Mcphs Mmd Ii Final Exam Meningitis And Encephalitis

Front 1

An inflammatory response to bacterial infection of the pia-arachnoid and CSF of the subarachnoid space

Back 1

Bacterial meningitis

Front 2

What is the major cause of meningitis in neonates (<1 month)?

Back 2

Gram Negative Bacilli

Front 3

What is the major cause of meningitis in children (1 month to 15 years)?

Back 3

H. Influenzae

Front 4

What is the major cause of meningitis in adults (>15 years)

Back 4

S. Pneumonia

Front 5

This involves nasopharyngeal colonization

Bacterial cell death causes release of cell wall components which activate cytokines

Cytokine activation leads to cerebral edema, increased ICP, and altered cerebral blood flow.

Back 5

Pathophysiology of Meningitis

Front 6

The following are hallmarks of what?

Exudate in the subarachnoid space

Accumulation of exudate in the dependent areas of the brain

Large number of PMN's

Within 2-3 days inflammation in the walls of the small and medium sized blood vessels

Blockage of normal CSF pathways and blockage of the normal absorption may lead to obstructive hydrocephalus

Back 6

Hallmarks of Meningitis

Front 7

How does meningitis manifest?

Back 7

HA

Fever

Meningismus

Cerebral Dysfunction - confusion, delirium, decreased level of consiousness

N/V

Photophobia

Nuchal Rigidity - Kernig's and Brudzinksi's

Cranial Nerve Palsies - IV, VI, VII

Seizures

Front 8

Classic signs of meningitis are often missing in what types of patients?

Back 8

Neonates

Elderly

Front 9

How do you diagnose meningitis?

Back 9

Assess for increased ICP

Defer LP until CT scan or MRI obtained if any of the above is present

Front 10

This should be obtained before initiating antibiotics in meningitis?

Back 10

LP

Front 11

What will show up in the LP results with meningitis?

Back 11

WBC - >200 (90% PMNs)

Protein - 100-500+

Glucose - <40

CSF Serum Glucose - <0.4

Front 12

What are the four tubes of the LP-CSF specific for?

1.
2.
3.
4.

Back 12

1. Protein and Glucose

2. Gram stain and culture

3. Cell count and differential

4. Store (PCR, viral studies etc.)

Front 13

What is the diagnostic criteria of meningitis with LP-CSF?

Back 13

Opening Pressure: High, >200 mmH20

Cloudy

1000-5000 cells/mm3 with a neutrophil predominance of about 80-95%

<40 mg/dl and less than 2/3 of the serum glucose

Protein elevated

Front 14

What is the approach to TX with meningitis?

Back 14

Until a pathogen is identified, prompt empiric antibiotics should be started

Empiric antibiotics should target most likely organisms

Front 15

Common bacterial pathogens associated with meningitis in 18-60 year olds?

Back 15

S. pneumoniae

N. meningitidis

Front 16

Common bacterial pathogens associated with meningitis in patients over 60 years old?

Back 16

S. pneumoniae

Gram negative enterics

L. monocytogenes

Front 17

Approximately 50% of cases are secondary infections resulting from otitis media or sinusitis
Neurologic complications including seizure and coma are common
Alcoholics and asplenic patients are at higher risk for infection
At least 35% of strains are either intermediately or highly penicillin-resistant

Back 17

Strep pneumoniae - associated with meningitis

Front 18

What is the initial empric treatment for S. pneumoniae meningitis?

Back 18

Ceftriaxone plus Vancomycin

Front 19

Accounts for 25% of meningitis cases

Commonly occurs in patients in close quarters

Seizure and coma are uncommon
Presence of petechiae and/or purpuric lesions are common

Aggressive early intervention is important in these patients

Back 19

Neisseria meningitidis associated with meningitis

Front 20

What is the TX for Neisseria meningitidis?

Back 20

TX of choice is high dose Penicillin G

Patients with mild penicillin allergy use ceftriaxone

Patients intolerant to penicillins and cephalosporins use fluoroquinolones (moxifloxacin or gatifloxacin)

Front 21

What patients are at increased risk of neisseria meningitidis?

Back 21

Close contacts of patients with N. Meningitidis

Front 22

What is prophylaxis for Neisseria meningitidis?

Back 22

Rifampin

Front 23

Most common in elderly patients > 60 years of age

Food-borne pathogen that will colonize the GI tract
Coleslaw, pasturized milk, ready-to-eat foods, raw beef and poultry

Incidence peaks in summer and early fall

Treatment of choice is ampicillin + gentamicin

Back 23

Listeria monocytogenes

Front 24

Predisposing factors include congenital CNS defects, cranial trauma, neurosurgery, excessive gram-positive antimicrobial use prior to neurosurgery

Enterobacteriaceae and Pseudomonas aeruginosa

Back 24

Enteric Gram-Negative Bacteria

Front 25

How do you treat Enterbacteriaceae

Back 25

Ceftriaxone

Trimethoprim/sulfamethoxazole

Front 26

How do you treat Pseudomonas aeruginosa?

Back 26

Ceftazidime plus aminoglycoside (gentamicin, or tobramycin or amikacin)

Front 27

Clinical and laboratory evidence of meningitis with negative routine blood cultures
Slow growing bacteria, fungi, and viruses
Patients present with symptoms similar to bacterial meningitis
Usually a self-limiting course that resolves without specific therapy

Back 27

Aseptic Meningitis

Front 28

What is the slow growing bacterial pathogen associated with aseptic meningitis and how is it tx?

Back 28

Mycobacterium tuberculosis (TB)
Isoniazid 5-10 mg/kg/day + Rifampin 600 mg/day + Pyrazinamide 15-30 mg/kg/day

Front 29

What is the Fungal pathogen associated with aseptic menongitis and how is it tx?

Back 29

Cryptococcus neoformans
Amphotericin B 0.5-1 mg/kg/day + flucytosine 100 mg/kg/day

Front 30

What is the Viral pathogen associated with aseptic meningitis and how is it tx?

Back 30

Herpes Simplex Encephalitis
Acyclovir 10 mg/kg IV q8 hours

Front 31

This population often presents with non specific symptoms in meningitis?

Back 31

Infants

Front 32

In the past this was the most common cause of meningitis in children

Back 32

H. Influenzae

Front 33

What is the TX for H. Influenzae induced meningitis?

Back 33

Ceftriaxone and chloramphenicol

Front 34

What prophylaxis for H. influenzae should be considered in children with close contact?

Back 34

Rifampin

Front 35

Streptococcus agalactiae
Many women are colonized with it in their vaginal tract
Premature babies are at the highest risk of infection
Most commonly seen within the first 7 days of life
Treatment with ampicillin plus gentamicin or cefotaxime plus gentamicin

Back 35

Group B Streptococcus

Front 36

Associated with the highest mortality rate of meningitis?

Back 36

Pneumococcal Meningitis

Front 37

Asplenic pts should have had a vaccine for this prior to their splenectomy?

Back 37

pneumoccocal vaccine

Front 38

The mosquito borne pathogens include three alphaviruses which may result in equine encephalitis, what are they?

Back 38

Western
Eastern
Venezuelan

Front 39

What are the five flaviviruses

Back 39

West Nile fever
St. Louis encephalitis
Japanese B encephalitis
Dengue
Yellow fever

Front 40

What is the Bunyaviruses

Back 40

California encephalitis caused by:
Lacrosse agent
viral hemorrhagic fever (Rift Valley fever)

Front 41

is an acute inflammatory process that primarily involves the brain.
The meninges are frequently involved (meningoencephalitis).

Back 41

Encephalitis

Front 42

Most cases of this are viral in origin

Back 42

Meningioencephalitis

Front 43

What is the most common cause of encephalitis in the US?

Back 43

Herpes simplex

Front 44

Eastern Equine Encephalitis is caused by an arthropod-borne alphavirus of the ? family.

Back 44

Togaviridae

Front 45

The following neurological findings are associated with what?

Bilateral papilledema
Nuchal rigidity
Focal sensory or motor deficit
Depressed or hyperactive reflexes
Tremors
Fasciculations
Seizure activity
Spastic paralysis

Back 45

Eastern Equine Encephalitis

Front 46

These are physical findings associated with what?

Cyanosis - With respiratory compromise
Facial, periorbital, or generalized edema
Lymphadenopathy - Not necessarily present
Possible pharyngeal erythema

Back 46

Eastern Equine Encephalitis

Front 47

What is associated with the work up of Eastern Equine Encephalitis?

Back 47

Immunoglobulin M (IgM) positive to the organism in the CSF

Presumptive positives can be made from other biochemical assays:
hemoagglutinin inhibition
immunofluorescence
neutralization
complement fixation

Front 48

Obtain a lumbar puncture (LP) as soon as possible when this is strongly suspected.

Back 48

Eastern Equine Encephalitis

Front 49

What is the TX for Eastern Equine Encephalitis?

Back 49

Antibiotic therapy for generalized coverage of bacterial meningitis (as appropriate for age and antibiotic resistance patterns)

and

Acyclovir to treat HSV infection should be started until these diseases are ruled out.

Front 50

Pharmacologic therapy for EEE consists primarily of what?

Back 50

Antipyretics

Analgesics

Anticonvulsants

Front 51

What specific meds are used to TX EEE?

Back 51

Phenytoin

Phenobarbital

Benzodiazepine drip

Dilantin