Meningitis Flashcards
What are the common viral culprits for meningitis?
Enterovirus, Arboviruses, Herpes
What is the leading cause of Meningitis?
Viruses
Bacterial Meningitis is caused by?
S. Pneumoniae and N. Meningitidis
Who is susceptible to Listeria Monocytogenes Meningitis?
Pregnant women, newborns, old ppl (generally ppl with weak immune system)
What two tests can help diagnose meningitis?
Brudzinski’s neck sign and Kerning’s sign
What does the CSF sample reveal for those with bacterial meningits?
Elevated WBC (above 400mm3), Neutophilic WBC, protein over 80, Decreased glucose,
How do you differentiate fungal from viral infections based on CSF samples?
You can’t really. They share similar characterstics: WBC range up to 500mm3, lymphocytic, protein up to 150 and glucose up to 70mg/dL
What are the normal CSF limits?
glucose up to 60% of serum glucose, WBC
What diagnostic test could you use to r/o bacterial etiology?
Enzyme immunoassay or CSF gram stain and culture
What single test could differentiate viral from fungal meningitis?
PCR. Can also evaluate for mycobacteria
How soon should you start and continue empiric therapy of meningitis?
within 30min of presentation and continued for 48-72 hours until r/o
Your pt’s LP doesn’t take to stain: how do you treat?
50yo or immune system suppressed(listeria)-Tx. same as
If you suspect Listeria what should you always add to your tx?
Ampicillin
The LP takes to the gram stain technique. What bacteria should come to mind?
Strep Pneumoniae>Neisseria Meningitidis>Haemophilus influenzae or listeria monocytogenes if pt is 50yo or immunocomp
The LP gram stain came back gram - diplococci: what bacteria and how do you treat?
Nessiera Meningitids Tx: IV PCN G or cefotaxime or ceftriaxone or chloramphenicol
Lp reveals a gram - bacilli: bacteria and tx?
H.Influenza Tx: ceftriaxone or cefotaxime+/- gentomycin
LP reveals a gram + diplococci
S. Pneumoniae tx: Ceftriaxone or cefotaxime(x10-14days)+vancomycin(if beta lactam resistant) + dexamethasone
LP reveals a gram + baccilli
Listeria Monocytogenes Tx: IV ampicillin and gentomycin(aminoclycoside)
What drug do you use to treat the inflammation with meningitis?
Dexamethasone: inhibits cytokines
When should you administer dexamethasone?
before antibiotics
How many days do you have a dexamethasone administered for in children >2mo? adults?
2 days for pediatrics/ 4 days for adults
When should you avoid dexamethasone?
with patients that have septic shock and meningitis
What is the prophylaxis regimen for meningitis contact?
adults: Rifampin 600mgx4, 1mo-12yo 10mgx4,
what meningitis patients might have a purpuric rash?
Neisseria Meningitidis and rarely in H.Influenza pts
What is pneumococcal meningitis?
Streptococcus pneumoniae(most common)
what is meningococcus meningitis?
Neisseria Meningitidis
What vaccinations can be given to prevent meningitis?
Prevar(Pneumoccal meningitis) Hib vaccine(Haemophilus influenzae)
Does gram + or - meningitis have worse post-infection outcomes?
gram - meningitis is associated with more complications
Psudomonas aeruginosa meningits?
Gram - bacilli, tx IV ceftazidime + gentamicinx3weeks
treatment of other gram - bacilli?
3rd gen cephalosporin x 3 weeks
What should always be your first line of treatment initiated?
Ceftriazone or cefotaxime and vancomycin
