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DOOS3 > Meningitis encephalitis-Table 1 > Flashcards

Meningitis encephalitis-Table 1 Flashcards

1
Q

Once S. pneumo and N. meningitidis are inside CNS- why are they able to survive so well?

A

The level of complement proteins and other immune cells are insufficient.

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2
Q

What ages are at the most risk for meningitis?

A

65 y.o.

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3
Q

What sources of immunosuppression put a patient at increased risk of meningitis?

A

S/p splenectomy
Malignancy
DM
Immunosuppressive disease/drugs

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4
Q

What are the acute complications of meningitis?

A

Shock
Seizures
Increased ICP
Intracranial/subdural abscess

How well did you know this?
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3
4
5
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5
Q

What are the sequelae of meningitis?

A 
Focal neurologic deficits
Seizure disorder 
Impaired cognition 
Impaired intellectual functioning 
Gait disturbances
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6
Q

What pathogen of meningitis has the highest mortality?

A

Listeria

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7
Q

What factors are associated with increased mortality?

A 
Delay in antimicrobial therapy 
Altered mental status on admission 
Seizures 
Hypotension 
Increased intracranial pressure 
Extremes of age (neonate or > 50 years) 
Mechanical ventilation
How well did you know this?
1
Not at all
2
3
4
5
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8
Q

What are the common pathogens in neonates under 1 month? Why are these bugs a concern?

A 
S. agalactiae (GBS)
E. coli
L. monocytogenes
Klebsiella spp.
These are all normal flora of the vaginal tract
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9
Q

What are the common pathogens in patients 2-50

A

N. meningitidis
S. pneumoniae
H. influenza

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10
Q

Gm positive cocci in pairs and chains

A

S. Agalactiae

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11
Q

Gm negative rods (lactose positive)

A

E. coli

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12
Q

Gm positive rods

A

L. monocytogenes

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13
Q

Gm negative rods

A

H influenza

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14
Q

Gm positive diplococcic

A

S. pneumo

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15
Q

Gm negative cocci

A

N. meningitidis

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16
Q

Clinical presentation of meningitis

A

Fever, headache, stiff neck, confusion or altered mental status, lethargy, malaise,
seizures, vomiting, Kernig’s sign, Brudzinski’s sign, petechiae, purpura

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17
Q

What is the triad of symptoms that 44% have?

A

Fever, neck stiffness and altered mental status

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18
Q

95% of people will have two classic symptoms and/ or what other finding?

A

Headache

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19
Q

severe stiffness of the hamstrings causes an inability to straighten the leg when the knees are flexed to 90 degrees

A

Kernig’s sign

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20
Q

severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

A

Brudzinski’s sign

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21
Q

How do you diagnose meningitis?

A

Clinical evaluation and lumbar puncture

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22
Q

What do you examine from LP

A

Analysis, gram stain and culture preferred

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23
Q

Which patients require CT prior to LP, and why?

A 
Severe immunocompromised 
History of CNS disease 
New onset seizure 
Papilledema 
Focal neurologic deficit
Performing LP could drop their ICP too dramatically and cause a brain herniation. CT is performed to rule out mass lesion or increased ICP.
How well did you know this?
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24
Q

What test do you perform if you suspect viral meningitis?

A

PCR of CSF—can get results in 4 hours

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25
Q

What findings will you have in CSF for bacterial meningitis?

A

WBC>1000
>80% PMN
>100 protein

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26
Q

What findings will you have for aseptic meningitis?

A

WBC 5-500
>50% lymphocytes (aseptic is usually viral—lymphocytes react to viruses)
30-150 protein

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27
Q

What are the goals of therapy in meningitis?

A

Intiate prompt empiric abx coverage
Ameliorate signs and symptoms
Eradicate infection
Prevent development of neurologic sequelae

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28
Q

What is empiric therapy for

A

Ampicillin + cefotaxime

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29
Q

Empiric therapy for meningitis for 2-50 years old

A

Vanco + 3rd generation cephalosporin (ceftriaxone)

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30
Q

Empiric therapy for meningitis over 50 years old

A

Vanco + 3rd generation cephalosporin (ceftriaxone) + ampicillin

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31
Q

What microbe does the addition of ampicillin in empriric therapy over 50 cover?

A

Listeria

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32
Q

If someone has indications for CT scan, what should you order STAT while waiting for negative CT to come back?

A

Blood cultures

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33
Q

What bugs does ceftriaxone cover (in concern to meningitis)?

A

S. pneumo, H. influenza and N. meningitidis

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34
Q

Why is vancomycin given in empiric therapy for meningitis?

A

Used in combo with 3rd generation cephalosporin for empiric therapy to cover the emergence of resistant S. Pneumo

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35
Q

What dose do you give of ceftriaxone with meningitis?

A

2 g IV q 12 hours

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36
Q

What dose of Vanco do you give with meningitis?

A

15 mg/kg with interval based on renal function

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37
Q

What dose of ampicillin do you give with meningitis?

A

2g IV q 4 hours

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38
Q

What are your options for empiric therapy for PCN/cephalosporin allergy?

A

Moxifloxacin

Meropenem (Mero/vanco)

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39
Q

In empiric therapy of meningitis, what medicine is given to help reduce neurologic sequelae

A

dexamethasone

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40
Q

In what situations should you add in dexamethasone?

A

In children under 2 months with bacterial meningitis, especially if they have not been vaccinated
AND in adults with pneumococcal meningitis

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41
Q

When do you start dexamethasone?

A

Should be given with or right before first dose of Abx. Start with empiric treatment, and if CSF culture comes back with S.penumo or H influenza- continue, if neither of those bugs, stop

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42
Q

What dose and how long should you give dexamethasone?

A

0.15 mg/kg q6h x 2-42 days

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43
Q

What are targeted standard therapy options for S. Pneumo

A 
Pen G (IV—po doesn’t have good bioavailability) OR ampicillin OR ceftriaxone for sensitive organisms
Vanco + Ceftriaxone for resistance
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44
Q

What are targeted standard therapy options for L. monocytogenes?

A

Ampicillin or Penicillin G

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45
Q

What are targeted standard therapy options for S. agalactiae?

A

Ampicillin or Pen G

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46
Q

What are targeted standard therapy options for S. aureus (MSSA)?

A

Nafcillin or oxacillin

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47
Q

What are targeted standard therapy options for S. aureus (MRSA)?

A

Vancomycin

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48
Q

What are targeted standard therapy options for S. epidermidis?

A

Vancomycin

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49
Q

What are targeted standard therapy options for Enterococcus spp (ampicillin sensitive)

A

Amp + gent

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50
Q

What are targeted standard therapy options for enterococcus spp. (ampicillin resistant)?

A

Vanco + gent

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51
Q

What are targeted standard therapy options for enterococcus spp (amp and vanc resistant)

A

linezolid

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52
Q

What are targeted standard therapy options for N meningitidis

A

Pen G or amp or ceftriaxone

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53
Q

What are targeted standard therapy options for H influenza – beta lactamase negative

A

Ampicillin

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54
Q

What are targeted standard therapy options for H. influenza - beta lactamase positive

A

Ceftriaxone

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55
Q

What is the targeted standard therapy options for E. coli or other enterobacteracieae

A

Ceftriaxone

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56
Q

What are targeted standard therapy options for P. aeruginosa

A

Ceftriaxone

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57
Q

What are causative agents for viral meningitis?

A 
Enterovirus- Summer/fall 
West nile 
Measles/mumps/rubella, polio 
Varicella-zoster virus 
Herpes simplex virus (HSV2)
How well did you know this?
1
Not at all
2
3
4
5
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58
Q

Treatment of viral meningitis

A

Supportive care, Acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Other causative agents of aseptic meningitis?

A 
Fungal (Cryptococcal meningitis)
Parasitic
Rare
TB meningitis 
Lyme disease 
Syphilis 
Rocky Mountain spotted fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Duration of therapy for N. meningitidis and H. influenza

A

7 days

61
Q

Duration of therapy for S. penumoniae

A

10-14 days

62
Q

Duration of therapy for S. agalactiae

A

14-21 days

63
Q

Duration of therapy for aerobic gram negative bacilli (e. coli and pseudomonas)

A

21 days

64
Q

Duration of therapy for Listeria monocytogenes

A

> 21 days

65
Q

How do you define close proximity when considering chemoprophylaxis

A

Prolonged close contact (> 8 hours) in close proximity (

66
Q

Prophylaxis options for N. meningitidis

A

Rifampin, ceftriaxone or ciprofloxacin

67
Q

Which chemoprophylaxis option for N. meningitidis is NOT indicated for children?

A

Ciprofloxacin

68
Q

Prophylaxis regimens for Rifampin

A

Rifampin

69
Q

Etiology of encephalitis

A

HSV-1
Varicella-Zoster virus
TB
Listeria o Arboviruses→ West nile

70
Q

Encephalitis symptoms

A 
Altered mental status 
Motor or sensory deficits 
Altered behavior and personality changes 
Speech or movement disorders 
Hallucinations
71
Q

What is the major distinguishing feature between encephalitis and meningitis?

A

Presence or absence or normal brain function

72
Q

What is the treatment of choice for encephalitis?

A

Acyclovir

73
Q

What is the dosing recommendation for encephalitis (hint: different for neonates)?

A

10 mg/kg IV q8h for children and adults

20 mg/kg IV q8h for neonates

74
Q

What is the recommended therapy for encephalitis?

A

14-21 days

75
Q

Once S. pneumo and N. meningitidis are inside CNS- why are they able to survive so well?

A

The level of complement proteins and other immune cells are insufficient.

76
Q

What ages are at the most risk for meningitis?

A

65 y.o.

77
Q

What sources of immunosuppression put a patient at increased risk of meningitis?

A

S/p splenectomy
Malignancy
DM
Immunosuppressive disease/drugs

78
Q

What are the acute complications of meningitis?

A

Shock
Seizures
Increased ICP
Intracranial/subdural abscess

79
Q

What are the sequelae of meningitis?

A 
Focal neurologic deficits
Seizure disorder 
Impaired cognition 
Impaired intellectual functioning 
Gait disturbances
80
Q

What pathogen of meningitis has the highest mortality?

A

Listeria

81
Q

What factors are associated with increased mortality?

A 
Delay in antimicrobial therapy 
Altered mental status on admission 
Seizures 
Hypotension 
Increased intracranial pressure 
Extremes of age (neonate or > 50 years) 
Mechanical ventilation
82
Q

What are the common pathogens in neonates under 1 month? Why are these bugs a concern?

A 
S. agalactiae (GBS)
E. coli
L. monocytogenes
Klebsiella spp.
These are all normal flora of the vaginal tract
83
Q

What are the common pathogens in patients 2-50

A

N. meningitidis
S. pneumoniae
H. influenza

84
Q

Gm positive cocci in pairs and chains

A

S. Agalactiae

85
Q

Gm negative rods (lactose positive)

A

E. coli

86
Q

Gm positive rods

A

L. monocytogenes

87
Q

Gm negative rods

A

H influenza

88
Q

Gm positive diplococcic

A

S. pneumo

89
Q

Gm negative cocci

A

N. meningitidis

90
Q

Clinical presentation of meningitis

A

Fever, headache, stiff neck, confusion or altered mental status, lethargy, malaise,
seizures, vomiting, Kernig’s sign, Brudzinski’s sign, petechiae, purpura

91
Q

What is the triad of symptoms that 44% have?

A

Fever, neck stiffness and altered mental status

92
Q

95% of people will have two classic symptoms and/ or what other finding?

A

Headache

93
Q

severe stiffness of the hamstrings causes an inability to straighten the leg when the knees are flexed to 90 degrees

A

Kernig’s sign

94
Q

severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

A

Brudzinski’s sign

95
Q

How do you diagnose meningitis?

A

Clinical evaluation and lumbar puncture

96
Q

What do you examine from LP

A

Analysis, gram stain and culture preferred

97
Q

Which patients require CT prior to LP, and why?

A 
Severe immunocompromised 
History of CNS disease 
New onset seizure 
Papilledema 
Focal neurologic deficit
Performing LP could drop their ICP too dramatically and cause a brain herniation. CT is performed to rule out mass lesion or increased ICP.
98
Q

What test do you perform if you suspect viral meningitis?

A

PCR of CSF—can get results in 4 hours

99
Q

What findings will you have in CSF for bacterial meningitis?

A

WBC>1000
>80% PMN
>100 protein

100
Q

What findings will you have for aseptic meningitis?

A

WBC 5-500
>50% lymphocytes (aseptic is usually viral—lymphocytes react to viruses)
30-150 protein

101
Q

What are the goals of therapy in meningitis?

A

Intiate prompt empiric abx coverage
Ameliorate signs and symptoms
Eradicate infection
Prevent development of neurologic sequelae

102
Q

What is empiric therapy for

A

Ampicillin + cefotaxime

103
Q

Empiric therapy for meningitis for 2-50 years old

A

Vanco + 3rd generation cephalosporin (ceftriaxone)

104
Q

Empiric therapy for meningitis over 50 years old

A

Vanco + 3rd generation cephalosporin (ceftriaxone) + ampicillin

105
Q

What microbe does the addition of ampicillin in empriric therapy over 50 cover?

A

Listeria

106
Q

If someone has indications for CT scan, what should you order STAT while waiting for negative CT to come back?

A

Blood cultures

107
Q

What bugs does ceftriaxone cover (in concern to meningitis)?

A

S. pneumo, H. influenza and N. meningitidis

108
Q

Why is vancomycin given in empiric therapy for meningitis?

A

Used in combo with 3rd generation cephalosporin for empiric therapy to cover the emergence of resistant S. Pneumo

109
Q

What dose do you give of ceftriaxone with meningitis?

A

2 g IV q 12 hours

110
Q

What dose of Vanco do you give with meningitis?

A

15 mg/kg with interval based on renal function

111
Q

What dose of ampicillin do you give with meningitis?

A

2g IV q 4 hours

112
Q

What are your options for empiric therapy for PCN/cephalosporin allergy?

A

Moxifloxacin

Meropenem (Mero/vanco)

113
Q

In empiric therapy of meningitis, what medicine is given to help reduce neurologic sequelae

A

dexamethasone

114
Q

In what situations should you add in dexamethasone?

A

In children under 2 months with bacterial meningitis, especially if they have not been vaccinated
AND in adults with pneumococcal meningitis

115
Q

When do you start dexamethasone?

A

Should be given with or right before first dose of Abx. Start with empiric treatment, and if CSF culture comes back with S.penumo or H influenza- continue, if neither of those bugs, stop

116
Q

What dose and how long should you give dexamethasone?

A

0.15 mg/kg q6h x 2-42 days

117
Q

What are targeted standard therapy options for S. Pneumo

A 
Pen G (IV—po doesn’t have good bioavailability) OR ampicillin OR ceftriaxone for sensitive organisms
Vanco + Ceftriaxone for resistance
118
Q

What are targeted standard therapy options for L. monocytogenes?

A

Ampicillin or Penicillin G

119
Q

What are targeted standard therapy options for S. agalactiae?

A

Ampicillin or Pen G

120
Q

What are targeted standard therapy options for S. aureus (MSSA)?

A

Nafcillin or oxacillin

121
Q

What are targeted standard therapy options for S. aureus (MRSA)?

A

Vancomycin

122
Q

What are targeted standard therapy options for S. epidermidis?

A

Vancomycin

123
Q

What are targeted standard therapy options for Enterococcus spp (ampicillin sensitive)

A

Amp + gent

124
Q

What are targeted standard therapy options for enterococcus spp. (ampicillin resistant)?

A

Vanco + gent

125
Q

What are targeted standard therapy options for enterococcus spp (amp and vanc resistant)

A

linezolid

126
Q

What are targeted standard therapy options for N meningitidis

A

Pen G or amp or ceftriaxone

127
Q

What are targeted standard therapy options for H influenza – beta lactamase negative

A

Ampicillin

128
Q

What are targeted standard therapy options for H. influenza - beta lactamase positive

A

Ceftriaxone

129
Q

What is the targeted standard therapy options for E. coli or other enterobacteracieae

A

Ceftriaxone

130
Q

What are targeted standard therapy options for P. aeruginosa

A

Ceftriaxone

131
Q

What are causative agents for viral meningitis?

A 
Enterovirus- Summer/fall 
West nile 
Measles/mumps/rubella, polio 
Varicella-zoster virus 
Herpes simplex virus (HSV2)
132
Q

Treatment of viral meningitis

A

Supportive care, Acyclovir

133
Q

Other causative agents of aseptic meningitis?

A 
Fungal (Cryptococcal meningitis)
Parasitic
Rare
TB meningitis 
Lyme disease 
Syphilis 
Rocky Mountain spotted fever
134
Q

Duration of therapy for N. meningitidis and H. influenza

A

7 days

135
Q

Duration of therapy for S. penumoniae

A

10-14 days

136
Q

Duration of therapy for S. agalactiae

A

14-21 days

137
Q

Duration of therapy for aerobic gram negative bacilli (e. coli and pseudomonas)

A

21 days

138
Q

Duration of therapy for Listeria monocytogenes

A

> 21 days

139
Q

How do you define close proximity when considering chemoprophylaxis

A

Prolonged close contact (> 8 hours) in close proximity (

140
Q

Prophylaxis options for N. meningitidis

A

Rifampin, ceftriaxone or ciprofloxacin

141
Q

Which chemoprophylaxis option for N. meningitidis is NOT indicated for children?

A

Ciprofloxacin

142
Q

Prophylaxis regimens for Rifampin

A

Rifampin

143
Q

Etiology of encephalitis

A

HSV-1
Varicella-Zoster virus
TB
Listeria o Arboviruses→ West nile

144
Q

Encephalitis symptoms

A 
Altered mental status 
Motor or sensory deficits 
Altered behavior and personality changes 
Speech or movement disorders 
Hallucinations
145
Q

What is the major distinguishing feature between encephalitis and meningitis?

A

Presence or absence or normal brain function

146
Q

What is the treatment of choice for encephalitis?

A

Acyclovir

147
Q

What is the dosing recommendation for encephalitis (hint: different for neonates)?

A

10 mg/kg IV q8h for children and adults

20 mg/kg IV q8h for neonates

148
Q

What is the recommended therapy for encephalitis?

A

14-21 days

149
Q

Once S. pneumo and N. meningitidis are inside CNS- why are they able to survive so well?

A

The level of complement proteins and other immune cells are insufficient.

DOOS3 (12 decks)

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