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31 Cards in this Set
- Front
- Back
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Group B Strep
E. coli Listeria |
Neonate
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Strep pneumo
Neisseria meningitidis H. flu b |
2 mos - 12 years
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Pseudomonas
Staph Salmonella Listeria |
Immunosuppressed
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Age
Recent colonization Close contact (Neisseria, H. flu b) Black, Native American, Eskimo, male Splenic dysfunction Congenital/acquired CSF leak |
Factors predisposing to meneigitis
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Meningeal purulent exudate
Ventriculitis Cerebral infarction Increased intracranial pressure Raised CSF protein-from ↑ permeability Hypoglycorrhachia-from ↓ glucose transport |
Pathos of Meningitis
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Bacteremia-posssibly from nasopharyngeal colonization
Enter CSF through choroid plexus Multiply in CSF-low complement/Ab Inflammatory response triggered-can result in brain injury |
Pathogenesis of Meningitis
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Shock
Purpura Disseminated Intravascular Coagulopathy Can progress to coma, death w/in 24 h |
Sudden onset of Meningitis
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Fever for several days
Associated with URI, GI Nonspecific signs-lethargy, irritability |
Insidious onset meningitis
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3rd or 6th cranial nerve palsy
Hypertension/bradycardia/respiratory (Cushing’s triad) Severe cardiorespiratory compromise Skin infection over LP site |
Contraindications for spinal tap
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Ampicillin + aminoglycoside
Ampicillin + 3rd generation cephalosporin |
neonate
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Vancomycin + 3rd geneation cephalosporin
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strep pneumo
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Cefotaxime/ceftriaxone
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Neisseria Meningitis
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Cefotaxime/ceftriaxone
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H. Flu B
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Ceftazidime + aminoglycoside
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Immunocompromised
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supports use only in H. flu b Limits production of inflammatory mediators
Data meningitis |
Corticosteroids
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Seizures
Increased ICP Cranial nerve palsies Stroke Subdural effusions |
Complications of Meningitis
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What is the most common sequela for meningitis?
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sensorineural hearing loss
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Which microbe causes the highest mortality in meningitis?
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pneumococcus
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What factors confer the worst prognosis?
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<6 mos old and high bacterial concentration in CSF
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H. flu b
Strep pneumo Neisseria |
microbes that can be vaccinated
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Rifampin for close contacts (household, daycare, nursery school, healthcare exposed to oral secretions)
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Treatment of Neisseria
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B-rifampin (4h/day for 5/7 days)
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H. flu
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What is the most common cause of viral meningitis?
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enterovirus
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This virus causes:
Focal involvement Death in 70% if not treated |
HSV
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What is used to culture WNV?
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CSF serology
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What serology may useful for arbovirus?
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acute and convalescent serology
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Varies
Usually acute onset after nonspecific febrile illness Headache-frontal, sometimes retrobulbar Fever, nausea, vomiting, photophobia Stupor, hallucinations, bizarre movements Seizures Paralysis Rashes |
Clinical presentation of Viral Meninigitis
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Most have complete recovery
Mild to severe sequelae, especially with HSV Motor incoordination, seizures, deafness, visual disturbances, behavioral distrubances Poor prognosis if severe clinical illness and substantial parenchymal involvement Always do followup eye/ear |
Clinical Course for viral meningitis
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What should always be done to follow up on HSV meningitis?
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Eye and ear exam
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Suspected CNS infection
Suspected subarachnoid hemorrhage Therapeutic reduction of CSF pressure Sampling of CSF for other reasons Delivering medications |
Indications for spinal tap
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Headache most common
Epidermoid tumor-rare, manifests years later Infection Spinal hematoma Herniation-unliklely unless focal findings, coma |
Complications of spinal tap
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