Meningitis Flashcards
Causative organisms?
S. pneumonia, H. influenza, Nisseria meningitis
Which cephalosporins interact with warfarin?
Cefazolin
Ceftriaxone
Cefoxitin
Cefotetan
Cefamandole
Cefoperazone
Pathophysiology of meningitis
inflammation of meninges
often caused by group B strep (gram positive), H. Influenza, L. monocytogenes, N. meningitidis, Strep. pneumonia
Which vaccines cover the 5 different serotypes of N. meningitidis?
conjugate vaccines: Menactra, Menveo
serogroup B (recombinant) vaccines: Bexsero and Turkmenia
What are the 5 serotypes of N. Meningitidis?
A, B, C, W, Y
Which Serotype is most common to infect children under 5 years old?
Type B (b for baby)
Which serotype commonly infects adolescents?
Type Y and C (young n chill)
Which serotype commonly affects travelers?
Type W and A (think of travelling –> waters)
What are the endemic areas for meningitis?
saudi arabia
sub-saharan africa
Chile
vaccine dosing in children for meningococcal Type B conjugate vaccine (bexsero)?
2, 4, and 6 month age
booster dose at 12-23 months
Which vaccine is preferred in infants?
Conjugated H. influenza type b
S. pneumonia and S. meningitis type C vaccines.
Which vaccines are preferred in Children over 2 years old
Quadrivalent meningococcal vaccine against types A, C, W, and Y-135.
What is the gold standard for diagnosis?
bacterial culture
patients C&S came positive for pseudomonas aeruginosa. Which antibiotic should be started?
ceftazidime
Purpose of dexamethasone use?
Given before or within 1 hr of the first antibiotic dose. Helps reduce CNS inflammation and complications (like severe hearing loss).
Can ceftriaxone be given to neonates?
no, risk of hyperbilirubinemia
Causative organism and empiric therapy in: neonates from 0-1 month old?
Group B strep, S. pneumo, E. coli, Listeria
ampicillin + aminoglycoside OR ampicillin + cefotaxime
Causative organism and empiric therapy in: infants 1 month old and up ?
N. meningitidis, H. influenza, S. pneumo
Vancomycin + cefotaxime or ceftriaxone
Which antibiotic does not require renal dose adjustment?
ceftriaxone
Causative organism and empiric therapy in: teenagers to adults less than 60 years old?
Stp Pneumo, N. meningitidis (+ H. influenza, HS, enterococci in adults)
Vanco + ceftriaxone or cefotaxime
Causative organism and empiric therapy in: adults 60+ , alcoholism, or immunocompromised?
S. pneumo, E. coli, Listeria
Vanco + ampicillin + cefotaxime/ or ceftriaxone
In bacterial meningitis, upon doing a lumbar puncture for CSF analysis, how does it appear in both bacterial and viral meningitis
CSF is a clear solution.
glucose levels in bacterial vs. viral meningitis?
bacterial: low glucose
viral: high glucose
and in both, WBC count is high
What are the symptoms of meningitis?
-sudden onset after 1-2 days of infection
fever, stiff neck, altered mental status, seizure, nausea/vomiting, sensitivity to light
what happens if you give a patient with renal disease, high doses of cephalosporin?
risk of seizure
if patient has penicillin and cephalosporin-resistant S. pneumo, what antibiotics should be used?
adding vancomycin +/- rifampin to high-dose cephalosporins = enhances bacterial eradication in the CSF
when should dexamethasone be given?
before or within 1 hr of the first dose of antibiotics
do not combine ceftriaxone with…?
calcium containing solutions —> can cause precipitation.
which antibiotic is the drug of choice in pregnancy?
ceftriaxone
when should empiric therapy be initiated?
as soon as meningitis is suspected or confirmed
Duration of therapy?
N. meningitis is 5 to 7 days
If Strep pneumo = 10-14 days
If Group B Strep = 14-21 days
If Listeria or enterobacteriacae = atleast 21 days
When meningitis is suspected, what form of investigation is essential?
Examine the CSF via lumbar puncture
If a lumbar puncture cant be performed right away, should empiric antibiotics be withheld until confirmation?
No, do not delay.
When is a lumbar puncture contraindicated?
- presence of increased intracranial pressure (ex. focal neurologic signs, new onset seizures, altered consciousness, papilledema)
- seizures
- shock or coagulopathy
- infection at the proposed site of the lumbar puncture
When should lumbar puncture be performed if a patient has high inctracranial pressue?
defer LP until after CT
What are the CSF findings consistent with bacterial meningitis?
- turbid, cloudy with increased pressure about 20 cm h2o
- elevated WBC (>100)
- low CSF glucose
- elevated CSF lactate level common in post-op neuro patients with BM
