Meningitis Flashcards

LOWER PRIORITY

1
Q

Meningitis is the

A

inflammation of the meninges

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2
Q

The most common pathogens that cause bacterial meningitis are
1
2
3

A

1 S. pneumoniae
2 H. influenzae
3 N. meningitides

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3
Q

The most common cause of meningitis is through _________ spread

A

hematogenous (via blood stream)

Contiguous spread (sinusitis, otitis media)
and direct bacterial inoculation (head trauma, neurosurgery) are less common

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4
Q

Group B streptococci, _____________, _____________ are significant causes of meningitis in neonates, immunocompromised, and older adults

A

E. coli
Listeria monocytogenes

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5
Q

What are the 3 cardinal symptoms of meningitis
1
2
3

A

Stiff neck
Fever
Altered mental status

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6
Q

One of the main risk factors associated with bacterial meningitis:

A

extremes of age

additionally:
- head trauma
- exposure to known meningitis patient
- IMMUNOCOMPROMISED

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7
Q

Examination of the ___ is essential for making the diagnosis and is warranted whenever meningitis is suspected

A

CSF

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8
Q

Delay empiric antibacterial therapy if a lumbar puncture (LP) cannot be performed at the time of presentation

True or False

A

FALSE - NEVER DELAY !!

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9
Q

Complications of bacterial meningitis include
1
2
3

A

1 death
2 neurological sequelae
3 inappropriate secretion of ADH (hyponatremeia and worsening cerebral edema)

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10
Q

Immediately start empiric IV antibiotics + __________ after lumbar puncture is done or if delayed lumbar puncture for meningitis treatment

A

dexamethasone

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11
Q

Meningitis:

When administering vancomycin in combination with a third-generation cephalosporin, give the ___________ followed 2 hours later by __________

A

cephalosporin followed 2 hours later by vancomycin, giving the cephalosporin first ensures initial broad coverage and penetration into the CSF

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12
Q

Most likely organisms for meningitis in Neonates <1 month are
1
2
3

A

1 GROUP B STREP
2 E COLI
3 LISTERIA
other gram negatives

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13
Q

Most likely organisms for meningitis in infants and children >1 month - 2 yrs
1
2
3
4

A

1 E coli
2 S pneumo
3 N menin
4 H influ

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14
Q

Most likely organisms for meningitis in older children and adults 2-50 years old
1
2
3

A

S pneumo
H influ
N menin

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15
Q

Most likely organisms for meningitis in >50 and those with risk factors such as alcoholism, altered immune status
1
2
3
4

A

S pneumo
N menin
Listeria
E coli

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16
Q

What two organisms in meningitis of the elderly/immunocompromised and very young are most common?
1
2

A

E coli
Listeria

17
Q

Empiric Drug Therapy (Meningitis)
Neonates <1 months
1.
2.

A
  1. Ampicillin + cefotaxime
  2. Ampicillin + aminioglycosides (gentamicin)

Ampicillin will cover Strep, Listeria
additions cover gram negative

18
Q

In the treatment of meningitis of neonates, this drug cannot be used as it can cause SLUDGING

A

Ceftriaxone

19
Q

In all individuals >1 month - 50 years of age with presumed meningitis, use __________ or __________ followed ≥2 hours later by vancomycin as empiric therapy. This will provide coverage for penicillin-susceptible and -resistant S. pneumoniae, N. meningitidis and H. influenzae

A

Cefotaxime + vancomycin
Ceftriaxone + vancomycin

(ampicillin if immunocompromised)
Vancomycin covers drug resistant S. pneumo

Beta lactam allergy?
Meropenem (S.pneumo, H.influ, N.menin) + Vanco (add tmp- smx if immunocompromised)

20
Q

Patients > 50 or with risk factors such as alcoholism, immunosuppression should use
________ + _________ + _________ for empiric treatment of meningitis

A

Ampicillin (to provide coverage for listeria) + 3rd gen cephalosporin + Vancomycin

Beta lactam allergy?

TMP-SMX (listeria) + meropenem + vancomycin

TMP-SMX + moxifloxacin + vancomycin

21
Q

______________ can be used in patients with meningitis who have blood or CSF isolates of S. pneumoniae

A

Penicillin G or 3rd gen cephalosporin +/- vanco x 10-14 days

22
Q

Meningitis:
_______________, a broad spectrum fluoroquinolone, may be an option (if the isolate is susceptible) in the rare event of resistance to ceftriaxone, cefotaxime and meropenem, or true anaphylaxis

A

Moxifloxacin

23
Q

Meningitis:
____________ is thought to increase the risk of seizures more than meropenem

24
Q

______________ can be used in patients with meningitis who have blood or CSF isolates of N. meningitidis

A

Pen G or 3rd gen ceph x 7 days

25
______________ can be used in patients with meningitis who have blood or CSF isolates of Group B strep/ Listeria
Pen G or ampicillin + gentamicin for synergy x 14 -21 days
26
______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase negative
IV ampicillin x 7-10 days
27
______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase positive
3rd gen cephalosporin x 7-10 days
28
Adjunctive __________ in meningitis (S. pneumoniae/ H. influenzae) helps reduce cerebral edema, lower intracranial pressure and prevent hearing loss and short term neurological sequalae
DEXAMETHASONE
29
Consider the addition of _______ to vancomycin for suspected S. pneumo resistance to 3rd gen cephalosporin meningitis
Rifampin
30
In certain individuals ie. close contact individuals, meningitis prophylaxis should be offered with exposure to these two pathogens 1 2
N. meningitidis H influenzae
31
Meningitis prophylaxis treatment: 1. Exposure to N. meningitidis ______ or ______ or ______ (in pregnant patients) 2. Exposure to H. influenzae ______ or ______ (in pregnant patients)
1. rifampin or cipro or ceftriaxone 2. rifampin or ceftriaxone