Meningitis and Encephalitis

Question 1

Morphology of different bacterias
S. pneumo
H. flu
N.meningitidis
Gram neg. bacteria
L. monocytogenes

Answer 1

S. pneumo=gram + cocci
H. flu= gram - coccobacilli
N.meningitidis= gram - cocci
Gram neg. bacteria= gram - bacilli
L. monocytogenes = gram + bacilli

Question 2

Neuro sequelae

Answer 2

sensorineural hearing loss
hyrdocephalus
focal sensory motor deficits
sz disorder
death

Question 3

Factors that increase penetration of abx into the CSF

Answer 3

meningeal irritation
low molecular weight medication
lipid soluble compoundws
compounds that remain un-ionized at physiologic pH
low protein bound meds

Question 4

Drugs that reach therapeutic levels in the CSF +/- inflamm

Answer 4

sulfonamides/trimethoprim
chloramphenicol
rifampin
metronidazole
isoniazid, pyrazinamide, ethionamide

Question 5

Drugs that reach therapeutic levels in the CSF with inflamm

Answer 5

Pen G, Nafcillin
Cefotaxime, Ceftriaxone, Ceftazidime
Imipenem, Meropenem
Vanco
Linezolid
Aztreonam
Ciprofloxacin
Fluconazole
Ganciclovir, Acyclovir

Question 6

Non therapeutic levels in the CSF +/- inflamm (DONT USE)

Answer 6

aminoglycosides
first and second gen cephalosporins
clindamycin
amphotericin

Question 7

Neg CSF gram stain or gram stain not available

Answer 7

<1 month: amp + cefotaxime; or amp + aminoglycoside

Question 8

Positive CSF gram stain

Answer 8

G + diplococci (S. pneumo) : ceftriaxone OR cefotaxime + vanco + dexamethasone
G - diplococci ( N. men.) : ceftriaxone OR cefotaxime
G + bacilli (L. mono) : amp +/- gentamicin
G - bacilli (H. flu, coliforms, P.auer): Ceftazidime OR Cefepime +/- Gentamicin

Question 9

Adjunctive Dexamethasone in Bact. Meninigitis

Answer 9

Infants and children w/ H. flu type b (only if started before abx)
Adults with pneumococcal meningitis (only if started before abx)

Question 10

Meningitis Prophylaxis

Answer 10

H. flu- Rifampin 600mg po q24h x 4 d

N. menin-Ceftriaxone 250mg IM x 1 or Rifampin 600mg PO q12h x 4 doses

Question 11

Tx for West Nile Viral encephalitis

Answer 11

supportive care
anti-sz meds as needed
tx for increased ICP as needed

Question 12

Tx for HSV encephalitis

Answer 12

Supportive care
Anti-sz meds
Acyclovir ( 10mg/kg IV q8h for 2-3 wks) *maintain adequate hydration to help prevent AKI d/t crystal nephropathy