF findings show increased lymphocytes, low glucose, high protein, and moderately elevated opening pressure. what is the type of meningitis? (2)
mycobacterial or fungal
CSF findings show increased lymphocytes, normal glucose, high protein, and normal-elevated opening pressure. what is the type of meningitis?
spirochetal meningitis
CSF findings show increased lymphocytes, normal-low glucose, high protein, and slightly elevated opening pressure. what is the type of meningitis?
viral meningitis
what should be done before obtaining blood or CSF?
IV empiric therapy
what is the treatment for a 2-50 yo patient with bacterial meningitis? (2)
vancomycin
+
cefotaxime OR ceftriaxone
what is the treatment for a patient over 50 yo with bacterial meningitis? (3)
vancomycin
+
ampicillin
+
cefotaxime OR ceftriaxone
what is the treatment for a immunocompromised patient with bacterial meningitis? (3)
vancomycin
+
ampicillin
+
cefepime
what is the treatment for a post-surgical/post-trauma patient with bacterial meningitis? (2)
vancomycin
+
cefepime
what treatment should be given at the same time as the first dose of antibiotics, for bacterial meningitis if bacteria is unknown or strep pneumo is confirmed?
IV dexamethasone
what are 3 considerations for transitioning to outpatient therapy?
inpatient therapy > 6 days
no fever for at least 24-48 hours
no significant neuro dysfunction
what is the treatment for viral meningitis?
supportive care
what is the treatment for fungal meningitis?
IV amphotericin B x 11-21 days
what is the treatment for syphilis meningitis? (2)
IV aqueous penicillin x 10-14 days
THEN
IM benzathine pen G 1/week x 3 weeks
what is the treatment for lyme disease meningitis? (2)
IV ceftriaxone x 2-4 weeks
+/- dexamethasone
what is the treatment for TB meningitis?
IM/PO Isoniazid x 6-18 months
what is the complication of DIC associated with?
meningococcal meningitis
what can cause hearing loss in a patient with meningitis?
inflammation of cochlear aqueduct (CN VIII)
