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Infectious Disease > Meningitis > Flashcards

Meningitis Flashcards

1
Q

clinical classic 3 presentation of acute bacterial meningitis

A

high fever, neck stiffness and AMS

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2
Q

Common organism for bacterial meningitis in ages 2-50 yrs

A

Streptococcus pneumoniae and Neisseria meningitidis

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3
Q

Empiric abx for patients from 2-50 yrs with acute bacterial meningitis

A

vancomycin and 3rd gen cephalosporin

cover cephalosporin resistant strep and reg Strep

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4
Q

Common organisms that cause bacterial meningitis >50 yrs

A

Strep pneumoniae, N meningitidis, Listeria

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5
Q

Empiric abx for patients from >50 yrs with acute bacterial meningitis

A

Vancomycin, ampicillin and 3rd generation cephalosporin

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6
Q

Common organisms that cause bacterial meningitis in immunocompromised pts

A

Strep pneumoniae, N meningitidis, Listeria and GRAM NEGATIVE RODS

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7
Q

Empiric abx for immunocompromised pts with acute bacterial meningitis

A

vancomycin + ampicillin + cefepime

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8
Q

Common organisms that cause acute bacterial meningitis in patients who recently had neurosurgery/ penetrating skull trauma

A

gram negative rods, MRSA,

coagulase negative Staph

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9
Q

Empiric abx for patients who have suspected bacterial meningitis and had recen neurosurgery or skull penetrating injury

A

vancomycin and cefepime

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10
Q

Who needs a CT scan prior to lumbar puncture in the rule out of meningitis?

A

AMS, new seizure, focal deficit, immunocompromise, CNS dx or papilledema

Also give abx prior to LP or CT scan.

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11
Q

What drug is given before first dose of abx for patients with suspected bacterial meningitis?

A

dexamethasone 10 mg

(reduces neurological sequelae and lowers risk for hearing loss) and mortality in those with pneumococcal meningitis.

STOP steroids if CSF gram stain or culture or blood culture) indicates infection with a non penumoccocal organism.

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12
Q

herpes encephalitis presentation

A

high fever, AMS, seizure, and/or focal neurological deficits and rarely associated w/ neck stiffness or nuchal rigidity.

85% of cases of HSV will have gential lesions

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13
Q

Medication used to treat herpes encephalitis

A

acyclovir.

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14
Q

In patients who have suspected meningitis or HSV encephalitis what can you give?

A

can give vancomycin + rocephin and acyclovir as empiric if strong enough suspicion but never give acyclovir alone.

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15
Q

cause of meningococcal meningitis

A

neisseria meningitidis

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16
Q

presentation of meningococcal meningitis

A

nonspecific fever, headache, vomiting, myalgias, sore throat, and within 12-24 hrs see petechiae, purpura, meningeal signs and AMS

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17
Q

treatment of meningococcal meningitis

A

ceftriaxone

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18
Q

complications of meningococcal meningitis

A

shock,
DIC,
adrenal hemorrhage

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19
Q

precautions and prevention of spread of meningococcal meningitis

A

droplet precautions (wear surgical mask within 6 feet) and chemoprophylaxis for close contacts

house hold members
roommates of intimate contacts
child care center workers
persons directly exposed to respiratory or oral secretions

person seated next to affected person for >8 hrs (airline traveler)

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20
Q

What is chemoprophylaxis for close contacts with meningococcal meningitis?

A

rifampin, ciprofloxacin, and ceftriaxone

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21
Q

how to treat protein C deficiency and purpura fulminans related to Neisseria meningitidis?

A

protein c concentrate

22
Q

how often to vaccinate asplenic patients?

A

vaccinate asplenic patients 14 days prior to and post splenectomy and revaccinate every 5 years

23
Q

Gram positive bacilli seen on CSF and immunocompromised pt with meningitis. What abx do you use to treat?

A

ampicillin only

it’s going to be Listeria. Affects neonates, adults>50 yrs and immunocompromised pts.

Can give penicillin G too. Sometimes can have aminoglycoside added for synergy.

24
Q

who is at greater risk for meningococcal dx?

A

apslenic pts

need booster vaccine for meningococcus every 5 years for boster.

25
Q

if suspecting meningitis first thing you should do for management

A

IV antibiotics and adjuvant dexamethasone.

CT scan can take up to 6 hrs and LP also takes a while. Can still have pathogens culture after 4-10 hrs of antibiotic initiation.

26
Q

Does a pt with suspected meninigitis need a CT scan prior to LP?

A

no they don’t.

27
Q

presentation of West Nile Virus

A

asymptomatic but 20-40% with symptoms
see encephalitis, meningitis or mixed.

maculopapular rash (20-50% in chest arms, back

acute asymmetric flaccid paralysis

extrapyramidal symptoms (upper>lower extremity)

Parkinsonian symptoms (with rigidity)

Sometimes described as a poliomyelitis like syndrome- see unilateral weakness to quadriplegia and respiratory failure

28
Q

labs of WNV

A

CSF pleocytosis with lymphocytic predominance
CT head is normal and MRI may show nonspecific FLAIR enhanced abnormalities

EEG -show frontal and temporal generalized slowing

MRI- shows bilateal enhancement of thalamus and basal ganglia

IgM is detectable in CSF in greater than 90% of pts with WNV neuroinvasive dx at the time of presentation.

29
Q

Diagnosis of WNV

A

positive serum IgM antibody (pts with fever only)

CSF positive IgM antibody (pts with CNS dx)

30
Q

highest incidence of WNV is

A

summer months due to vector of the mosquito

31
Q

asymmetrical flaccid paralhysis and extrapyramidal symptoms with fever and sometimes a maculopapular rash and AMS

A

West Nile infection

32
Q

where does the west nile virus attack

A

anterior horn cell (poliomyelitis) rather than transverse leukomyelitis thus will have sparing of ascending (pain and temperature and vibration or proprioception) and descending (pyramidal and extrapyramidal motor system and autonomics)

33
Q

Treatment of WNV

A

supportive and prevention of mosquito control

34
Q

enterovirus causing viral meningitis presentation

A

happens in summer and early fall and present with severe headache, neck stiffness and photophobia and low grade fever and no mental status changes. NO flaccid paralysis

35
Q

who gets airborne precautions

A

TB

varicella and SARS and measles

36
Q

who gets contact precautions

A

MRSA, VRE
C diff, E coli O157:H7
parasitic scabies
viral RSV

37
Q

who gets droplet precautions

A

H influenzae type B, neisseria meningitidis
mycoplasma pneumoniae
influenzae and adenovirus

38
Q

Does a partner need Neisseria meningitis prophylaxis if they have been exposed to someone who has it and already had vaccination for Neisseria

A

yes. doesn’t matter if they had been vaccinated for Neisseria.

Anyone with 3-6 feet for more than 8 hours need repeat prophylaxis with rifampin, ciprofloxacin, and ceftriaxone.

39
Q

age 2-50 yrs:

most common organisms for meningitis

empiric antibiotics:

A

strep pneumo
neisseria meningitis

tx with vancomycin and 3rd gen cephalosporin

40
Q

Age >50 yrs

most common organisms for meningitis

empiric antibiotics:

A

strep pneumoniae
Neisseria meningitis
listeria

Start vancomycin + ampicillin + 3rd gen cephalosporin

41
Q

Immunocompromised pt

most common organisms for meningitis

empiric antibiotics:

A

strep pneumoniae
Neisseria meningitis
listeria

AND gram neg rods

Vancomycin + ampicillin + cefepime

42
Q

Neurosurgery and penetrating skull trauma

most common organisms for meningitis

empiric antibiotics:

A

Gram neg rods, MRSA
coagulase neg staph

vancomycin and cefepime

43
Q

if you can’t use cefepime to treat meningitis what alternate antibiotics can you use?

A

ceftazidime or meropenum

44
Q

if you can’t use ampicillin to treat listeria meningitis what can you use instead?

A

bactrim for listeria.

45
Q

Why do we not like pipercillin/tazobactam for pseudomonal coverage in meningiditis?

A

it has poor CNS penetration unlike cefepime which is excellent.

46
Q

lab findings concerning for HSV encephalitis:

A

CSF with HSV PCR positive or show lymphocytic pleocytosis
CT or MRI brain shows temporal lobe abnormalities
EEG shows high amplitude slow waves >80% of pts

47
Q

signs of HSV encephalitis

A

rapid onset <1 week and fever and headache
see focal neurological deficits (cranial nerve palsies, hemiparesis, ataxis)
see mental status changes and seizures

48
Q

will giving empiric acyclovir skew results for CSF?

A

no it won’t it doesn’t affect PCR results even if acyclovir has been given for 7 days

49
Q

When treating someone with viral meningitis or HSV meningitis and they are on acyclovir what should you also do to their regimen?

A

need to give IVF fluids of at least 2L/day with goal UOP of 75 cc/hr to reduce renal drug concentration and prevent crystal formation.

Acyclovir is a very poorly soluble medication and you can have AKI develop within 48 hrs of using this medication and so need to prevent this happening.

Can give loop diuretics ot help flush crystals from renal tubules.

50
Q

consider meningitis when there’s

A

sinusitis and recent head trauma

Infectious Disease (52 decks)

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