Meningitis

Question 1

What is meningitis?

Answer 1

infection of meinges, CSF, and ventricles. can be bacterial or viral or fungal. bater - pyogenic and viral - aseptic.

Question 2

What is encephalitis?

Answer 2

inflammation of brain

Question 3

signs of encephalitis?

Answer 3

flu-like symptoms - fever or severe headache. confusion, seizures, sensory or motor impairment. usually viral so fewer meningal sings.

Question 4

Bacterial meningitis pathogens?

Answer 4

Strept. pneum (+ diplococci)
H influ ( gram negative coccobacilli)
Staphylococcus (gram + cocci)
N. meningitidis (gram negative diplococci)

Question 5

Recommended vaccines to prevent meningitis?

Answer 5

PCV 7 (children)
PPV 23
MCV4
MPSV4

Question 6

incubation of N meningitis?

Answer 6

2-4 days, (1-10 day range)

Question 7

Presentation of bacterial Meningitis?

Answer 7

triad: fever, headache, nuchal rigidity, stiff neck

Brudzinski and kernig sign

Question 8

Possible causes of viral Encephalitis?

Answer 8

HSv, varicella, enterovirus, mosquito, tickborne viruses. rabies. measles, mumos.

Question 9

CSF results in bacterial meningitis?

Answer 9

pleocytosis (WBC > 5 cell/mm3), elevated CSF pressure (also see in viral) WBC 1200, 90-95% neutrophils, reduced CSF glucose (

Question 10

CSF results in viral meningitis?

Answer 10

pleocytosis (WBC > 5 cell/mm3), elevated CSF pressure, normal glucose, normal - elevated protein, lymphocytosis.

Question 11

What is brudzinski sign?

Answer 11

passive neck flexion in supine patient causes flexion of knees and hips

Question 12

What is kernig sign?

Answer 12

supine patient and flex hip 90 degrees, extension of knee from position elicits resistance or pain in lower back or posterior thigh.

Question 13

signs of increased ICP?

Answer 13

papilledema, optic disk bulging, absence venous pulsations on funduscopic exam.

severe signs - vomiting, nausea, seizures, altered consciousness

Question 14

What is common signal sign of N meningitidis?

Answer 14

purpura or petechial rash

Question 15

Daignostic for encephalitis?

Answer 15

MRI or CT.

lumbar puncture

Question 16

What strands of meningitis does the vaccination cover?

Answer 16

A, C, Y, W135.

does not cover serogroup B.

Question 17

Prophylaxis during epidemic?

Answer 17

NO. limited help.

Question 18

Prophylaxis during those in close contact with infected?

Answer 18

yes, single does oral cipro or IM ceftriaxone.

oral rifampin over 2 days.

Question 19

Can vaccinations be used in outbreak?

Answer 19

yes

Question 20

MCV4 is recommended for who?

Answer 20

those in outbreak and for all children during 11-12 yo. 13-18 if late. or booster if later.

Question 21

Who gets a booster MCV 4?

Answer 21

16 yo for those who got it at 11-12. , college freshman, immune dx, outbreak in 11-55.

Question 22

MPSV4 recommended for whom?

Answer 22

56+

Question 23

Tx of bacterial meningitis?

Answer 23

supportive care and anti-infective agents.
empiric therapy based on stain, culture or CSF.

1) gram + diplococci (s. pneum) - ceftriaxone or cefotaxime + vancomycin + dexamethasone
2) gram - diplocci - N menginit - cefotaxime or ceftriaxone.
3) gram positive bacilli or coccobacilli (Staphyl) - ampicillin with or without gentamicin
4. ) gram negative bacilli (H influ) ceftazidime or cefepime with or without gentamicin

Question 24

Tx viral meningitis?

Answer 24

acyclovir is an option