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Clinical 2.0 > Meningitis > Flashcards

Meningitis Flashcards

1
Q

risk factors for meningitis

A 
neonates 
advanced age
pregnancy 
nasopharyngeal colonization with n.meningitis, spneumoniae, h.influenzae 
prior URTI
choclear implants 
cranial anatomical defects
trauma
fracture
neruosurgery
prosthesis
drains 
IC
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2
Q

pathogenesis of meningitis

A

bug originates in nasopharyngeal cavity
adheres to cells and gets into bloodstream
have capsules to protect from bloodstream IS
cross the BB and gets into CSF where theres no IS
massive inflammatory response, bacteria lysis, release of exotoxins

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3
Q

most likely pathogens of meningitis

A

strep pneumo 50% = gram positive diplococci
niesseria menigitis = gram negative cocci
h.influenzae found in unimmunized
listeria monocytogenes 5% gram positive bacilli

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4
Q

most common pathogens in neonates

A

s. agalactiae

ecoli

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5
Q

most common pathogens in children

A

n. meningitidis

s. pneumoniae

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6
Q

most common pathogens in adults

A

s.pneumoniae
n.meningitidis (younger adults)
l.monocytogenes - pregnancy, >60, IC
s.aureus
gram negative bacilli - IC, health care associated

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7
Q

3 most common clinical signs of meningitis

A

fever >40 (90%)
nuchal rigidity or neck stiffness
CNS: headache, photophobia, confusion, siezures

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8
Q

clinical signs in infants

A

non specific symptoms

fever, seizure, resp distress, septic shock

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9
Q

what sign is highly suggestive of meningococcal infection

A

rash thats hemorrhagic

also disseminated - septic shock

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10
Q

3 complications of meningitis

A

herniation - diffuse swelling, hydrocephalus
infarcts - inflammatory occlusion of basal arteries
seizures - cortical inflammation

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11
Q

what is the prognosis affected by

A

pathogen
patient age
health status
treatment

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12
Q

mortality rates for

  1. penumoniae
  2. meningitidis
  3. monocytogenes
A
  1. 10-30%
  2. 10-40%
  3. 15%
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13
Q

3 fundamentals for AM therapy

A
  1. early prompt initiation
  2. CSF penetration
  3. rapid sterilization
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14
Q

what factors determine CSF penetrations

A 
antibiotic size
lipophilicity
ionization
protein binding
barrier inflammation
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15
Q

describe the blood/CSF barrier

A

tight junctions
thick wall
can pump out solutes
depend on the inflammation for drugs to get through

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16
Q

which drugs can achieve therapeutic concentrations with or without inflammation

A

chloramphenicol ( dont use toxic to blood cells)
metronidazole
rifampin

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17
Q

which drugs can acheive therapeutic concentrations in the CSF with inflammation

A 
penicillins
3rdGC and cefuroxime
daptomycin
fluoroquinolones
linezolid
meropenem
tmp-smx
vanco
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18
Q

which drugs is a therapeutic CSF concentration not achieved

A

aminoglycosides

other cephalosporins

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19
Q

empirical therapy for children under 1 month

A

cefotax
ampicillin
+/- gent (to make amp more cidal)

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20
Q

empirical therapy for 1mon to 17 years

A

cefotax/ceftriax +vanco
vanco added initially to cover penicilllin resistant strep pneumo with reduced susceptibility to ceph until susceptibility determined

21
Q

empirical treatment for 18-50 years

A

cefotax/ceftriax +vanco

22
Q

empirical therapy for >50

A

cefotax/ceftriax + vanco + amp (risk of listeria)

23
Q

why must you treat empirically

A

if miss the bug the patient dies

24
Q

cefotax menigitis dose

A

2g q4hr

25
Q

ceftriax dose

A

2g q12hr

26
Q

ampicillin dose

A

2g q4hr

27
Q

vanco dose

A

15-20mg/kg q8hr

28
Q

nero dose

A

2g q8hr

29
Q

pen G dose

A

4MU q4h (upper limit of normal dosing)

30
Q

rifampin dose

A

600mg q24hr (same as normal dosing)

31
Q

lab results in meningitis

A

increase WBC, mostly PMNs
protein elevated bc increased permeability
glucose in CSF low becuase bacteria using it as food, normally its 50% of what is in the serum

32
Q

peak incidence of meningococcal meningitis

A

children and young adults

natural immunity usually by 20 yoa

33
Q

treatment for n.meningitidis penicillin susceptible

A

pen G or amp 5-7days

cipro alternative

34
Q

treatment for n.meningitidis penicillin resistant

A

cefotax/ceftriax

alternative chloram?

35
Q

how has the conjugate vaccination affected streptococcal meningitis

A

declining incidence but increased incidence on non included serotypes

36
Q

directed therapy for s.pneumoniae if penicillin sensitive

A

penG or amp
cipro alternative
5-7 days

37
Q

directed therapy for penicillin resistant streptococcal

A

cefotac/ceftriax 10-14 days

alternative levo/moxi +/- vanco chloram, linezolid??

38
Q

directed therapy for strep pneumoniae with 3rdGC MIC >1

A

cefotax/ceftriax + vance

dont just do vanco bc not sure how much penetrates CSF

39
Q

directed therapy for strep pneumoniae with 3rdGC MIC >2

A

cefotax/ceftriax + vanco + rifampin

40
Q

directed therapy for l.monocytogenes

A

pen G or amp + gent 21 days
for synergy may not pass into CSF but only need a little amount for synergy to occurs
alternatives: TMP-SMX, linezolid

41
Q

recommended guidelines for using adjunctive dexamethasone therapy

A

immunocompetent adults with suspected or proen pneumococcal meningitis
infants or children with h.influenzae

42
Q

dose of adjuvant dexamethasone

A

0.15mg/kg q 6hr x 2-4 days
initiated 10-20min before or with 1st antibiotic dose bc when antibiotic kills the bacteria it explodes and thats when inflammation occurs

43
Q

when should fever resolve

A

24-48 hours

44
Q

when should neck stiffness resolve

A

48-72 hours

45
Q

when should CSF values resolve

A

culture negative within 24 hours

normal glucose by 3 days and protein by 7-10 days

46
Q

when should rash resolve

A

over 7 days

47
Q

vaccines that reduce the incidence of meningitis

A

h.influenzae
pneumococcal conjugate 13 valent
meningococcal c conjugate
penumococcal polysaccharide

48
Q

meningococal infection should treat close contacts within 60 days prophylactically with what

A

cipro 500 1 dose oral children 10mg/kg
rifampin 600mg q12 hour x 4 doses oral, children 10mg/kg
ceftriaxone 250 im 1 dose, children 125

Clinical 2.0 (24 decks)

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