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77 Cards in this Set
- Front
- Back
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what is m/c organism for meningitis?
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1. streptococcus pneumonia (50%)
2. Neisseria menigitidis (25%) 3. H. flu= no rare b/c of vaccination |
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what is n/c organism for meningitis in neonates, elderly and immunocompromised?
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Listeria
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what are the #1 and #2 m/c causes of neonatal meningitis?
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1. group B strep (strep agalactiae)
2. E. coli |
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what are the si/sx of meningitis clinically?
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1. meningismus=pt cannot touch chin to chest
2. pos. Kernig's sign=pt is supine c/ hip and knees flexed at 90 degrees, examiner cannot extend knee 3. pos. Brudzinski's sign= pt is supine, when examiner flexes neck, pt involuntarily flexes hip and knees |
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what is kernig's sign?
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1. seen in meningitis
2. pt is supine c/ hip and kneed flexed at 90 degrees, examiner cannot extend knee |
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what is brudzinski's sign?
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1. seen in meningitis
2. pt is supine when examiner flexes nect, pt involuntarily flexes hip and knees |
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what labs should you obtain for acute meningitis?
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1. CSF for gram stain
2. bacterial cultures 3. herpes simplex (HSV) PCR |
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for viral causes of meningitis, what two can be treated?
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1. HSV (tx with acyclovir)
2. HIV (tx with AZT) |
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what do you tx meningitis from HSV with?
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acyclovir
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what are the CSF findings in bacterial meningitis?
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1. increased neutrophils
2. high protein (>50) 3. low glucose (<2/3 serum) (<45) |
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what are the CSF findings in viral meningitis?
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1. increased mononuclear cells/lymphocytes
2. high protein (>50) 3. normal or low glucose |
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what are the CSF findings in fungal meningitis?
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1. mod. increase in lymphocytes
2. high protein (>50) 3. low glucose (<45) |
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what are normal CSF findings?
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1. 0-5 lymphocytes
2. protein 15-45 3. glucose 45-85 |
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what are si/sx of subacute/chronic meningitis?
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per acute but evolves over wks to mon; +/- fever
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what are ddx of subactue/chronic meningitis?
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1. fungal
2. mycobacterial 3. noninfectious |
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what are ddx of fungal meningitis?
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1. cryptococcus (common in AIDS; seen on india ink stain)
2. coccidioides (blastocysts seen on CSF cytology) |
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what is the m/c organism in an AIDS pt with fungal meningitis?
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1. cryptococcus
2. india ink stain will show organisms in CSF 3. opening pressure is commonly elevated |
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how do you determine coccidioides for fungal meningitis?
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1. coccidioides blastocysts seen on CSF cytology
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how do you tx fungal meningitis?
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1. IV amphotericin B (intrathecal may be necessary)
2. for cryptococcus and coccidioides) |
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what type of meningitis is found in elderly by reactivation?
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TB meningitis
dx is made by TB PCR of the CSF |
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what is the tx for TB meningitis?
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RIPE:
R=rifampin + I=INH + P=pyrazinamide + E=ethambutol |
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other causes of subacute/chronic meningitis include:
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1. sarcoid
2. cancer 3. collagen-vascular dz 4. drug reactions |
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what are the m/c etiologies of meningitis in neonates (<1 mon)?
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1. S. agalactiae (group B strep)
2. E. coli 3. Listeria |
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what is the tx regimen for meningitis in neonates?
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1. ampicillin +
2. cefotaxime (group B strep, e. coli, listeria) |
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what are the m/c etiologies of meningitis in children and teens?
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1. strep pneumo
2. n. meningitidis |
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what is the tx regimen for meningitis in children and teens?
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1. cefotaxime +
2. vancomycin (d/t increaseing rate of B-lactam reistance in S. pneumo) (strep pnemo, n. menigitidis) |
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what are the m/c etiologies of meningitis in adults?
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1. strep pneumo (by far!!)
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what is the tx regimen for meningitis in adults?
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1. cefotxime +
2. vancomycin (d/t increaseing rate of B-lactam reistance in S. pneumo) (strep pnemo) |
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what is the m/c cause of bacterial meningitis in adults?
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streptococcus pneumoniae
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what is the m/c cause of bacterial menigitis in the elderly, asplenic pts and pts with poor health?
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streptococcus pneumoniae
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what are the characteristics of strep pneumo bacterial meningitis?
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1. can progress from otitis media, sinusitis, or bacteremia
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what is the tx for strep pneumo bacterial meningitis?
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1. Pen G (if susceptible)
2. cefotaxime (2nd line)=claforan 3. vancomycin (3rd line) |
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what is a common organism for bacterial meningitis in:
1. >1 yr olds 2. adults in epidemics 3. pts in close populations (military barracks)? |
N. meningitidis
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what are the characteristics of N. meningitidis bacterial meningitis?
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1. petechiae on trunk and legs
2. conjunctivae 3. beware of Waterhouse-Friderichsen syndrome (adrenal infarct) |
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what is tx for N. meningitidis bacterial meningitis?
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1. Pen G
2. Rifampin or fluoroquinolone prophylaxis for close contacts |
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What was formely the #1 casue of bacterial menigitis in children until the vaccine?
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H. influenzae type B
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what are the characteristics of H. influenzae bacterial meningitis?
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1. now rare, but can cause epiglottitis
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what is tx for H. influenzae bacterial meningitis?
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cefotaxime (claforan)
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what is the #1 cause of bacterial meningitis in neonates?
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s. agalactiae (group B strep)
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how is s. agalactiae bacterial meningitis acquired in neonates?
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acquired at birth
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what is the tx for s. agalactiae bacterial meningitis?
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ampicillin
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what is another common organism of bacterial meningitis found in neonates?
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1. e. coli
2. acquired at birth 3. tx with cefotaxime |
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what organism is common for bacterial meningitis in:
1. elderly/neonates 2. AIDS 3. diabetes 4. steroids |
Listeria monocytogenes
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how do you dx listeria monocytogenes for bacterial meninigitis?
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1. difficult CSF gram stain/cx
2. dx--blood cx |
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how do you tx bacterial meninigitis with listeria monocytogenes?
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ampicillin
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what organism do you find in bacterial meningitis in trauma/neurosurgical pts?
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staphylcoccus aureus
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where does staph aureus start from for bacterial meningitis in trauma/neurosurgical pts
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wound infxn from skin
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how do you tx staph aureus bacterial meninigitis?
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oxacillin/vancomycin
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what are si/sx of encephalitis?
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similar to meningitis, but focal findings are evident
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what are si/sx of an neurologic abscess?
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1. HA
2. fever 3. increased intracranial pressure (ICP) 4. focal neurologic findings |
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what are risk factors for a neurologic abscess?
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1. congential R-to-L shunt (lung filtration bypassed)
2. otitis 3. paranasal sinusitis 4. metastases 5. trauma 6. immunosuppression |
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what are causes of a neurologic abscess?
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1. anaerobes and aerobes
2. gram-pos cocci 3. gram-neg rods |
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what is tx for a neurologic abscess?
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1. abx +
2. surgical drainage!!! 3. brain abscesses are invariably fatal in untreated |
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what are two helminthic infections that can cause a neurologic abscess?
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1. cysticercosis (taenia solium)
2. hydatid cysts (echinococcus) |
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how is cysticercosis transmitted?
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1. cysticercosis=taenia solium
2. helminthic infx causing a neurologic abscess 3. eggs transmitted by fecal-oral route 4. tx=praziquantel + steroids (dead cyst=inflamm) |
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how do you tx cysticercosis (taenia solium)?
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1. praziquantel +
2. steroids (b/c dead cyst=inflamm) |
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what is encephalitis in Lain American immigrant caused from until proven otherwise?
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Neurocysticercosis!!!!
*cysticercosis (taenia solium); helminthic infxn |
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what is a hydatid cyst?
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1. echinococcus
2. neurologic absess--cysts that rupture can cause fatal anaphylaxis 3. acquired by dog feces |
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how do you tx a hydatid cyst?
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echinococcus (helminthic infx)
1. mebendazole 2. careful surgical excystation |
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what are si/sx of toxoplasmosis encephalitis?
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1. multiple ring-enhancing lesions
2. causing focal neurologic deficits |
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what is toxoplasmosis encephalitis?
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1. transplacental congenital dz from exposure to T. gondii
2. leading to hydrocephalus and mental retardation |
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what is tx for toxoplasmosis encephalitis?
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Bactrim (trimethoprim/sulfonamide)
*used to tx a number of bacterial and parasitic infxn |
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what is the #1 CNS lesion in AIDS?
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1. toxoplasmosis!!
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how do you acquire toxoplasmosis encephalitis?
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1. adults exposed via cat feces
2. get the dz if immunosuppressed 3. toxoplasmosis antibody test is very sensitive |
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when do you begin prophylaxis for toxoplasmosis encephalitis in an AIDS pt?
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prophylax with bactrim if CD4<200
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what is the #1 cause of viral encephalitis?
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HSV!!!
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what are the si/sx of HSV encephalitis?
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1. olfactory hallucinations
2. bloody CSF 3. personality changes 4. temporal lobe dz on EKG/MRI |
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what is tx for HSV encephalitis?
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acyclovir!!!
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what is the etiology of tabes dorsalis and dementia paralytica?
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syphilis!
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what is tabes dorsalis?
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1. B/L spinal cord demyelination
2. caused by syphilis (treponema pallidum) 3. may bee argyll-robertson pupil (pupil accommodates, but does not react to direct light) |
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what are si/sx of tabes dorsalis?
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1. pain
2. hypotonia 3. decreased tone 4. decreased DTRs 5. decreased proprioception 6. incontinence |
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what is tx for syphilis encphalitis?
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IV penicillin
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what is dementia paralytica?
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1. cortical atrophy, neuron loss, gliosis
2. caused by syphilis (treponema pallidum) |
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what are si/sx of dementia paralytica?
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1. psychosis
2. dementia 3. personality change |
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what is Argyll-Robertson pupil?
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1. pupil accommodates but does not react to direct light
2. seen in meninigovascular dz of syphilis |
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what is Tabes dorsalis?
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1. chronic progressive degeneration of the parenchyma of the posterior columns of the spinal cord
2. may see Argyll-Robertson pupil (reacts poorly to light, but well to accommodation) |
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what is PML (progressive multifocal leukoencephalopathy)?
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1. diffuse neurologic dz
2. usually seen in AIDS 3. caused by JC virus 4. tx the HIV |
