Meningitis

Question 1

Mortality of meningitis

Answer 1

25%

depends on organism

Question 2

Pathogens causing meningitis

Answer 2

Strep pneumo ('95 -> 46%)
Haemophilus influenzae ('85 45%)

Question 3

Other pathogens associated w/ meningitis

Answer 3

Listeria
Aerobic gram negative bacilli
Streptococcus agalactiae (52% of cases in neonates)
Staphylococcus aureus (trauma, CSF shunts)

Question 4

Classic triad of meningitis

Answer 4

Fever
Neck stiffness
Altered mental status

Question 5

How many pts have all 3 of the classic triad

Answer 5

2/3

Question 6

Possible long term complications

Answer 6

Hearing loss 10%
Seizure disorders
Learning difficulties
Neurologic problems: spasticity, paresis, ataxia

Question 7

Occupying lesions may displace brainstem downward. What increases this?

Answer 7

Lumbar puncture increases this process

Question 8

What might lumbar puncture precipitate w/ meningitis

Answer 8

Brain herniation

Question 9

What meningitis pts benefit from CT?

Answer 9

Immunocompromise
History of CNS disease
New onset seizures
Papilledema
Altered consciousness or focal neurologic deficit

Question 10

How do we diagnose meningitis

Answer 10

Cerebral spinal fluid examination by lumbar puncture

We will do a gram stain, culture and sensitivities, cell count w/ differential, CSF protein, CSF glucose

Question 11

CSF opening pressure w/ bacterial meningitis

Answer 11

180 mm H2O

Question 12

CSF w/ bacterial meningitis WBC count

Answer 12

1000-5000/mm^3

Question 13

CSF w/ bacterial meningitis % of neutrophils

Answer 13

> 80%

Question 14

CSF w/ bacterial meningitis proteins

Answer 14

100-500 mg/dL

Question 15

CSF w/ bacterial meningitis glucose

Answer 15

< 40 mg/dL

normally 2/3 of normal plasma glucose

Question 16

CSF w/ bacterial meningitis gram stain

Answer 16

+ in 60-90% of cases

Question 17

CSF w/ bacterial meningitis culture

Answer 17

+ in 70-85% of cases

Question 18

Abx for pts 1 month - 50 years old

Answer 18

Ceftriaxone 2g IV q12h
Dexamethasone
Vancomycin

Question 19

Abx for pts > 50 years

Answer 19

Pt at increased risk for L. monocytogenes (ETOH; other debilitating diseases)
Rx = Ampicillin + ceftriaxone, dexamethasone, and vancomycin

Question 20

Therapy for Gram + diplococci S. pneumoniae

Answer 20

Ceftriaxone 2g IV q12h

Vancomycin

Question 21

Therapy for Gram - diplococci N. meningitidis

Answer 21

Pen G4 Mu IV q4hr x 5-7d

Question 22

Therapy for Gram + bacilli or coccobacilli: L monocytogenes

Answer 22

Ampicillin

Gentamicin (used for synergy against Gram +s)

Question 23

N. meningitidis length of therapy

Answer 23

7 days

Question 24

H. influenzae length of therapy

Answer 24

7 days

Question 25

S. pneumoniae length of therapy

Answer 25

10-14 days

Question 26

S. agalactiae length of therapy

Answer 26

14-21 days

Question 27

Aerobic Gram – bacilli length of therapy

Answer 27

21 days

Question 28

L. monocytogenes length of therapy

Answer 28

> 21 days

Question 29

Dexamethasone findings

Answer 29

Reduction of unfavorable outcomes
Reduction in mortality
Even better findings in pts w/ S. pneumoniae meningitis

Question 30

Dexamethaosne recommendations

Answer 30

Use adjunctive dexamethasone in adults w/ documented or suspected S. pneumoniae meningitis
Give w/ or 15 min BEFORE first abx dose
DONT start if abx if already started
DON’T use in pts w/ septic shock
Discontinue dexamethasone if meningitis is found not to be caused by S. pneumoniae

Question 31

Dexamethasone dose and length of tx

Answer 31

10 mg q6 hours x4 days