Meningitis

Question 1

wht is meningitis

Answer 1

Meningitis is a CNS infection that involves membranes of the brain and spinal cord (Meninges)

Question 2

CNS infections?

Answer 2

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.

Question 3

mortality with CNS infections

Answer 3

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.

Question 4

CNS infections can be caused by?

Answer 4

by bacteria, fungi, mycobacteria, viruses, parasites, and spirochetes, though bacteria is the most common cause

Question 5

Risk factors for CNS infections

Answer 5

• Environmental
• Recent infection in the patient
• Immunosuppression
• Surgery, trauma
• malignancy, medications, autoimmune disease and truama

Question 6

medication that can cause cns infection

Answer 6

1. sulfonamides,
2. NSAIDs,
3. IV immunoglobulin

Question 7

Causes of Bacterial Meningitis

Answer 7

1. Haemophilus influenzae type b (Hib)
2. Neisseria meningitidis
   Causes Meningococcal Meningitis
3. Streptococcus pneumoniae
   Causes Pneumococcal Meningitis

Question 8

Mode of transmission of Bacterial Meningitis

Answer 8

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

Question 9

Incubation period:
Household risk if exposed:
Transmission highest :

Answer 9

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

Question 10

Signs and Symptoms
Under Age 2

Answer 10

Fever
Stiff neck
Poor feeding
Excessive irritability or crying
Inactivity
Vomiting
Headache
Seizures (May be hard to detect in infants)

Question 11

Advanced bacterial meningitis can lead to

Answer 11

Brain damage
Coma
Death (fatality rate of meningitis: 15% in adults)

Question 12

Survivors can suffer long-term:

Answer 12

Hearing loss
Mental retardation
Paralysis
Seizures

Question 13

Lab. Findings

Answer 13

CSF appears cloudy
High WBCs
Predominant PMN (polymorphonuclear neutrophils)
High protein
Low glucose

Question 14

Treatment goals

Answer 14

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.

Question 15

Supportive care

Answer 15

Hydration
Electrolyte replacement
Antipyretics
Antiemetics
Analgesics
Antiepileptic drugs
Wound care (for surgical wounds)

Question 16

Neonates (<1 month)
recommended and alternative therapy

Answer 16

Neonates (<1 month)
recommended: ampicillin and cefotaxime
alternative: ampicillin and gentamycin

Question 17

infant, adult, closed head trauma

Answer 17

recommended:
cefotaxime/ ceftrixone and vancomycin

alternative: vancomycin, refampin, aztreonam

Question 18

elderly, alcoholl, low immune

Answer 18

recommended:
ampicillin, cefoxime/ceftrixone , vancomycin

alternative: Vancomycin + TMP-SMX + aztreonam

Question 19

post surgicall and penetrating head truam

Answer 19

vancomycin, ceftazidime

alternative: Vancomycin + cefepime or
Meropenem

Question 20

Dexamethasone

Answer 20

• inhibits the release of the proinflammatory cytokines and limits the CNS inflammatory response

benefits: reducing cerebral edema and lowering intracranial pressure.
reducing neurologic deficits

Question 21

Vaccinations

Answer 21

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.

Question 22

Chemoprophylaxis

Answer 22

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

Question 23

Neisseria
meningitidis

Answer 23

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

Question 24

Streptococcus pneumoniae

Answer 24

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

Question 25

Haemophilus influenzae

Answer 25

beta-Lactamase-negative:
Ampicillin
alt: Cefotaxime or Ceftriaxone
beta-Lactamase-positive:
Cefotaxime or ceftriaxone
alt: Cefepime or Moxifloxacin