Meningitis

Question 1

Causative organisms?

Answer 1

S. pneumonia, H. influenza, Nisseria meningitis

Question 2

Which cephalosporins interact with warfarin?

Answer 2

Cefazolin
Ceftriaxone
Cefoxitin
Cefotetan
Cefamandole
Cefoperazone

Question 3

Pathophysiology of meningitis

Answer 3

inflammation of meninges
often caused by group B strep (gram positive), H. Influenza, L. monocytogenes, N. meningitidis, Strep. pneumonia

Question 4

Which vaccines cover the 5 different serotypes of N. meningitidis?

Answer 4

conjugate vaccines: Menactra, Menveo
serogroup B (recombinant) vaccines: Bexsero and Turkmenia

Question 5

What are the 5 serotypes of N. Meningitidis?

Answer 5

A, B, C, W, Y

Question 6

Which Serotype is most common to infect children under 5 years old?

Answer 6

Type B (b for baby)

Question 7

Which serotype commonly infects adolescents?

Answer 7

Type Y and C (young n chill)

Question 8

Which serotype commonly affects travelers?

Answer 8

Type W and A (think of travelling –> waters)

Question 9

What are the endemic areas for meningitis?

Answer 9

saudi arabia
sub-saharan africa
Chile

Question 10

vaccine dosing in children for meningococcal Type B conjugate vaccine (bexsero)?

Answer 10

2, 4, and 6 month age
booster dose at 12-23 months

Question 11

Which vaccine is preferred in infants?

Answer 11

Conjugated H. influenza type b
S. pneumonia and S. meningitis type C vaccines.

Question 12

Which vaccines are preferred in Children over 2 years old

Answer 12

Quadrivalent meningococcal vaccine against types A, C, W, and Y-135.

Question 13

What is the gold standard for diagnosis?

Answer 13

bacterial culture

Question 14

patients C&S came positive for pseudomonas aeruginosa. Which antibiotic should be started?

Answer 14

ceftazidime

Question 15

Purpose of dexamethasone use?

Answer 15

Given before or within 1 hr of the first antibiotic dose. Helps reduce CNS inflammation and complications (like severe hearing loss).

Question 16

Can ceftriaxone be given to neonates?

Answer 16

no, risk of hyperbilirubinemia

Question 17

Causative organism and empiric therapy in: neonates from 0-1 month old?

Answer 17

Group B strep, S. pneumo, E. coli, Listeria

ampicillin + aminoglycoside OR ampicillin + cefotaxime

Question 18

Causative organism and empiric therapy in: infants 1 month old and up ?

Answer 18

N. meningitidis, H. influenza, S. pneumo

Vancomycin + cefotaxime or ceftriaxone

Question 19

Which antibiotic does not require renal dose adjustment?

Answer 19

ceftriaxone

Question 20

Causative organism and empiric therapy in: teenagers to adults less than 60 years old?

Answer 20

Stp Pneumo, N. meningitidis (+ H. influenza, HS, enterococci in adults)

Vanco + ceftriaxone or cefotaxime

Question 21

Causative organism and empiric therapy in: adults 60+ , alcoholism, or immunocompromised?

Answer 21

S. pneumo, E. coli, Listeria

Vanco + ampicillin + cefotaxime/ or ceftriaxone

Question 22

In bacterial meningitis, upon doing a lumbar puncture for CSF analysis, how does it appear in both bacterial and viral meningitis

Answer 22

CSF is a clear solution.

Question 23

glucose levels in bacterial vs. viral meningitis?

Answer 23

bacterial: low glucose
viral: high glucose

and in both, WBC count is high

Question 24

What are the symptoms of meningitis?

Answer 24

-sudden onset after 1-2 days of infection
fever, stiff neck, altered mental status, seizure, nausea/vomiting, sensitivity to light

Question 25

what happens if you give a patient with renal disease, high doses of cephalosporin?

Answer 25

risk of seizure

Question 26

if patient has penicillin and cephalosporin-resistant S. pneumo, what antibiotics should be used?

Answer 26

adding vancomycin +/- rifampin to high-dose cephalosporins = enhances bacterial eradication in the CSF

Question 27

when should dexamethasone be given?

Answer 27

before or within 1 hr of the first dose of antibiotics

Question 28

do not combine ceftriaxone with…?

Answer 28

calcium containing solutions —> can cause precipitation.

Question 29

which antibiotic is the drug of choice in pregnancy?

Answer 29

ceftriaxone

Question 30

when should empiric therapy be initiated?

Answer 30

as soon as meningitis is suspected or confirmed

Question 31

Duration of therapy?

Answer 31

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

Question 32

When meningitis is suspected, what form of investigation is essential?

Answer 32

Examine the CSF via lumbar puncture

Question 33

If a lumbar puncture cant be performed right away, should empiric antibiotics be withheld until confirmation?

Answer 33

No, do not delay.

Question 34

When is a lumbar puncture contraindicated?

Answer 34

1. presence of increased intracranial pressure (ex. focal neurologic signs, new onset seizures, altered consciousness, papilledema)
2. seizures
3. shock or coagulopathy
4. infection at the proposed site of the lumbar puncture

Question 35

When should lumbar puncture be performed if a patient has high inctracranial pressue?

Answer 35

defer LP until after CT

Question 36

What are the CSF findings consistent with bacterial meningitis?

Answer 36

• 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