Meningitis Flashcards
wht is meningitis
Meningitis is a CNS infection that involves membranes of the brain and spinal cord (Meninges)
CNS infections?
encephalitis, brain abscess, CSF shunt infections, and postoperative infections.
CNS infections, are considered neurologic emergencies that require prompt recognition, diagnosis, and management to prevent death and residual neurologic deficits.
mortality with CNS infections
Improperly treated, CNS infections are associated with high rates of morbidity and mortality.
Despite advances in care, the overall mortality of bacterial meningitis in USA is approximately 15%, and at least 10% - 30% of survivors suffer from neurologic impairment, including hearing loss, hemiparesis, and learning disabilities.
CNS infections can be caused by?
by bacteria, fungi, mycobacteria, viruses, parasites, and spirochetes, though bacteria is the most common cause
Risk factors for CNS infections
- Environmental
- Recent infection in the patient
- Immunosuppression
- Surgery, trauma
- malignancy, medications, autoimmune disease and truama
medication that can cause cns infection
- sulfonamides,
- NSAIDs,
- IV immunoglobulin
Causes of Bacterial Meningitis
- Haemophilus influenzae type b (Hib)
-
Neisseria meningitidis
Causes Meningococcal Meningitis - Streptococcus pneumoniae
Causes Pneumococcal Meningitis
Mode of transmission of Bacterial Meningitis
The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing).
bacteria that cause meningitis are less contagious than the common cold or the flu viruses.
not spread by casual contact or by simply breathing the air
Incubation period:
Household risk if exposed:
Transmission highest :
Incubation period: 2-10 days (average 4 days)
Household risk if exposed: increase by 400-800x
Transmission highest in 1st week
Some may be carrier for many years before becoming ill
Signs and Symptoms
Under Age 2
Fever
Stiff neck
Poor feeding
Excessive irritability or crying
Inactivity
Vomiting
Headache
Seizures (May be hard to detect in infants)
Advanced bacterial meningitis can lead to
Brain damage
Coma
Death (fatality rate of meningitis: 15% in adults)
Survivors can suffer long-term:
Hearing loss
Mental retardation
Paralysis
Seizures
Lab. Findings
CSF appears cloudy
High WBCs
Predominant PMN (polymorphonuclear neutrophils)
High protein
Low glucose
Treatment goals
Prevent death and residual neurologic deficits
Eradicate or control causative micro-organisms
Ameliorate clinical signs and symptoms
Implement vaccination and suppressive measures to prevent future infections.
Supportive care
Hydration
Electrolyte replacement
Antipyretics
Antiemetics
Analgesics
Antiepileptic drugs
Wound care (for surgical wounds)
Neonates (<1 month)
recommended and alternative therapy
Neonates (<1 month)
recommended: ampicillin and cefotaxime
alternative: ampicillin and gentamycin
infant, adult, closed head trauma
recommended:
cefotaxime/ ceftrixone and vancomycin
alternative: vancomycin, refampin, aztreonam
elderly, alcoholl, low immune
recommended:
ampicillin, cefoxime/ceftrixone , vancomycin
alternative: Vancomycin + TMP-SMX + aztreonam
post surgicall and penetrating head truam
vancomycin, ceftazidime
alternative: Vancomycin + cefepime or
Meropenem
Dexamethasone
- inhibits the release of the proinflammatory cytokines and limits the CNS inflammatory response
benefits: reducing cerebral edema and lowering intracranial pressure.
reducing neurologic deficits
Vaccinations
Haemophilus influenzae (Hib) vaccination: All children older than 2 months of age should receive
Meningococcal vaccine is recommended for young adolescents (11–12 years of age) with a booster at age 16 years.
Pneumococcal vaccine should be given to those at high risk for pneumococcal infection.
Chemoprophylaxis
Ciprofloxacin 500 mg in a single dose
easiest option in adults
Children could receive either:
* a single IM injection of ceftriaxone,
* 4 oral doses of rifampin over 2 days, according to BW
Common drugs :
Rifampin, ciprofloxacin, ceftriaxone, minocycline, & spiramycin
Oily chloramphenicol
In areas with limited health facilities
Neisseria
meningitidis
Penicillin MIC <0.1 mcg/mL:
Penicillin G or Ampicillin
alt: Cefotaxime or Ceftriaxone
Penicillin MIC 0.1–1.0 mcg/mL:
Cefotaxime or ceftriaxone
alt:: Meropenem
7 Days
Streptococcus pneumoniae
Penicillin MIC ≤0.06 mcg/mL:
Penicillin G or Ampicillin
alt: Cefotaxime or Ceftriaxone
Penicillin MIC≥0.12 mcg/mL: Cefotaxime or ceftriaxone (if Susceptible)
alt: Cefipime or Meropenem
Haemophilus influenzae
beta-Lactamase-negative:
Ampicillin
alt: Cefotaxime or Ceftriaxone
beta-Lactamase-positive:
Cefotaxime or ceftriaxone
alt: Cefepime or Moxifloxacin
