Neisseria Meningitis ID Case

Question 1

What is the most common cause of bacterial meningitis in infants?

In 2-18 yr-olds?

In adults?

In those over 60?

Answer 1

infants = group B strep

2-18: Neisseria meninigitidis

adults: streptococcus pneumoniae

over 60: streptococcus pneuminae

Question 2

How do most cases of bacterial meningitis reach the brain?

Answer 2

nasopharyngeal infection that invades bloodstream and crosses BBB to the subarachnoid space

Question 3

What are the two major areas a bacterial meningitis can reach the CNS thorugh direct extension?

Answer 3

sinusiits and epidural abscesses

Question 4

Bacterial meningitis is often preceded with what symptoms?

Answer 4

a short prodromal respiratory illness or sore throat

Question 5

What should the differential been for the 19 yrold college student in the case?

Answer 5

aseptic meningitis

Septic meningitis

viral encephalitis

arbovirus (west nile, eastern equine ancephalitis, rocky mountain spotted)

brain abscess

Question 6

What is the parimary diagnostic for meningitis?

Answer 6

LP

Question 7

Where do most cases of neisseria meningitidis occur globally?

Answer 7

the major disease burden is in non-industrialized countries

Question 8

What are some characteristics of neisseria meningitidis?

Answer 8

obligate intracellular

non-motile

aerobic

encapulated

gram-negative diplococci

Question 9

What is the classic risk setting for neisseria meningitidis?

Answer 9

crowded counditions

dorms, military training camp

Question 10

True or false: active infection occurs most often in carriers, not newly infected individuals.

Answer 10

false - more often in newly infected (partially why dorms are such an issue - noninfected coming in close contact with carriers)

Question 11

What is the fatality rate for neisseria meningitidis? Long term complication risk?

Answer 11

10% fatality

20% long term complicaitons

Question 12

What causes the petechiae seen in 50% of patients with neisseria meningitis?

Answer 12

the endotoxin shedding causes diffuse coagulation

Question 13

What is the treatment fo rneisseria meningitis?

Answer 13

IV fluids and immediate antibiotics

in ages 2-50 vancomycin and ceftriazone

over 50: ampicillin, vancomycin and ceftrixone (covering for listeria)

Question 14

Why is neisseria meningitis a reportable disease?

Answer 14

so public health departments can prophylactically treat close contacts

Question 15

How do you prevent neisseria meningitis?

Answer 15

vaccine with the bivalent and tetravalent vaccines - age 11 to 12 and in at-risk adults

Question 16

1. A 42 year-old male presents to your office with a fever and headache. He has nuccal rigidity and a fever of 101 degrees. He has an unremarkable past medical history. The most likely bacterial organism causing his illness is:

Answer 16

strep pneumoniae

Question 17

1. A 50 year-old female presents with a fever and seizure. She has a history of sinus infections. What test should be done before an LP?

Answer 17

Brain CT

Question 18

Why is C. diff a particular concern for ceftriaxone even though it tpically isn’t for beta lactams?

Answer 18

Beta lactams are typically excreted in the urine, but ceftriaxone is unique in that it’s also excreted thoruhg the bile, meaning it’s present in the GI tract and capable to eliminating normal GI flora

Question 19

What agar will neisseria meningitidis grow on?

Answer 19

chocolate agar