Meningitis and Encephalitis Flashcards
Even with ABx therapy & imaging, condition still carries a ~
___% mortality rate.
14
Meningitis typically occurs through what two routes of inoculation?
(a) Hematogenous seeding
(b) Direct contiguous spread
What route of meningitis inoculation?
Organisms enter CSF via neighboring anatomic structures (otitis media, sinusitis) or foreign objects (medical devices, penetrating trauma).
Direct contiguous spread
What route of meningitis inoculation?
Bacteria colonize in nasopharynx & enter bloodstream. Upon making their way to the subarachnoid space, the bacteria cross the blood-brain barrier, causing a direct inflammatory and immune-mediated reaction.
Hematogenous seeding
What is the Classic Meningeal Tetrad
Fever, nuchal rigidity, altered mental status, & severe headache
True/False
However, the presence of all four signs of meningitis is necessary for clinical diagnosis;
False
patients may only have 2-3 out of the 4 signs.
Meningitis
What should be done prior to lumbar puncture and CSF collection?
CT
What comprises the foundation of meningitis management/treatment
Managing airway
maintaining oxygenation
sufficient IV fluids
controlling fever
Meningitis Antibiotic Treatment:
(a) Ceftriaxone 2g IV Q12H x 7 days
(b) Pen-G 4 million units IV Q4H x 7 days
Steroids
Administration of ________________ IV is associated with reduction in rate of hearing loss, neurologic complications, and decreased mortality rates.
dexamethasone 4mg
Meningitis
Signs of ICP (altered mental status, neurologic deficits, non-reactive pupils, bradycardia), may require what
-Elevating the head of the bed to 30 degrees
-inducing mild hyperventilation in the intubated patient
-osmotic diuretics such as 25% mannitol or 3% saline (CALL MO)
Chemoprophylaxis regimen for meningitis
a) Ceftriaxone 250mg IM one time
b) Ciprofloxacin 500mg PO one time
Meningitis – Disposition
Medical Evacuation is indicated for any patient with suspected meningitis, regardless of etiology or status.
Meningitis Differential Diagnosis
Stroke,
subdural hematoma,
subarachnoid hemorrhage,
metastatic brain disease,
brain abscess (may coexist with meningitis)