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BCPS > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Common organisms for <1mo meningitis

A

S. agalactiae
Listeria monocytogenes
Strep pneumo
Neisseria meningitidis

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2
Q

Common organisms for 1-23 mo meningitis

A

S. pneumo
Neisseria meningitidis
H. influenzae
S. agalactiae

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3
Q

Common organisms for 2-50 y/o meningitis

A

N. meningitidis
S. pneumo

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4
Q

Common organisms for >50 y/o meningitis

A

S. pneumo
N. meningitidis
L. monocytogenes

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5
Q

N. meningitidis meningitis common symptom

A

Petechiae or purpura

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6
Q

Physical signs of meningitis

A

Brudzinski sign (involuntary flexion of hips/knees when neck flexed)
Kernig sign (pain or resistance when leg moved from 90 degree to 135 degree)
Bulging fontanel (infants)

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7
Q

Bacterial meningitis CSF culture

A

Glucose: <50 (<=0.4 CSF:blood)
Protein: >150
WBC: >1000-5000 (neutrophils)
pH:: 7.1
Lactic acid: >35

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8
Q

Viral meningitis CSF culture

A

Glucose: normal (30-70; 2/3 peripheral)
Protein: normal-slightly elevated (<50 is normal)
WBC: 5-300 (lymphocytes)
pH: normal (7.3)
lactic acid: normal (<14)

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9
Q

C reactive protein in meningitis

A

High negative predictive value (if negative, unlikely meningitis)

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10
Q

Empiric meningitis therapy for neonate

A

Ampicillin + aminoglycoside
OR
ampicillin + cefotaxime

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11
Q

Empiric meningitis therapy for 1-23 mo/old

A

Ceftriaxone + vancomycin

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12
Q

Empiric meningitis therapy for 2-50 y/o

A

Ceftriaxone + vancomycin

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13
Q

Empiric meningitis therapy for >50 y/o

A

Ceftriaxone + vancomycin + ampicillin

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14
Q

Empiric meningitis therapy if head trauma, neurosurgery, or CSF shunt

A

Vanco + cefepime, ceftazidime, or meropenem

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15
Q

Vancomycin purpose in empiric meningitis therapy

A

Activity against highly resistant S. pneumoniae

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16
Q

S. pneumoniae meningitis therapy if MIC to PCN <=0.1

A

Penicillin G 4 million units q4h
Ampicillin 2gm q4h

alt: ceftriaxone 2gm q12h
alt: chloramphenicol 1-1.5g q6h

17
Q

S. pneumoniae meningitis therapy if MIC to PCN 0.1-1.0

A

ceftriaxone

alt: cefepime 2gm q8h
alt: meropenem 2gm q8h

18
Q

S. pneumoniae meningitis therapy if MIC >=2.0

A

Vancomycin + ceftriaxone

alt: moxifloxacin 400 q24

Cephalosporin resistant: add rifampin; linezolid; vanc + moxifloxacin

19
Q

N. meningitidis meningitis therapy if MIC to PCN <0.1

A

Pen G
Ampicillin

Alt: 3rd gen cephalosporin
Alt: chloramphenicol

20
Q

N. meningitidis meningitis therapy if MIC to PCN 0.1-1.0

A

Ceftriaxone

Alt: chloramphenicol
Alt: FQ
Alt: meropenem

21
Q

H. influenzae meningitis therapy if B lactamase negative

A

Ampicillin

Alt: 3rd gen cephalosporin
Alt: cefepime
Alt: chloramphenicol
Alt: FQ

22
Q

H. influenzae meningitis therapy if B lactamase positive

A

3rd gen cephalosporin

Alt: cefepime
Alt: chloramphenicol
Alt: FQ

23
Q

S. agalactiae meningitis therapy

A

Penicillin G
Ampicillin

Alt: Bactrim 5mg/kg q6-12h
Alt: meropenem

24
Q

HSV meningitis therapy

A

Acyclovir 10mg/kg/dose over 1 hour every 8 hours

Alt: cidofovir
Alt: foscarnet

25
Q

Meningitis duration of treament

A

7 days (N. meningitidis, H. influenzae)

10-14 days (S. pneumo, HSV)

14-21 days (S. agalactiae)

> =21 days (L. monocytogenes)

26
Q

Dexamethasone for meningitis

A

0.15mg/kg or 10mg q6h x2-4 days

Start 10-20 min before or with first dose of ABX

children: H. flu, prevents hearing loss
adults: S. pneumo, reduces mortality

27
Q

Chemoprophylaxis for N. meningitidis meningitis

A

Close contacts and exposure to oral secretions:

RIFAMPIN Q12H X4 DOSES
Adults: 600mg
Children: 10 mg/kg
Neonates: 5mg/kg

OR

Adults: cipro 500mg PO once

OR

Ceftriaxone 125-250mg IM once

28
Q

Chemoprophylaxis for H. influenzae meningitis

A

Close contacts with unvaccinated or immunocompromised children

RIFAMPIN DAILY FOR 4 DAYS
Adults: 600mg daily
Children (<12 y/o): 20mg/kg/day
Neonates: 10mg/kg/day

29
Q

Brain abscess

A

Generally cover for streptococcus and anaerobes

BCPS (27 decks)

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