Pediatric Meningitis

Question 1

what are the 3 membranes of the meninges

Answer 1

1. dura mater
2. arachnoid space
3. pia mater

Question 2

what keeps foreign matter out of CSF

Answer 2

tight junctions (BBB)

Question 3

when do antibiotics get the best penetration through BBB when trying to treat meningitis

Answer 3

when inflammation is present and tight junctions are open wider

Question 4

what is meningitis

Answer 4

infection/ inflammation of CSF in subarachnoid space of the brain (most common CNS infection)

Question 5

what is the difference in septic vs. aseptic meningitis

Answer 5

septic = bacterial
aseptic = viral (usually HSV)

Question 6

what is the main factor in determining mortality in meningitis

Answer 6

time until identified/ treated

Question 7

what are 3 common neurologic disabilities seen in pediatric meningitis

Answer 7

seizures, hearing loss, and hydrocephalus

Question 8

why is meningitis most common in pediatrics

Answer 8

the blood brain barrier is not fully developed in pediatrics

Question 9

what are some risk factors of meningitis

Answer 9

age
gender
immunosuppression
head trauma

Question 10

the pathophysiology of meningitis can lead to what

Answer 10

1. edema
2. increased intercranial pressure
3. DIC (dissmeninated intravascular coagulation
4. SIADH
5. ischemia

Question 11

what are the 6 classic signs and symptoms of meningitis

Answer 11

1. severe headache
2. fever/ vomiting
3. drowsiness/ impaired consciousness
4. stiff neck (unusual in young children)
5. dislike of bright lights (unusual in young children)
6. rash

Question 12

what are the 2 tests done in the ER for meningitis

Answer 12

1. Brudzinski’s sign (legs bend involuntarily when neck bends)
2. Kernig’s sign (when knees at 90, legs spasm)

Question 13

what is the first step to meningitis management

Answer 13

1. blood cultures
2. lumbar puncture
3. start empiric antimicrobial therapy +/- dexamethasone

Question 14

what range of protein in CSF indicates bacterial meningitis?
viral meningitis?

Answer 14

bacterial = 80-500

viral =30-150

Question 15

what range of glucose in CSF indicates bacterial meningitis?

Answer 15

bacterial = less than 30; or 1/2 serum glucose

bacteria need nutrition

Question 16

what range of WBC in CSF indicates bacterial meningitis?

viral meningitis?

Answer 16

bacterial = 400 - 100,000
viral = 5-500

Question 17

what is the most likely pathogen in newborns to 1 month old with meningitis

Answer 17

1. group B strep
2. E. choli
3. Listeria (why expecting mothers should avoided unpasteurized cheeses and dairy products)

Question 18

what is the most likely pathogen in people greater than one month old with meningitis

Answer 18

1. N. meningitis

2. strep pneumoniae

Question 19

what is the empiric treatment for bacterial meningitis in newborns, less than 1 month old

Answer 19

ampicillin and aminoglycoside
OR
ampicillin and cefotaxime

Question 20

what is the empiric treatment in people greater than 3 months old with meningitis

Answer 20

vancomycin AND cefotaxime or ceftriazone

Question 21

what is the most common cause of bacterial meningitis in people older than 1 month

Answer 21

neiserria meningitis (meningococcus)

Question 22

what is the most common symptom of meningococcus meningitis

Answer 22

rash

Question 23

what are the first choice options for treating N meningitis if PCN MIC is between 0.1-1

Answer 23

3rd gen cephalosporin (cefotaxime or ceftriaxone)

Question 24

what are the first choice options for treating N meningitis if PCN MIC is less than 0.1

Answer 24

Penicillin G

Question 25

what are some alternative treatments for treating N meningitis

Answer 25

fluoroquinolone
meropenem
chloramphenicol

Question 26

what is the duration of therapy when treating N meningitis

Answer 26

5-7 days

Question 27

which meningitis causing bug are coma and seizures most common

Answer 27

streptococcus pneumoniae (pneumococcal)