Neuro Infections 2- MJ Flashcards
Meningitis is an inflammatory dz of the __________
leptomeninges
What are the 5 etiologies of meningitis?
- Viruses
- Bacteria
- Fungi
- Medications
- Cancer
What are the 6 risk factors of meningitis?
- Extremes of age
- Birth hx/maternal infection
- Immunodeficiency/immunocompromised
- Vaccine status
- Exposure risk
- IV drug use
What is the clinical presentation of meningitis? (5)
1. HA
- Photophobia
- N/V
4. Neck stiffness
5. Fever
**If a pt has these sxs, it is bacterial meningitis until proven otherwise**
What is the most common etiology of viral meningitis?
Enteroviruses
The following is the clinical presentation of what condition?
- Fever
- HA
- N/V
- Neck stiffness
- Photophobia
- +/- URI sxs, rash or diarrhea
Viral meningitis
What are 2 associated historical clues that might make you think a patient has viral meningitis?
- HSV- genital lesions
- Mumps (this is the MC extra-salivary complication)
What is the course of viral meningitis?
usually self-limited
How do you diagnose viral meningitis?
H&P + CSF analysis
What does CSF analysis show for a patient with viral meningitis?
- Tubidity and color?
- Opening pressure?
- WBC count?
- Differential cells?
- RBC count
- Protein?
- Glucose?
- 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
CSF analysis of viral meningitis looks similar to what other condition?
- looks similar to CSF analysis of viral encephalitis
- LP doesnt help distinguish between the two
What is the pathophysiology of bacterial meningitis in adults vs. neonates?
- 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
What is the MC etiology of bacterial meningitis in neonates (<28d)?
Group B strep
(this will be a question)
What is the MC etiology of bacterial meningitis in babies/children?
Strep pneumonia
What is the MC etiology of bacterial meningitis in teens, young adults?
Neisseria meningitides
What is the MC etiology of bacterial meningitis in Adults?
Strep pneumonia
T/F, bacterial meningitis symptoms are usually rapid in onset
True
(can be slow (1-several days) but it is rare to go >24 hrs w/o seeking tx)
The following is the clinical presentation of what condition?
- Rapid onset (hours)
- Fever
- Meningismus
- Altered mental status
- Severe headache
- Nausea, vomiting
- Photophobia
- Back pain
Bacterial meningitis
(the bolded sxs are what differs from viral meningitis)
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
Bacterial meningitis
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
Bacterial Meningitis
What 2 special neuro exams would you perform on a pt w/ bacterial meningitis?
- 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
What is the Diagnosis and management of bacterial meningitis? (8 steps)
- IV access
- Blood culture x 2
- Administer antibiotics (ASAP- LP/CT should NOT delay abx)
- CBC with diff
- CMP
- Coags
- +/- CT
- LP with CSF analysis
What does CSF analysis show for a patient with bacterial meningitis?
- Tubidity and color?
- Opening pressure?
- WBC count?
- Differential cells?
- RBC count
- Protein?
- Glucose?
- 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”)
What is the empiric treatment for bacterial meningitis for a person <50y/o and has no allergies?
Ceftriaxone or cefotaxime
+
Vancomycin
What is the empiric treatment for bacterial meningitis for a person >50y/o and has no allergies?
Ceftriaxone or cefotaxime
+
Vancomycin
+
Ampicillin (only if > 50y/o)
What is the empiric treatment for bacterial meningitis for a person who is <50 y/o and has a severe beta lactam allergy?
Vancomycin
+
Moxifloxacin
What is the empiric treatment for bacterial meningitis for a person who is >50 y/o and has a severe beta lactam allergy?
Vancomycin
+
Moxifloxacin
+
TMP- SMX (only if >50y/o)
What antibiotics would you give to a patient with bacterial meningitis caused by Strep pneumo?
Vancomycin
+
3rd generation cephalosporin
What antibiotics would you give to a patient with bacterial meningitis caused by Neisseria meningitidis?
3rd gen cephalosporin
What antibiotics would you give to a patient with bacterial meningitis caused by Listeria?
Ampicillin or Penicillin G
What antibiotics would you give to a patient with bacterial meningitis caused by Haemophilus influenza?
3rd gen cephalosporin
What is the steps for treating bacterial meningitis? (4)
- antibiotics
- Fluid management
- Monitor and manage ICP (elevate bed, hyperventilate, +/- glucocorticoids/dexamethasone)
- Induced hypothermia
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
Bacterial meningitis
T/F: bacterial meningitis is a medical emergency?
TRUE
(untreated- mortality approaches 100%)
- When should you give chemoprophylaxis to close contacts of a person with bacterial meningitis?
- What is a common med given for prophylaxis?
- 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
How is Bacterial Meningitis prevented in neonates?
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)
What 4 vaccinations are available for prevention of bacterial meningitis? Which 2 are specifically for high risk pts?
- 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
Due to difficulty differentiating between viral encephalitis and bacterial meningitis, it is common to treat these patients with what pharmacologic treamtents?
empiric abx + Acyclovir
Is fungal meningitis common or rare?
Rare
(consider in HIV and cancer)
T/F: fungal meningitis is spread person to person
FALSE
Fungal meningitis is NOT spread person-to-person
What are the 4 causative agents of fungal meningitis?
- Cryptococcus
- Histoplasma
- Blastomyces
- Coccidioides
(“COPs BLAST CRYPTic HISTOry about fungus”)
The following is the definition of which condition?
- Clinical and lab evidence of meningeal inflammation without signs of (bacterial) infection
Aseptic meningitis
What are the 5 etiologies of aseptic meningitis?
- Malignancy
- Medications
- SLE
- Head injury
- Brain surgery
(“My Mother Said Have Brains”)
What 5 medications can cause aseptic meningitis?
- Trimethoprim-sulfamethoxazole
- Ibuprofen (and other NSAIDS)
- IVIG
- Certain chemo agents
- Certain immunosuppressive drugs (Azathioprine, Infliximab)
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
•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
