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20 Cards in this Set
- Front
- Back
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Bacterial Meningitis Clinical Presentation
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Diffuse, subacute.
-fever, abrupt worsening HA, photophobia, n/v, mental status changes -Meningeal signs: Brudzinski's = hip flexion precipitated by neck flexion; Kernig's = pain on knee extension while hip flexed |
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Bacterial Meningitis Pathology
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bacteria from nasopharynx spread hematogenously to choroid plexus, cross into SA space and Vs, and attract neutrophils. Proceeds with lymphocytes, macrophages, and eventually fibroblasts. PMNs observed also in perivascular inflammation.
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Bacterial Meningitis CSF
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wbcs>1000 (shifted to neutrophils)
protein>100 opening pressure>200 glucose<40% serum gram stain (+) 60-80% of the time culture (+) 90% of the time |
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Bacterial Meningitis Likely Organisms
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0-12 weeks: Group B Strep, E. Coli, L. monocytogenes
3 mos-50 years: S. pneumo, N. meningitidis, H. flu >50: S. pneumo, L. monocytogenes, Gram (-) bacilli Head trauma/neurosurg: Staph, Gram (-) bacilli, S. pneumo Immunocompromised: L. monocytogenes, Gram (-) bacilli, S. pneumo, H. flu |
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Bacterial Meningitis Tx
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1. 3rd gen cephalosporin
2. Vancomycin (covers resistant pneumo) 3. Ampicillin (covers L. monocytogenes) if immunocompromised 4. Dexamethasone before or during Tx 5. Mange complications: icp, seizures, SIADH, aspiration pneumonia |
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Viral Meningitis Pathology
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Vascular congestion and scanty infiltrate of lymphocytes in the meninges, perivascular spaces, and choroid plexus
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Viral Meningitis CSF
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wbcs: 10-200
protein: mildly elevated >45 but <100 opening pressure: normal (200) glc: normal (50% of serum) gram stain (-) PCR: enteroviruses |
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Viral Meningitis Organisms
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1. non-polio enteroviruses (coxsackie, echovirus) via hematogenous spread (most common cause)
2. poliovirus 3. Mumps |
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Viral Meningitis Clinical
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-same as bacterial but milder
-prognosis better |
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Fungal meningitis Clinical
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-intermediate btw bacterial and viral
-indolent course (months to years) -immunocompromised pts (e.g. HIV) |
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Fungal meningitis path
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-moderate thickening and opacification of meninges
-lymphocytic inflammation with hallmark of multinucleated giant cells -Cryptococcal: budding yeast |
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Fungal meningitis organisms
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Most common:
-cryptococcal (across USA) -histoplasma (Michigan) -blastomyces -coccidioides (SW USA) -candida (burn pts or TPN) -aspergillus -mucormycosis (diabetics) -paracoccidioides (Latin America) |
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Fungal meningitis Tx
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-Amphotericin B
-Flucytosine initially (esp. AIDS pts) -Fluconazole maintenance for AIDS pts |
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TB Meningitis Clinical Presentation
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-similar to fungal in course but loves base of brain
-several week prodrome: HA, malaise, personality change, low-grade fever -gradual worsening HA, n/v, stiff neck, confusion, papilledema -strokes may occur (perivascular inflammation) -seizures in 10% -stupor, coma, death if untreated |
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TB Meningitis Path
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Macro: gelatinous SA exudate, thickest in Sylvian fissures (lateral sulcus) and at base of brain
Micro: lymphocytic infiltrate in SA and Vs, hallmark is tubercles containing central area of caseous necrosis surrounded by epithelioid macrophage rxn with multinucleated giant cells and peripheral ring of lymphocytes. These tuberculomas can also be found in parenchyma. |
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TB Meningitis CSF
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-wbcs: 100-300
-protein: 100-500 -increased opening pressure -decreased glc -mycobacterial culture and acid-fast stain -PCR (low sensitivity) |
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TB Meningitis Tx
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2 months:
1. Rifampin 2. Ethambutol or Streptomycin 3. Pyrazinamide 4. Isoniazid continue rifampin and isoniazid for 1 year |
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Meningitis overview
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-Clin: fever, HA, mening signs (diffuse Sx)
-LP: bacterial (**wbcs + PMNs, very low glc, high very high opening pressure); others (*wbcs + monocytes/lymphocytes)....but be wary of exceptions -PCR for TB, enteroviruses |
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Normal CSF
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wbcs: <5
protein: 15-45 opening pressure: <200 glc: >50% of serum |
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Fungal meningitis CSF
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wbcs: increased but <800
protein: up to 500 opening pressure increased glc: 10-40 (decreased) India ink stain for crypto Fungal serology for cypto Fungal cultures |
