Meningitis and Encephalitis

Question 1

Empiric meningitis coverage in those age 2 - 50

Answer 1

Organisms: S. pneumoniae, N. meningitides

Abx: Vanc + 3rd gen cephalosporine

Question 2

Empiric meningitis coverage in those age > 50

Answer 2

Organisms: S. pneumoniae, N. meningitides, L. monocytogenes, aerobic gram negative bacilli

Abx: Vancomycin + 3rd generation cephalosporine + ampicillin

Question 3

Empiric meningitis coverage for basilar skull fracture-associated meningitis

Answer 3

Organisms: S. pneumoniae, H. influenzae, Group A Streptococci

Abx: Vancomycin + 3rd generation cephalosporine

Question 4

Empiric meningitis coverage for post-neurosurgery or head trauma-associated meningitis

Answer 4

Organisms: S. aureus, S. epidermidis, aerobic gram negative bacilli (including P. aeruginosa)

Abx: Vancomycin + (cefepime or ceftazidine)

Question 5

Empiric meningitis coverage in those with a CSF shunt-associated meningitis

Answer 5

Organisms: S. aureus, S. epidermidis, aerobic gram negative bacilli (including P. aeruginosa), diphtherioids (including P. acnes)

Abx: Vancomycin + (cefepime or ceftazidine)

Question 6

For all cases of meningitis, you add ___ as an adjunctive treatment until S. pnemoniae meningitis is ruled out.

Answer 6

For all cases of meningitis, you add corticosteroids as an adjunctive treatment until S. pnemoniae meningitis is ruled out.

Question 7

Viral encephalitis + poliomyelitis-like, Parkinsonian-like, or GBS-like syndrome

Answer 7

West Nile virus encephalitis

Will also usually be in the summer and be epidemic

Question 8

Empiric meningitis coverage in a neonate

Answer 8

Organisms: Group B Streptococci, E. coli, L. monocytogenes

Abx: Ampicillin + (Gentamicin or Cefotaxime)

Question 9

If a patient with known AIDS presents with PML, . . .

Answer 9

. . . HAART is indicated

50% of patients who present with PML that receive HAART will survive PML.

This is counter to many cases of severe infection in AIDS if there is hemodynamic instability, in which you may delay HAART in order to prevent IRIS overlapping with the current presentation.