Meningitis (Nicasio)

Question 1

Common Meningitis BACTERIA [3]

Answer 1

Strep pneumo
Neisseria meningitis
H. influenza

Question 2

Less common Meningitis BACTERIA [1 + 1]

Answer 2

Listeria monocytogenes

+ MYCOBACTERIA

Question 3

More common Meningitis BACTERIA in ELDERLY [3]

Answer 3

Staph aureus
Gram NEGATIVE aerobes
Strep agalacticae

Question 4

Common Meningitis VIRUS [1]

Answer 4

Enterovirus

Question 5

Less Common Meningitis VIRUSES [3]

Answer 5

Arbovirus
Herpes virus (HSV)
West Nile Virus

Question 6

Meningitis PARASITES [2]

Answer 6

Naeglaria

Aconthameoba

Question 7

Signs/Symptoms Meningitis: Adults [7]

Answer 7

**Fever
**Nuchal Rigidity/Stiff neck
**Headache (‘worst ever’)
**Photophobia
+
Altered mental state
Kernig (leg) + Brudzinksi’s (head)
Seizures

**Classic Symptoms

Question 8

Lumbar Puncture: Positive for Acute Meningitis [6]

Answer 8

1. ) Elevated Opening Pressure
2. ) Elevated WBC
3. ) Glucose Ratio (CSF:Serum) < 0.6
4. ) Elevated CSF protein
5. ) Positive Gram Stain
6. ) Turbid CSF

Question 9

Meningitis Age-related therapy (bugs): 2-70yo (3)

Answer 9

1. ) Strep pneumo
2. ) Neiserria meningitidis
3. ) H. influenza (??)

Question 10

Meningitis Age-related therapy (bugs): ≥70yo (3)

Answer 10

1. ) Strep pneumo (same)
2. ) Neiserria meningitidis (same)
3. ) Listeria
4. ) G- Bacilli (E. coli, Klebsiella, etc.)

Question 11

Empiric Therapy: Non-traumatic CNS (2-50yo)

WITH Dexamethasone

Answer 11

ALL IV

1. ) Dexamethasone
2. ) Vancomycin
3. ) Ceftriaxone
4. ) Rifampin

***DEX WITH ALL H. INFLUENZA > 2yo

Question 12

Empiric Therapy: Non-traumatic CNS (2-50yo)

NO Dexamethasone

Answer 12

ALL IV

1. ) Vancomycin (15-20mcg/mL)
2. ) Ceftriaxone (2g q12h)

Question 13

Empiric Therapy: Non-traumatic CNS (≥50yo)

WITH Dexamethasone

Answer 13

ALL IV

1. ) Dexamethasone
2. ) Vancomycin
3. ) Ceftriaxone
4. ) AMPICILLIN
5. ) Rifampin

***DEX WITH ALL H. INFLUENZA > 2yo

Question 14

Empiric Therapy: Non-traumatic CNS (≥50yo)

NO Dexamethasone

Answer 14

ALL IV

1. ) Vancomycin
2. ) Ceftriaxone
3. ) Ampicillin

Question 15

Predisposing Factors/Conditions [4]

Answer 15

1. ) Penetrating Trauma (Staph + G- bacilli)
2. ) Post-Neurosurgery (Staph + G- bacilli)
3. ) CSF Shunt (Staph + G- bacilli)
4. ) Infective emboli (Strep + Staph)

Question 16

Patients WITH Predisposing Factors: Empiric Therapy Options [3]

Answer 16

1. ) Vancomycin + Cefepime
2. ) Vancomycin + Meropenem
3. ) Vancomycin + Imipenem

Question 17

Anti-inflammatory: Dexamethasone: Side effects

Answer 17

> 2mo old –> may decrease hearing loss with H. influenza)

Adults –> Beneficial vs. Strep pneumo (reduced mortality)

Question 18

CSF Penetration: No Inflammation [3]

Answer 18

1. ) Rifampin
2. ) Metronidazole
3. ) Chloramphenicol

Question 19

CSF Penetration: Requires Inflammation [8]

Answer 19

1. ) Aztreonam
2. ) Penicillin
3. ) Ceftriaxone
4. ) Carbapenems
5. ) Fluoroquinolones
6. ) Linezolid
7. ) Daptomycin
8. ) Vancomycin

Question 20

CSF Penetration: Poor Penetration

Answer 20

1. ) 1st + 2nd Generation Cephalosporins
2. ) Aminoglycosides
3. ) Clindamycin

Question 21

Bug Specific Treatments: Meningococcus

Answer 21

S/Sx: behavioral changes, coma, seizures

DOC:

1. ) Penn G IV (MIC = S)
2. ) Ceftriaxone (MIC = I/R)

Prophylaxis:
Rifampin (Oral Dose x 4)

Question 22

Bug Specific Treatments: Strep pneumo

Answer 22

S/Sx: 20% Mortality
Common in ALCOHOLICS

DOC:

1. ) Ceftriaxone
2. ) Vancomycin (if allergy)

Question 23

Bug Specific Treatments: H. influenza

Answer 23

S/Sx: Rash, 40% resistant to AMP

DOC:
1.) Ceftriaxone

Prophylaxis
Rifampin PO x4
If vaccinated + >2yr may not benefit

Question 24

Bug Specific Treatments: Listeria

Answer 24

S/Sx: Neonates + immunocompromised patients
G+ Diptheria-like, GI tract bug

DOC:

1. ) Ampicillin + aminoglycoside (STAG)
2. ) Trimethoprim + sulfmethoxazole (if allergy)