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MJ- F2 E4- Neuro > Neuro Infections 2- MJ > Flashcards

Neuro Infections 2- MJ Flashcards

1
Q

Meningitis is an inflammatory dz of the __________

A

leptomeninges

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2
Q

What are the 5 etiologies of meningitis?

A
  1. Viruses
  2. Bacteria
  3. Fungi
  4. Medications
  5. Cancer
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3
Q

What are the 6 risk factors of meningitis?

A
  1. Extremes of age
  2. Birth hx/maternal infection
  3. Immunodeficiency/immunocompromised
  4. Vaccine status
  5. Exposure risk
  6. IV drug use
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4
Q

What is the clinical presentation of meningitis? (5)

A

1. HA

  1. Photophobia
  2. N/V

4. Neck stiffness

5. Fever

**If a pt has these sxs, it is bacterial meningitis until proven otherwise**

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5
Q

What is the most common etiology of viral meningitis?

A

Enteroviruses

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6
Q

The following is the clinical presentation of what condition?

  • Fever
  • HA
  • N/V
  • Neck stiffness
  • Photophobia
  • +/- URI sxs, rash or diarrhea
A

Viral meningitis

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7
Q

What are 2 associated historical clues that might make you think a patient has viral meningitis?

A
  • HSV- genital lesions
  • Mumps (this is the MC extra-salivary complication)
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8
Q

What is the course of viral meningitis?

A

usually self-limited

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9
Q

How do you diagnose viral meningitis?

A

H&P + CSF analysis

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10
Q

What does CSF analysis show for a patient with viral meningitis?

  • Tubidity and color?
  • Opening pressure?
  • WBC count?
  • Differential cells?
  • RBC count
  • Protein?
  • Glucose?
A
  • Tubidity and color- Clear or cloudy, colorless
  • Opening pressure- normal to increased
  • WBC count- increased
  • Differential cells- Lymphocytes
  • RBC count- 0
  • Protein- increased
  • Glucose- normal
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11
Q

CSF analysis of viral meningitis looks similar to what other condition?

A
  • looks similar to CSF analysis of viral encephalitis
  • LP doesnt help distinguish between the two
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12
Q

What is the pathophysiology of bacterial meningitis in adults vs. neonates?

A
  • Adults: hematogenous spread, extension from nearby infection, penetrating injury
  • Neonates: pathogens acquired from the birth canal, through the placenta, or from surroundings

After, there is rapid replication of the bacteria, which triggers the inflammatory cascade

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13
Q

What is the MC etiology of bacterial meningitis in neonates (<28d)?

A

Group B strep

(this will be a question)

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14
Q

What is the MC etiology of bacterial meningitis in babies/children?

A

Strep pneumonia

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15
Q

What is the MC etiology of bacterial meningitis in teens, young adults?

A

Neisseria meningitides

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16
Q

What is the MC etiology of bacterial meningitis in Adults?

A

Strep pneumonia

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17
Q

T/F, bacterial meningitis symptoms are usually rapid in onset

A

True

(can be slow (1-several days) but it is rare to go >24 hrs w/o seeking tx)

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18
Q

The following is the clinical presentation of what condition?

  • Rapid onset (hours)
  • Fever
  • Meningismus
  • Altered mental status
  • Severe headache
  • Nausea, vomiting
  • Photophobia
  • Back pain
A

Bacterial meningitis

(the bolded sxs are what differs from viral meningitis)

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19
Q

The following is the clinical presentation of what condition in neonates/infants?

  • Irritability
  • Poor feeding
  • Vomiting
  • Lethargy
  • High-pitched cry
  • “floppy”
  • Rash (petechiae if N. meningitides)
  • +/- seizures
A

Bacterial meningitis

20
Q

The following are possible physical exam findings for what condition?

Vitals:

  • signs of septic shock
  • Fever
  • decreased SaO2
  • Widened pulse pressure (seen w/ increased ICP)

Skin:

  • Viral exanthem, petechiae, purpura
A

Bacterial Meningitis

21
Q

What 2 special neuro exams would you perform on a pt w/ bacterial meningitis?

A
  • Kernig sign- inability or reluctance to allow full extwnsion of the knee when hip is flexed
  • Brudzinski sign- Spontaneous flexion of hips during attempted passive flexion of neck
22
Q

What is the Diagnosis and management of bacterial meningitis? (8 steps)

A
  1. IV access
  2. Blood culture x 2
  3. Administer antibiotics (ASAP- LP/CT should NOT delay abx)
  4. CBC with diff
  5. CMP
  6. Coags
  7. +/- CT
  8. LP with CSF analysis
23
Q
A
24
Q

What does CSF analysis show for a patient with bacterial meningitis?

  • Tubidity and color?
  • Opening pressure?
  • WBC count?
  • Differential cells?
  • RBC count
  • Protein?
  • Glucose?
A
  • Tubidity and color- Turbid, yellow
  • Opening pressure- Elevated
  • WBC count- VERY elevated
  • Differential cells- Neutrophils
  • RBC count- 0
  • Protein- VERY elevated
  • Glucose- Decreased (“bacteria eat up the glucose”)
25
Q

What is the empiric treatment for bacterial meningitis for a person <50y/o and has no allergies?

A

Ceftriaxone or cefotaxime

+

Vancomycin

26
Q

What is the empiric treatment for bacterial meningitis for a person >50y/o and has no allergies?

A

Ceftriaxone or cefotaxime

+

Vancomycin

+

Ampicillin (only if > 50y/o)

27
Q

What is the empiric treatment for bacterial meningitis for a person who is <50 y/o and has a severe beta lactam allergy?

A

Vancomycin

+

Moxifloxacin

28
Q

What is the empiric treatment for bacterial meningitis for a person who is >50 y/o and has a severe beta lactam allergy?

A

Vancomycin

+

Moxifloxacin

+

TMP- SMX (only if >50y/o)

29
Q

What antibiotics would you give to a patient with bacterial meningitis caused by Strep pneumo?

A

Vancomycin

+

3rd generation cephalosporin

30
Q

What antibiotics would you give to a patient with bacterial meningitis caused by Neisseria meningitidis?

A

3rd gen cephalosporin

31
Q

What antibiotics would you give to a patient with bacterial meningitis caused by Listeria?

A

Ampicillin or Penicillin G

32
Q

What antibiotics would you give to a patient with bacterial meningitis caused by Haemophilus influenza?

A

3rd gen cephalosporin

33
Q

What is the steps for treating bacterial meningitis? (4)

A
  • antibiotics
  • Fluid management
  • Monitor and manage ICP (elevate bed, hyperventilate, +/- glucocorticoids/dexamethasone)
  • Induced hypothermia
34
Q

The following are possible neuro complications for what condition?

  • Impaired mental status
  • Increased ICP and cerebral edema
  • Seizures
  • Focal neurologic deficits
  • Sensorineural hearing loss
  • Intellectual impairment
A

Bacterial meningitis

35
Q

T/F: bacterial meningitis is a medical emergency?

A

TRUE

(untreated- mortality approaches 100%)

36
Q
  • When should you give chemoprophylaxis to close contacts of a person with bacterial meningitis?
  • What is a common med given for prophylaxis?
A
  • Prolonged contact w/ the person (>8hrs)
  • Direct exposure to oral secretions 7d prior to onset until 24 hrs after initiation of abx therapy

Common med given= Ciprofloxacin

37
Q

How is Bacterial Meningitis prevented in neonates?

A

All pregnant women are tested for Group B Strep at 35-37wks gestation and if they are positive then they get abx during labor

(if they aren’t tested then they get prophylactic abx during labor)

38
Q

What 4 vaccinations are available for prevention of bacterial meningitis? Which 2 are specifically for high risk pts?

A
  • Quadrivalent meningococcal conjugate vaccines protecting against serogroups A, C, W, and Y
    • *Menactra: approved for 9mo- 55yrs
    • *​Menveo: approved for 2mo - 55 yrs
  • High risk pts recommended to get: Meningococcal vaccines against serogroup B
    • Trumenba: approved for 10-25yrs
    • Bexsero: approved for 10-25 yrs
39
Q

Due to difficulty differentiating between viral encephalitis and bacterial meningitis, it is common to treat these patients with what pharmacologic treamtents?

A

empiric abx + Acyclovir

40
Q

Is fungal meningitis common or rare?

A

Rare

(consider in HIV and cancer)

41
Q

T/F: fungal meningitis is spread person to person

A

FALSE

Fungal meningitis is NOT spread person-to-person

42
Q

What are the 4 causative agents of fungal meningitis?

A
  1. Cryptococcus
  2. Histoplasma
  3. Blastomyces
  4. Coccidioides

(“COPs BLAST CRYPTic HISTOry about fungus”)

43
Q

The following is the definition of which condition?

  • Clinical and lab evidence of meningeal inflammation without signs of (bacterial) infection
A

Aseptic meningitis

44
Q

What are the 5 etiologies of aseptic meningitis?

A
  1. Malignancy
  2. Medications
  3. SLE
  4. Head injury
  5. Brain surgery

(“My Mother Said Have Brains”)

45
Q

What 5 medications can cause aseptic meningitis?

A
  • Trimethoprim-sulfamethoxazole
  • Ibuprofen (and other NSAIDS)
  • IVIG
  • Certain chemo agents
  • Certain immunosuppressive drugs (Azathioprine, Infliximab)
46
Q

The following patients are considered “high risk” and should receive which vaccination in order to try to prevent meningitis?

  • Pt >10y/o w/ persistent complement component deficiency
  • functional or anatomical asplenia
  • microbiologists routinely working with N. meningitidis
  • Person at risk due to serogroup B meningococcal outbreak
A

•Meningococcal vaccines against serogroup B

  • Trumenba: approved for 10-25 years, 2-dose and 3-dose series
  • Bexsero: approved for 10-25 years, 2-dose series

MJ- F2 E4- Neuro (19 decks)

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