Meningitis

Question 1

meningitis sequelae

Answer 1

death
hearing loss
seizures
cognitive dysfunction (learning/speech)

Question 2

epi of meningitis

Answer 2

age: 70% by age 5
route: blood borne; some via direct extension

Question 3

BIG 3 bugs

Answer 3

S. pneumoniae (vaccine)
N. meningitidis (vaccine now for B)
H. influenzae type B (used to be major for kids under 5) *EPIGLOTITIS

makes sense b/c they colonize the nasopharynx

Question 4

signs/sx of meningitis

Answer 4

headache (>90%)
fever (>90%)
meningismus (>85%) anything that stiffens the neck
altered sensorium (>80%)
Kernig's sign (>50%)
Brudzinski's sign (>50%)
Vomiting (to reduce blood volume 35%)
seizures (30%)
focal findings (15%)
papilledema (<1%)

Question 5

diagnosis of meningitis

Answer 5

LUMBAR PUNCTURE ASAP
CT before LP if coma, focal neuro sx, papilledema
if their neuro exam is normal then OK to LP
it’s rare to not be able to get lumbar puncture

Question 6

what’s an abnormal LP pressure?

Answer 6

> 15

Question 7

4 markers of increased ICP

Answer 7

increased opening pressure
CN VI palsy
brain edema on CT
papilledema

Question 8

is glucose normal or low in aseptic meningitis? will you see cells?

Answer 8

normal

yep, mildly elevated protein/cell count

Question 9

which bacteria will cause you to have lymphocytes predominate in CSF first, then shifts to neutrophils?

Answer 9

Listeria

Question 10

etiologic agents:
neonates
children
adults
elderly (>50y)

Answer 10

S. agalactiae, E. coli, Listeria

S. pneumo, N. mening, H. flu

N. mening, S. pneumo

S. pneumo, Listeriaa, N. mening, H. flu type b, G- rods

Question 11

listeria in whom?

Answer 11

pregnant women

older adults

Question 12

antibiotics for meningitis

Answer 12

Want: excellent penetration into CSF; CIDAL activity

things that may reduce: low pH, high protein, high temp

Question 13

supportive therapy

Answer 13

intubation
fluid restriction (for ICP <1.5L/d)
seizure precautions
mannitol
correct metabolic issues
repeat LP in 48h if no improvement

Question 14

Steroids?

Answer 14

KIDS: dexamethasone decr neuro sequelae (give before abx) why? because you can reduce inflammation before the cidal action

Question 15

empiric therapy
neonates:
children:
adults:
adults >50:

Answer 15

Ceftriaxone + ampicillin (for Listeria)

ceftri + vanco (for PEN-resistant strep. pneumo) and DEXAMETHASONE

same for adults

> 50: add ampicillin regardless

always add ampicillin if suspect Listeria

Question 16

duration of therapy?

Answer 16

7-10d for big 3
listeria/GBS: 14-21d
G- bacilli: 21d

Question 17

common features of big 3

Answer 17

human reservoir
droplet transmission
nasopharyngeal colonization
sites of infection/disease
pathogenesis
capsular polysaccharide

Question 18

diseases of big 3

Answer 18

leptomeninges (all 3)
lung (not N)
middle ear (not N)
sinuses (not N)
epiglottitis (H. flu)

Question 19

pathogenesis

Answer 19

multiply in nasopharynx

Question 20

N. meningitidis

Answer 20

unique feature: SKIN LESIONS (RASH)
waterhouse-friderichsen
purpura fulminans

Question 21

Listeria
major diseases
treatment

Answer 21

G+ rod
grows at refrigerator temps
cantaloupe??
"tumbling motility" at 25C
soil, water, decaying vegetative matter, raw foods

FEBRILE GASTROENTERITIS: fever, watery diarrhea, nausea, myalgia, arthralgia (may precede CNS infection) don’t tx this

IV ampicillin or TMP-sulfa

*1st, worst, neurologically cursed headaches always require workup!