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Infectious Disease > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What are the signs of neurological sequelae?

A

Seizures
Hearing loss
Hydrocephalus

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2
Q

What are the meninges?

A

Membranes that surround the brain and spinal cord

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3
Q

What are the 3 layers of the meninges?

A

Dura mater - attached to the skull.
Arachnoid - middle.
Pia mater - covering the brain tissue.

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4
Q

What is the CSF?

A

Fluid within the CNS that suspends the brain and other CNS structures.

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5
Q

Where is the CSF produced?

A

In choroids plexus

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6
Q

What are the normal contents of the CSF?

A

WBC < 5 cells/m3
Protein < 50 mg/dL
Glucose 50-66% simultaneous serum value

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7
Q

BBB

A

Natural barrier.
Exchange of drugs and endogenous compounds among the blood, brain and CSF.
Consists of tightly joined endothelial cells.

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8
Q

What is the definition of meningitis?

A

Inflammation of the subarachnoid space or spinal fluid

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9
Q

What are the types of Meningitis?

A

Bacterial

Aseptic

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10
Q

What are the causes of aseptic meningitis?

A

NSAIDs
Bactrim
OKT3-anti-rejection monoclonal antibody
Azathioprine

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11
Q

What is the definition of encephalitis?

A

Inflammation of the brain

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12
Q

What type of bacteria are able to gain entry into the subarachnoid space?

A

Bacteria that have a polysaccharide capsule ad other cell surface structures are able to evade host defenses and gain entry

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13
Q

What are the steps for bacterial meningitis infection?

A

Hematogenous spread of organisms.
Contiguous spread from parameningeal focus.
Direct bacterial inoculation.

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14
Q

What are predisposing risk factors for meningitis?

A 
Immunosuppression
Head trauma
Neurosurgical patients 
Local infection
Exposure to someone with meningitis
Anatomicial or functional asplenia
Complement deficiency
Recent travel to area with endemic meningococcal disease
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15
Q

What are the 3 classical triad s/sx for meningitis?

A

Fever
Nuchal rigidity
Altered mental status

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16
Q

What are the classic s/sx for meningitis?

A 
Fever
Nuchal rigidity
Altered mental status
Severe HA
Photophobia
Petechial rash (N. meningitidis only)
Kernig sign (+)
Brudzinski sign (+)
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17
Q

What are the ways to diagnose meningitis?

A 
History and physical exam
Lumbar puncture
CSF gram stain and culture
Rapid-identification latex agglutination
PCR
CT scan
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18
Q

What does a rapid identification agglutination detect?

A 
H. influenzae
S. pneumonia
N. meingitides
E. coli
group B streptococci
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19
Q

What is different in the lumbar puncture in the differential?

A

> 80 PMNs

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20
Q

How many serotypes are there of N. meningitides?

A

5: A, B, C, Y, W135

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21
Q

What symptoms occur in ~50% of the population in N. meiningitides infections?

A

Petechiae

Purpuric lesions

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22
Q

What are the post infection immunologic reactions for patients with N. meningitides?

A

~10-14 days after onset of disease.
Fever, arthritis, pericarditis.
Even with successful treatment.

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23
Q

Which bacteria is the leading cause of mengintis?

A

S. pneumoniae

24
Q

What are the risk factors of meningitis caused by S. pneumoniae?

A

Repeated episodes of otitis media, CSF leaks, fracture of sinuses, COPD

25
Q

What kinds of complications are common in S. pneumonia meningitis?

A

Neurologic (coma, seizures)

26
Q

What are the risk factors for meningitis caused by H. influenzae?

A

Otitis media
Paranasal sinus infections
CSF leak

27
Q

What vaccination has decreased the incidence of H. influenzae pneumoniae?

A

Hib vaccine

28
Q

What populations are primarily affected by Listeria monocytogenes meningitis?

A

Neonates
Alcholics
Immunocompromised adults
The elderly

29
Q

What people are at risk for G- meningitis?

A

People with CNS trauma

30
Q

What are the treatment goals for bacterial meningitis?

A

Eradicate invading organism
Alleviate symptoms
Prevent neurologic sequelae

31
Q

What happens once meingitis is suspected?

A

NEUROLOGIC EMERGENCY! DO NOT delay once meningitis is suspected.

32
Q

How long do we treat meningitis?

A

48-72 hours or until it is ruled out

33
Q

What are antibiotic characteristics that affect penetration of antibiotics into the CSF?

A

Low molecular weight > high
Non-ionized at physiologic pH > ionic
Highly lipid soluble > water soluble
Non-protein bound > protein bound

34
Q

What are the common pathogens for < 1 month of age?

A

S. agalactiae
E. coli
L. monocytogenes
Klebsiella spp.

35
Q

What is the empiric therapy for < 1 month old?

A

Cefotaxime + ampicillin
OR
Ampicillin + aminoglycoside

36
Q

What are the common pathogens for 1-23 month olds?

A 
S. pneumonia
N. meningitideis
S. agalaciae
H. influenzae
E. coli
37
Q

What is the empiric therapy for 1-23 month olds?

A

Vancomycin + ceftriaxone (or cefotaxime)

38
Q

What are the common pathogens for 2-50 year olds?

A

S. pneumoniae

N. meningitidis

39
Q

What is the empiric therapy for 2-50 year olds?

A

Vancomcin + ceftriaxone (or cefotaxime)

40
Q

What are the common pathogens for > 50 year olds?

A

S. pneumoniae
N. meningitidis
L. monocytogenes
Aerobic G- bacilli

41
Q

What is the empiric therapy for > 50 year olds?

A 
Vancomycin 
\+
Ceftriaxone (or cefotaxime) 
\+
Ampicillin
42
Q

What is the duration of therapy for N. meningitidis?

A

7 days

43
Q

What is the duration of therapy for H. influenzae?

A

7 days

44
Q

What is the duration of therapy for S. pneumoniae?

A

10-14 days

45
Q

What is the duration of therapy for S. agalactiae

A

14-21 days

46
Q

What is the duration of therapy for aerobic G- bacilli?

A

21 days

47
Q

What is the duration of therapy for L. monocytogenes?

A

> /= 21 days

48
Q

When do you administer adjunctive dexamethasone therapy?

A

10-20 minutes before or at the same time as 1st dose of antibiotic, for 2-4 days

49
Q

What is the current thoughts on use of adjunctive dexamethasone therapy?

A

Controversial with conflicting data.
Evidence of decreased neurologic sequelae in:
-infants and children with H. influenzae type b meningitis.
-Adults with suspected S. pneumoniae meningitis

50
Q

What are the disadvantages in the use of adjunctive dexamethasone therapy?

A

Decreased inflammation which leads to decreased amount of drug that penetrates the CNS

51
Q

How do you prevent H. influenzae type b (Hib)

A

Hib conjugate vaccin

Routine vaccination starting at 2 months of age

52
Q

How do you prevent N. meningitidis?

A

Meningococcal conjugate vaccines
Hib-MenCY (infants), Menactra (MCV4-D), Menveo (MCV4-CRM)
Routine vaccination: MCV4 at age 11-18yo, with a booster at age 16

53
Q

When do you prophylax for N. meningitidis?

A

Chemoprophylaxis
Close contacts - persons with prolonged contact to the infected person or their secretions within 1 week before symptoms being until 24 h after antibiotics are initiated. Those who frequently sleep and ear in the same dwelling with the index case

54
Q

What is the N. meningitidis chemoprophylaxis treatment?

A

Rifampin for 2 days
Adults: 600mg q12h x 4 doses
Children > 1 month of age: 10mg/kg/d x 2 days

55
Q

Who should receive chemoprophylaxis?

A

Household members
Day care center contacts
Any person directly exposed to the patient’s secretions (coughing, sneezing, kissing)

56
Q

How do you prevent S. pneumoniae?

A

PCV13 - routine vaccination series starting at 2 months

PPSV23 - routine vaccination in persons >/= 65 yo

Infectious Disease (19 decks)

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