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Therapeutics IV > Meningitis - Block 2 > Flashcards

Meningitis - Block 2 Flashcards

1
Q

What is meningitis?

A

Inflammation of the subarachnoid space or spinal fluid

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2
Q

What are the characteristics of normal CSF?

A
  1. Clear protein content <50 mg/dL
  2. WBC <5
  3. Lack of antibodies or complements
  4. BBB is tightly joined by capillary endothelial cells
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3
Q

What are the 4 processes of bacterial meningitis?

A
  1. Mucosal colonization and bacterial invasio of the CNS
  2. Bacterial replication
  3. Inflammation from bacterial cell lysis -> ativating inflammatory pathway -> increase permeability of BBB by vasodilation
  4. Neurological damage -> increase intracranial pressure and cerebral edema
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4
Q

What is the meningitis triad?

A
  1. Fever
  2. Nuchal rigidity
  3. ALtered mental status
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5
Q

What are the presentations of meningitis apart from the triad?

A
  1. Chills
  2. Fever
  3. Photophobia
  4. Kerning/Brudzinski
  5. Abnormal CSF chem

2 of the following
1. Fever
2. Nuchal rigidity
3. ALtered mental status
4. Severe HA

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6
Q

What are the common pathogens associated with meningitis?

A
  1. S. pneumoniae
  2. Group B strep (agalactiae)
  3. N. men.
  4. H flu
  5. Listeria
  6. G-
  7. Staph spp
  8. HSV
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7
Q

What are the RF of meningitis?

A
  1. Age with immune decline
  2. Large communal groups
  3. Traveling in areas o high prevalence
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8
Q

What are the common causes of CA bacterial meningitis? How can infection be prevented?

A

Strep. pneumoniae -> Prevnar 20
Strep. agalactiae
Neisseria -> Meningococcal conjugate vaccine
H. Flu -> Hib vac
Listeria

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9
Q

What are the diagnostic tools for meningitis?

A

Lab:
* CSF: Culture sensitivities (gold standard), Gram stain, PCR (Biofire)
* Blood culture

Imaging:
* MRI
* Computer tomography

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10
Q

How do we test CSF?

A

Lumbar puncture
* CSF and blood culture is taken before ABX
* If puncture is delayed still intiate ABX immediately

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11
Q

What are the objective findings of bacterial meningitis?

A

WBC: 1000-5000
Neutrophils
Elevated proteins
Low glucose (bacteria is using it)

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12
Q

What ABX cross CNS?

A
  1. Lipophillic
  2. Noncharged
  3. Small
  4. Low PPB
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13
Q

What are ABX properties that should be considered?

A
  1. -cidal
  2. definitive
  3. No high resistant empiric coverage
  4. Avoid ABX that worsen CNS sx -> Merrem causes sz
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14
Q

Drug that targets Listeria?

A

Ampicillin

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15
Q

Drugs that target GBS?

A

Ampicillin + 3rd gen or AG
Vanc + 3rd gen

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16
Q

Drugs that target Strep. pneumoniae?

A

Vanc + 3rd gen

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17
Q

Drugs that cover GNR?

A

3rd gen (Ceftriazone and Cefotaxime)

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18
Q

Treatment and pathogens of <1 month?

A

G+: Listeria, GBS
G-: E. coli, Kleb, Enterobacter

**TX: **
* Ampicillin + Cefotaxime
* Ampicillin + Gentamicin

19
Q

Tx and pathogens of 1-23 months?

A

G+: Strep pneumoniae
G-: Neisseria

Tx:
+ Vanc + 3rd gen (Ceftriaxone, Cefotaxime)

20
Q

Tx and pathogens of 2-50 YO?

A

G+: Strep. pneumoniae
G-: Neisseria

Tx:
* Vanc + 3rd gen (Ceftriaxone, Cefotaxime)

21
Q

Tx and pathogens of >50YO?

A

G+: Step. pneumooniae, Listeria
G-: Neisseria, E. coli, Kleb, Enterobacter

Tx:
* Vanc + 3rd gen ceph + ampicillin

22
Q

When do you initiate empiric ABX tx?

A

within 48-72 H

23
Q

What are the supportative tx for meningitis?

A

Critical for early stages of tx:
* Fluids
* Electrolytes
* Antipyretics
* Analgesics
* Mannitol or Hypersol for ICP

24
Q

What is the vanc trough in mengingtis patients?

A

15-20 mcg/mL

25
Q

S. pneumonia PCN sesceptible tx and DOA?

A

PCN or ampicillin for 10-14 days

26
Q

S. pneumonia PCN resistant tx and DOA?

A

Vanc + 3rd gen for 10-14 dyas

27
Q

S. pneumonia ceftriaxone resistance tx and DOA?

A

Vanc + 3rd gen for 10-14 days

28
Q

GBS tx and doa?

A

PCN or Ampicillin + gentamicin for 14-21 days

29
Q

Listeria tx and DOT?

A

Pcn G or ampicillin +/- Gentamicin for ≥21 days

30
Q

Neisseria tx and DOT?

A

PCN susceptibe: PCN G or ampicillin
Resitant: cetriaxone or cefotaxime

7-10 days

31
Q

Tx for H flu and DOT?

A

b-lactamase negative: ampicillin
b-lactamase postive: cefotaxime or ceftriaxone

32
Q

E. coli tx and DOT?

A

Cefotaxime or ceftriaxone for 21 days

33
Q

What are the benefits of using steroid adjuct?

A
  1. Reduces inflammation
  2. Reduces hear loss
34
Q

How do we initiate steroids?

A

Dexmethasone -> start before or simultaneously with first dose of ABX

35
Q

Types of meningicoccal vaccines?

A
  1. MenACWY
  2. MenB
36
Q

Types of pneumococcal vaccines?

A

PCV15 or PCV20

37
Q

H flu vaccines?

A
  1. ActHib
  2. Hiberix
  3. PedvaxHIB
  4. Pentacel
38
Q

Chemoprophylaxis for H. flu?

A

Incompletely vaccinated <48 MO
* Rifampin

39
Q

Chemoprophylaxis for Neisseria?

A

Close contact ≥8H or contact with oral secretions:
* Rifampin 600 mg Q12 for 2 days
* Cipro 500mg once
* Ceftriaxone 250 mg once

40
Q

Pathogen that causes viral encephalitis?

A

HSV 1 and 2

41
Q

Objective results of viral encephalitis?

A

WBC: increases but <250
Lymphocytes
Proteins: Increased but <150
Normal glucose

42
Q

Sup[portive care for VE?

A
  1. Sz prophylaxis
  2. ICP management
  3. DVT prophylaxis
  4. Secondary bacterial meningitis management
43
Q

What is the tx for HSV VE?

A

Acyclovir 10mg/kg IV Q8H for 2-3 wks

HSV is the most treatable etiology of VE

Therapeutics IV (39 decks)

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