Meningitis & Endocarditis

Question 1

Meningitis patho

Answer 1

Cerebral edema, elevated ICP, CSF pleocytosis, dec cerebral blood flow, cerebral ischemia, death

Question 2

Meningitis risk factors

Answer 2

age (young and elderly), alcohol use, DM, immunosuppression, head trauma or surgery, congenital defects

Question 3

Classic triad

Answer 3

-fever, change in mental status, nuchal rigidity

Question 4

Kernig’s sign

Answer 4

inability to straighten the leg when the hip is flexed to 90 degrees

Question 5

Brudzinski’s sign

Answer 5

flexion of the neck causes hip and knee flexion

Question 6

Bacterial meningitis

Answer 6

• Predominant WBC are neutrophils
• Glucose: <40 (bacteria love glucose!)
• protein: 100-500

Question 7

Viral meningitis

Answer 7

• Predominant WBC are lymphocytes
• glucose: 40-85
• protein: 50-100

Question 8

Meningitis 2-50 years

Answer 8

s. pneumoniae, n. meningitidis

Question 9

Meningitis >50 years

Answer 9

s. pneumoniae, n. meningitidis, l. monocytogenes

Question 10

Increased BBB penetration

Answer 10

• inc inflammation of meninges
• dec molecular weight
• non ionization
• inc lipid solubility
• dec protein binding

Question 11

BBB penetration of antimicrobials

Answer 11

Good penetration: fluoroquinolones, linezolid

Penetration w/ inflammation: ampicillin, ceftriaxone, vanco

Question 12

2-50 yo empiric treatment of meningitis

Answer 12

Vanco + 3rd gen ceph

Question 13

> 50 yo empiric treatment of meningitis

Answer 13

Vanco + 3rd gen ceph, ampicillin to cover listeria

Question 14

S. pneumoniae definitive threapy

Answer 14

Penicillin MIC:
<0.1 : Pen G or ampicillin
0.1-1.0: 3rd gen ceph
>/= 2.0: vanco + 3rd gen ceph
10-14 day treatment

Question 15

N. meningitidis definitive therapy

Answer 15

Penicillin MIC:
<0.1: Pen G or amp
0.1-1: 3rd gen ceph
7 day treatment

Question 16

H. influenzae definitive therapy

Answer 16

B-lactamase +: amp
B-lactamase -: 3rd gen ceph
7 day treatment

Question 17

L. monocytogenes definitive therapy

Answer 17

• Amp or pen g

- >/= 21 day treatment

Question 18

Endocarditis major criteria

Answer 18

• positive blood culture > at least 2 seperate blood cultures drawn > 12 hrs apart
• positive echo

Question 19

Viridans group strep

Answer 19

• Penicilln G MIC < 0.12: use pen G at a lower dose + gentamicin; could also use ceftri for 4 weeks or cefti for 2 weeks + gentamicin
• Pen G MIC > 0.12: use pen G at higher dose + gen or ceftriaxine

Question 20

MRSA (endocarditis)

Answer 20

Vanco for 6 weeks

Question 21

MSSA (endocarditis)

Answer 21

Nafcillin in divided doses for 6 weeks

Question 22

Penicillin susceptible enterococcus

Answer 22

Amp plus ceftri for 6 weeks

Question 23

S. aureus with prosthetic valve

Answer 23

add on rifampin and gentamicin