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25 Cards in this Set
- Front
- Back
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Causes of pyogenic meningitis
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Bacteria: group B strep, H flu, strep pneumo, N. meningitidis, listeria
Fungi: histoplasma, cocciodomyces, cryptococcus neoformans Ameba: Nagleria |
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Causes of asceptic meningitis
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Viruses
Drugs Malignancy |
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Mollert's syndrome
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Recurrent asceptic meningitis
Recurrent herpes simplex |
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Most common meningitis pathogens from 0-2 months
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Group B strep
E. coli Listeria |
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Most common meningitis pathogens from 2 months - 2 years
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W/o vaccines:
H. flu Strep pneumo N. meningitidis W/ vaccines N. meningitditis |
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Most common meningitis pathogens
5-60 years |
N. meningitidis
Strep pneumo |
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Most common meningitis pathogens
> 60 years |
Strep pneumo
Listeria |
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Most common meningitis pathogens
in immunocompromised |
Listeria
Cryptococcus neoformans |
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Most common meningitis pathogens
in basilar skull fracture |
Strep pneumo
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Changing epi of meningitis
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Vaccines for kids against H flu and strep pneumo
Now average age is now 40 |
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Pathophysiology of bacterial meningitis
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Nasopharynyx colonization
Mucosal disruption before humoral immunity sets in Leads to bacteremia Encapsulated bacteria marginate in cerebral vessels PMNs respond, damaging the BBB |
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Symptoms of meningitis arise from
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Decreased cerebral blood flow
Caused by bacterial replication -->cytokine response --> inflammation --> cerebral edema and vasculitis |
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What is special about bacteria that cause meningitis?
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They all have capsules
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Virchow-Robin space
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Enlarged perivascular space around blood vessel where it enters the brain
These are the main site of inflammation/infilitrate during meningitis |
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Viral diseases limited to CNS
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Enteroviruses (polio, coxsacki, echo)
Arbroviruses |
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Viral diseases with CNS and systemic
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Mumps
Herpes simplex Varicella zoster Adenovirus EBV parvovirus b19 Lymphocytic choriomeningitis virus |
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Enteroviruses pathophysiology
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Ingestion
Infects oropharynx/GI tract Minor viremia Lymphoid organs infected Major viremia--symptoms CNS, myocardium, etc infection |
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Meningitis symptoms signs in neonates
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Irritablity, lethargy
Poor feeding Vomiting Seizures Temperature Instability Tense fontenelle CN palsy Maybe nuchal rigidity |
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Meningitis signs and symptoms in kids and adults
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fever, HA, n/v, stiff neck, lethargy/confusion
Nuchal ridigity, Kernig's, Brudzinski's |
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Meningitis signs and symptoms in the elderly
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Confusion
Obtundation May not have a fever |
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Labs in meningitis
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CSF - WBC/diff, glucose, protein, gram stain, culture
Blood culture Serum Na (looking for SIADH) |
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Neuroimaging in meningitis
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Usually done
Usually normal early Not really necessary for diagnosis |
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Complications of bacterial meningitis
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Subdural effusion
Hydrocephalus Infarction 2/2 vascular insufficiency |
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Prognosis of bacterial meningitis
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Adults: strep 22% death, N. men 13%)
Kids: strep 8%, N men 8% H. flue 4% 85% who recover are wnl Other have deafness, cognitive impairment, spasticity/paresis, seizure disorder |
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How to treat bacterial meningitis
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Antibiotics (ceftriaxone, vanco)
Corticosteroids Fluid management Hearing evaluation |
