Meningitis

Question 1

Meningitis is the

Answer 1

inflammation of the meninges

Question 2

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

Answer 2

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

Question 3

The most common cause of meningitis is through _________ spread

Answer 3

hematogenous (via blood stream)

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

Question 4

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

Answer 4

E. coli
Listeria monocytogenes

Question 5

What are the 3 cardinal symptoms of meningitis
1
2
3

Answer 5

Stiff neck
Fever
Altered mental status

Question 6

One of the main risk factors associated with bacterial meningitis:

Answer 6

extremes of age

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

Question 7

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

Answer 7

CSF

Question 8

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

True or False

Answer 8

FALSE - NEVER DELAY !!

Question 9

Complications of bacterial meningitis include
1
2
3

Answer 9

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

Question 10

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

Answer 10

dexamethasone

Question 11

Meningitis:

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

S pneumo
H influ
N menin

Question 15

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

Answer 15

S pneumo
N menin
Listeria
E coli

Question 16

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

Answer 16

E coli
Listeria

Question 17

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

Answer 17

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

Ampicillin will cover Strep, Listeria
additions cover gram negative

Question 18

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

Answer 18

Ceftriaxone

Question 19

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

Answer 19

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)

Question 20

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

Answer 20

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

Beta lactam allergy?

TMP-SMX (listeria) + meropenem + vancomycin

TMP-SMX + moxifloxacin + vancomycin

Question 21

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

Answer 21

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

Question 22

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

Answer 22

Moxifloxacin

Question 23

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

Answer 23

Meropenem

Question 24

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

Answer 24

Pen G or 3rd gen ceph x 7 days

Question 25

______________ can be used in patients with meningitis who have blood or CSF isolates of Group B strep/ Listeria

Answer 25

Pen G or ampicillin + gentamicin for synergy x 14 -21 days

Question 26

______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase negative

Answer 26

IV ampicillin x 7-10 days

Question 27

______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase positive

Answer 27

3rd gen cephalosporin x 7-10 days

Question 28

Adjunctive __________ in meningitis (S. pneumoniae/ H. influenzae) helps reduce cerebral edema, lower intracranial pressure and prevent hearing loss and short term neurological sequalae

Answer 28

DEXAMETHASONE

Question 29

Consider the addition of _______ to vancomycin for suspected S. pneumo resistance to 3rd gen cephalosporin meningitis

Answer 29

Rifampin

Question 30

In certain individuals ie. close contact individuals, meningitis prophylaxis should be offered with exposure to these two pathogens
1
2

Answer 30

N. meningitidis
H influenzae

Question 31

Meningitis prophylaxis treatment:
1. Exposure to N. meningitidis
______ or ______ or ______ (in pregnant patients)

2. Exposure to H. influenzae
   ______ or ______ (in pregnant patients)

Answer 31

1. rifampin or cipro or ceftriaxone
2. rifampin or ceftriaxone