MeningitisC Flashcards
What are viral pathogens in meningitis?
Enterovirus, arbovirus, herpes
What are parasitic pathogens in meningitis?
Naeglaria sp, Acanthameoba sp
What are bacterial pathogens in meningitis
Step pneumo, neisseria meningitidis, h influenzae, listeria monocytogens
What are fungal pathogens in meningitis
Cryptococcus neoformans
What is meningitis most commonly caused by and how it it treated?
Virus, Empirically w/acyclovir until results are back , Tx symptoms
What is the most common bacterial meningitis?
Strep pneumo
Why is HIB making a comeback?
People arenít vaccinating! ESTUPIDOS!
Clinical presentation of meningitis in adults is typically what?
HA, fever, stiff neck, photophobia, change in mental status, obtundation, seizures, and vomiting
Clinical presentation of meningitis in infants is typically what?
Irritability, altered sleep, vomit, high pitch cry, decreased oral intake
Clinical presentation of meningitis in children is typically what?
Lethargy, confusion, somnolence
What are the 2 ìsignsî you can test for in meningitis?
Brudzinski neck sign and kernigs sign
What are the characteristics of normal CSF?
Clear, 50-60% serum glucose, pH 7.4,
What type of infection has the highest WBC count, neutrophilic differential, 80-500 mg/dL protein, and
Bacterial
Viral and fungal causes of meningitis both have what differential?
Lymphocytic
How do you diagnose meningitis?
CSF evaluaton w/ gram stain and culture, enzyme ammunoassay for bacteria, and PCR for virus, mycobacteria and fungal
When is empiric therapy started and how long is it continued for?
w/in 30 minutes of presentation regardless, 48-72 hrs or until diagnosis of meningitis is ruled out, if ID causative agent, stop empirical and start specific
If the CSF gram stain has nothing growing, is meningitis ruled out?
NO , Start empirical tx until ruled out by other more definitive testing
If clinical presentations are in an infant
Listeria monocytogens
What other pt population is more likely to be infected by listeria?
> 50 or alcoholic
What drug do you add to tx if you suspect listeria?
Ampicillin
What anti-inflammatory is used in meningitis?
Dexamethasone
Should dexamethasone be given before or after antibiotics?
BEFORE
What are concerns associated with use of dexamethasone?
Increased GI bleeds, decreased antibiotic penetration
What drug penetration is NOT affected by dexamethasone?
vancomycin
What type of adult pt should NOT be given dexa?
Meningitis with septic shock
What pt population most often gets N meningitidis and when?
Kids and young adults in the winter and spring
What is the drug of choice for n. meningitidis and alternatives?
High dose IV PCN G , Cefotaxime, ceftriaxone, and chloramphenicol are, alternatives for allergy
Do pt with n. meningitidis need to have prophylaxis tx of all close contacts? If so what is given and when?
YES!, Rifampin w/in 24 hours is ideal, after 14 days no effect
Strep pneumo is the most common cause of meningitis is what pt population?
Adults but also in kids
What is a condition commonly seen in survivors?
Neurologic sequelae
How is meningitis from strep pneumo treated?
IV 3rd generation ceph for 10-14 days. Cefotaxime or ceftriaxone
What if the meningitis from strep pneumo is resistant to beta lactam drugs? What do you treat with?
Vancomycin
How can you prevent meningitis from strep pneumo?
Vaccine- >65, immunocompromised, asplenic or have a cochlear implant. Also prevnar vaccine as a infant
What is the tx of choice for H influenzae meningitis?
Ceftriaxone or cefotaxime bc lots of ampicillin resistance, Vaccinate your children then they wont be at risk for this- duhhhh
Do pt with H influenzae induced meningitis need prohylaxis tx for close contacts?
Yes unless fully vaccinated before 2y/o
When do cases of meningitis from listeria peak?
Summer/ early fall
What is the D.O.C for listeria meningitis?
IV ampicillin x14 -21 days +/-aminoglycosides x10 days
What type of meningitis are neonates most at risk for?
E.coli and klebsiella
What are the risk factors for gram neg bacilli meningitis?
Cranial trauma, neurosurgery, immunosuppressant, hospitalization, and elderly
How do you treat gram ñ bacilli meningitis?
IV ceftazidime WITH gentamicin x3weeks for pseudo aeruginosa Other bacteria 3rd gen ceph for 3 weeks
