Meningitis

Question 1

What is meningitis?

Answer 1

inflammation of membranes around spine and brain

Question 2

What age does meningitis appear? What gender?

Answer 2

children and males

Question 3

What are the 2 general causes of meningitis?

Answer 3

Bacteria-PMN response
Aseptic- no evidence of bacterial

Question 4

What could cause aseptic meningitis?

Answer 4

viral, fungal, or atypical bacteria that are not easily grown, chemical irritation

Question 5

What routes can introduced pathogen for meningitis?

Answer 5

from blood, trauma, from URTI

Question 6

What bacteria commonly cause meningitis?

Answer 6

H influenza, meningitidis, S pneumoniae, Group b strep, listeria monocytogenes

Question 7

What is the process of meningitis?

Answer 7

colonization
replicate in subarachnoid space
inflammation by cytokine into CSF= neutrophils come
increased pressure=damage

Question 8

Of the bacteria that cause meningitis, what do they all share?

Answer 8

polysaccharide capsule- stops phagocytosis
make immunoglob A protease

Question 9

Why cant the brain stop these pathogens?

Answer 9

only BBB
no antibodies inside

Question 10

What are the risk factors for meningitis?

Answer 10

> 60
<5
trauma
crowding
low money
recent colonize

Question 11

What is the CSF? Where is it produced?

Answer 11

produces in ventricles of choroid plexus
have some protein and glucose

Question 12

If >50 what is the likely organism?

Answer 12

Pneumoniae, meningitides, monocytogenes

Question 13

Why isnt H influenzae not seen as much anymore?

Answer 13

vaccine has lowered alot

Question 14

What are the sx of meningitis?

Answer 14

headache, fever, stiff neck, change in mental, malaise, seizure

Question 15

What is the classic triad of meningitis?

Answer 15

Stiff neck, altered mental status, malaise

Question 16

How often do kernig and brudzinski signs happen in meningitis? What is this?

Answer 16

50%
kernig=pain with passive extension of knee
B=flex neck and if it moves hip it is positive

Question 17

How can we determine for sure if meningitis?

Answer 17

lumbar puncture

Question 18

When cant you do lumbar punture?

Answer 18

if high intracranial pressure

Question 19

After diagnosis, when do you start antibiotics?

Answer 19

within 1 hour

Question 20

What is CSF chemistry test? What is abnormal?

Answer 20

Glucose-serum ratio <50-60%
protein >0.5g/L

Question 21

What CSF WBC count indicates meningitis?

Answer 21

> 500= mostly PMNs(neutrophils)

Question 22

WHat organisms are for 2-50 years?

Answer 22

Pneumonia, meningitidis

Question 23

What organisms for 1-23 months?

Answer 23

same as 2-50 but also influenza

Question 24

What are the complications of meningitis?

Answer 24

respiratory failure
seizures
abscess
death
high pressure
neurologic deficits- blind, deaf, paralysis

Question 25

What are the chances of death for meningitis for each age? What increases this risk?

Answer 25

10%- children 25%-adults 50%-elderly risk increased if ICP, seizure, YOUNG or OLD, lower consciousness

Question 26

What routes can we give antibiotics? Which is best?

Answer 26

Intralumbar-subA space Intracisternal Intraventricular-GOOD

Question 27

What part of drug could cause chemical irritation to meninges?

Answer 27

preservatives-dont use

Question 28

When should you repeat lumbar puncture?

Answer 28

1-2 days to ensure sterilization

Question 29

For each of the common pathogens, What is duration of therapy?

Answer 29

Pneumonia- 10-14 days Meningitidis- 5-7 Influenza- 7-14 days B strep- 14-21 abcess-4-6 weeks

Question 30

What are the empiric antibiotics for each age?

Answer 30

<1 month= Amp+cefotaxime 1-50=Vanco+ Cetriaxone/cefotaxime >50= Vanco+ampicilic+ ceftriaxone/cefotaxime

Question 31

What antibiotics for Pneumoniae?

Answer 31

Vanco+ Cetriaxone/Cefotaxime OR Penicillin if susceptible

Question 32

What antibiotics for monocytogenes?

Answer 32

Amp/pen + AMG

Question 33

What antibiotics for Meningitidis?

Answer 33

Ceftriaxone/cefotaxime, Pen G, amp

Question 34

What antibiotic for H influenza?

Answer 34

cefotaxime/ceftriaxone

Question 35

What is an issue with AMG? How can we improve effeectiveness?

Answer 35

need direct CSF administration add with penicillin=Increase synergy

Question 36

Why cant you use other cephalosporins?

Answer 36

1st gen= dont penetrate 2nd= delayed and can fail 3=AMAZINE for gram negative bacillus

Question 37

What are some supportive therapy for meningitis?

Answer 37

mannitol- diuretic to lower pressure shunts= drain steroids

Question 38

How doe shunts work?

Answer 38

catheter into ventricle to drain into peritoneal cavity to be resorbed

Question 39

How do CS help for meningitis?

Answer 39

death of organisms release cytokines so it stops this lowers mortality and complications such as hearing loss in kids

Question 40

Why is CS controversial for meningitis?

Answer 40

decrease inflam lowers penetration of antibiotics

Question 41

What CS is given for meningitis? When is it given?

Answer 41

Dex 0.15mg/kg q6h for 2-4 days give before or within 2 hours of antibiotics

Question 42

When do you d/c CS?

Answer 42

within 2 days if influenza or pneumonia not cultured

Question 43

DO we need to give prophylaxis if in contact with patient with meningitis?

Answer 43

Only if high risk= inmates, houshold or very close contact, exposure to secretions (kissing), school and daycare contact within 7 days of patient sick

Question 44

Do HCP need prophylaxis?

Answer 44

NO

Question 45

What are the regimens for prophylaxis of meningitidis meningitis?

Answer 45

Rifampin: Adult= 600mg BID for 2 days Kid(1-12)= 10 mg/kg q12h for 2 days ALT Cipro 500mg once- only for adults Ceftriaxone 250 mg IM if >12 years

Question 46

Which strain of meningitis needs no prophylaxis?

Answer 46

pneumonial

Question 47

What are the regimens for prophylaxis of Influenza meningitis?

Answer 47

rifampin: A=600 mg OD for 4 days K= 20mg/kg/d for 4 days

Question 48

What can we also do to prevent spread of meningitis?

Answer 48

Vaccine for meningococcus, influenza, and pneumococcal