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77 Cards in this Set

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what is m/c organism for meningitis?
1. streptococcus pneumonia (50%)
2. Neisseria menigitidis (25%)
3. H. flu= no rare b/c of vaccination
what is n/c organism for meningitis in neonates, elderly and immunocompromised?
Listeria
what are the #1 and #2 m/c causes of neonatal meningitis?
1. group B strep (strep agalactiae)
2. E. coli
what are the si/sx of meningitis clinically?
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
what is kernig's sign?
1. seen in meningitis
2. pt is supine c/ hip and kneed flexed at 90 degrees, examiner cannot extend knee
what is brudzinski's sign?
1. seen in meningitis
2. pt is supine when examiner flexes nect, pt involuntarily flexes hip and knees
what labs should you obtain for acute meningitis?
1. CSF for gram stain
2. bacterial cultures
3. herpes simplex (HSV) PCR
for viral causes of meningitis, what two can be treated?
1. HSV (tx with acyclovir)
2. HIV (tx with AZT)
what do you tx meningitis from HSV with?
acyclovir
what are the CSF findings in bacterial meningitis?
1. increased neutrophils
2. high protein (>50)
3. low glucose (<2/3 serum) (<45)
what are the CSF findings in viral meningitis?
1. increased mononuclear cells/lymphocytes
2. high protein (>50)
3. normal or low glucose
what are the CSF findings in fungal meningitis?
1. mod. increase in lymphocytes
2. high protein (>50)
3. low glucose (<45)
what are normal CSF findings?
1. 0-5 lymphocytes
2. protein 15-45
3. glucose 45-85
what are si/sx of subacute/chronic meningitis?
per acute but evolves over wks to mon; +/- fever
what are ddx of subactue/chronic meningitis?
1. fungal
2. mycobacterial
3. noninfectious
what are ddx of fungal meningitis?
1. cryptococcus (common in AIDS; seen on india ink stain)
2. coccidioides (blastocysts seen on CSF cytology)
what is the m/c organism in an AIDS pt with fungal meningitis?
1. cryptococcus
2. india ink stain will show organisms in CSF
3. opening pressure is commonly elevated
how do you determine coccidioides for fungal meningitis?
1. coccidioides blastocysts seen on CSF cytology
how do you tx fungal meningitis?
1. IV amphotericin B (intrathecal may be necessary)
2. for cryptococcus and coccidioides)
what type of meningitis is found in elderly by reactivation?
TB meningitis
dx is made by TB PCR of the CSF
what is the tx for TB meningitis?
RIPE:
R=rifampin +
I=INH +
P=pyrazinamide +
E=ethambutol
other causes of subacute/chronic meningitis include:
1. sarcoid
2. cancer
3. collagen-vascular dz
4. drug reactions
what are the m/c etiologies of meningitis in neonates (<1 mon)?
1. S. agalactiae (group B strep)
2. E. coli
3. Listeria
what is the tx regimen for meningitis in neonates?
1. ampicillin +
2. cefotaxime

(group B strep, e. coli, listeria)
what are the m/c etiologies of meningitis in children and teens?
1. strep pneumo
2. n. meningitidis
what is the tx regimen for meningitis in children and teens?
1. cefotaxime +
2. vancomycin (d/t increaseing rate of B-lactam reistance in S. pneumo)

(strep pnemo, n. menigitidis)
what are the m/c etiologies of meningitis in adults?
1. strep pneumo (by far!!)
what is the tx regimen for meningitis in adults?
1. cefotxime +
2. vancomycin (d/t increaseing rate of B-lactam reistance in S. pneumo)

(strep pnemo)
what is the m/c cause of bacterial meningitis in adults?
streptococcus pneumoniae
what is the m/c cause of bacterial menigitis in the elderly, asplenic pts and pts with poor health?
streptococcus pneumoniae
what are the characteristics of strep pneumo bacterial meningitis?
1. can progress from otitis media, sinusitis, or bacteremia
what is the tx for strep pneumo bacterial meningitis?
1. Pen G (if susceptible)
2. cefotaxime (2nd line)=claforan
3. vancomycin (3rd line)
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
what are the characteristics of N. meningitidis bacterial meningitis?
1. petechiae on trunk and legs
2. conjunctivae
3. beware of Waterhouse-Friderichsen syndrome (adrenal infarct)
what is tx for N. meningitidis bacterial meningitis?
1. Pen G
2. Rifampin or fluoroquinolone prophylaxis for close contacts
What was formely the #1 casue of bacterial menigitis in children until the vaccine?
H. influenzae type B
what are the characteristics of H. influenzae bacterial meningitis?
1. now rare, but can cause epiglottitis
what is tx for H. influenzae bacterial meningitis?
cefotaxime (claforan)
what is the #1 cause of bacterial meningitis in neonates?
s. agalactiae (group B strep)
how is s. agalactiae bacterial meningitis acquired in neonates?
acquired at birth
what is the tx for s. agalactiae bacterial meningitis?
ampicillin
what is another common organism of bacterial meningitis found in neonates?
1. e. coli
2. acquired at birth
3. tx with cefotaxime
what organism is common for bacterial meningitis in:
1. elderly/neonates
2. AIDS
3. diabetes
4. steroids
Listeria monocytogenes
how do you dx listeria monocytogenes for bacterial meninigitis?
1. difficult CSF gram stain/cx
2. dx--blood cx
how do you tx bacterial meninigitis with listeria monocytogenes?
ampicillin
what organism do you find in bacterial meningitis in trauma/neurosurgical pts?
staphylcoccus aureus
where does staph aureus start from for bacterial meningitis in trauma/neurosurgical pts
wound infxn from skin
how do you tx staph aureus bacterial meninigitis?
oxacillin/vancomycin
what are si/sx of encephalitis?
similar to meningitis, but focal findings are evident
what are si/sx of an neurologic abscess?
1. HA
2. fever
3. increased intracranial pressure (ICP)
4. focal neurologic findings
what are risk factors for a neurologic abscess?
1. congential R-to-L shunt (lung filtration bypassed)
2. otitis
3. paranasal sinusitis
4. metastases
5. trauma
6. immunosuppression
what are causes of a neurologic abscess?
1. anaerobes and aerobes
2. gram-pos cocci
3. gram-neg rods
what is tx for a neurologic abscess?
1. abx +
2. surgical drainage!!!
3. brain abscesses are invariably fatal in untreated
what are two helminthic infections that can cause a neurologic abscess?
1. cysticercosis (taenia solium)
2. hydatid cysts (echinococcus)
how is cysticercosis transmitted?
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)
how do you tx cysticercosis (taenia solium)?
1. praziquantel +
2. steroids (b/c dead cyst=inflamm)
what is encephalitis in Lain American immigrant caused from until proven otherwise?
Neurocysticercosis!!!!
*cysticercosis (taenia solium); helminthic infxn
what is a hydatid cyst?
1. echinococcus
2. neurologic absess--cysts that rupture can cause fatal anaphylaxis
3. acquired by dog feces
how do you tx a hydatid cyst?
echinococcus (helminthic infx)
1. mebendazole
2. careful surgical excystation
what are si/sx of toxoplasmosis encephalitis?
1. multiple ring-enhancing lesions
2. causing focal neurologic deficits
what is toxoplasmosis encephalitis?
1. transplacental congenital dz from exposure to T. gondii
2. leading to hydrocephalus and mental retardation
what is tx for toxoplasmosis encephalitis?
Bactrim (trimethoprim/sulfonamide)
*used to tx a number of bacterial and parasitic infxn
what is the #1 CNS lesion in AIDS?
1. toxoplasmosis!!
how do you acquire toxoplasmosis encephalitis?
1. adults exposed via cat feces
2. get the dz if immunosuppressed
3. toxoplasmosis antibody test is very sensitive
when do you begin prophylaxis for toxoplasmosis encephalitis in an AIDS pt?
prophylax with bactrim if CD4<200
what is the #1 cause of viral encephalitis?
HSV!!!
what are the si/sx of HSV encephalitis?
1. olfactory hallucinations
2. bloody CSF
3. personality changes
4. temporal lobe dz on EKG/MRI
what is tx for HSV encephalitis?
acyclovir!!!
what is the etiology of tabes dorsalis and dementia paralytica?
syphilis!
what is tabes dorsalis?
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)
what are si/sx of tabes dorsalis?
1. pain
2. hypotonia
3. decreased tone
4. decreased DTRs
5. decreased proprioception
6. incontinence
what is tx for syphilis encphalitis?
IV penicillin
what is dementia paralytica?
1. cortical atrophy, neuron loss, gliosis
2. caused by syphilis (treponema pallidum)
what are si/sx of dementia paralytica?
1. psychosis
2. dementia
3. personality change
what is Argyll-Robertson pupil?
1. pupil accommodates but does not react to direct light
2. seen in meninigovascular dz of syphilis
what is Tabes dorsalis?
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)
what is PML (progressive multifocal leukoencephalopathy)?
1. diffuse neurologic dz
2. usually seen in AIDS
3. caused by JC virus
4. tx the HIV