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49 Cards in this Set
- Front
- Back
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What are the meninges?
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membranes that cover the brain and spinal cord
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List 9 differential dx for meningitis / encephalopathy.
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1. Viral meningitis
2. Fungal meningitis 3. Bacterial meningitis 4. Chemical / drug induced 5. Collagen vasc d/o 6. Reyes syndrome 7. Other infection such as brain abscess or epidural abscess. 8. SAH 9. Neuroleptic malignant syndrome |
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What is the difference in sites of inflammation b/w encephalitis and meningitis?
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Encephalitis - brain & parenchyma
Meningitis - meninges & parenchyma |
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What is the most common SPORADIC form of encephalopathy / viral meningitis?
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Herpes simplex
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What is the most common EPIDEMIC form of encephalopathy / viral meningitis & how is it transmitted?
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Arbovirus; transmitted via mosquitoes, ticks etc.
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Are the microbes in bacterial meningitis more commonly gram + or gram -? What is a good drug for broad coverage?
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Gram -
Cephalosporins |
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List the 7 major organisms responsible for bacterial meningitis and their % of all cases.
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1. S. pneumoniae - 30-50%
2. N. meningitidis 10-35% 3. H. influenzae - 1-3% 4. GN bacilli - 1-10% 5. Listeria - 5% 6. Streptococci - 5% 7. Staphylcocci - 5-15% |
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What is the triad of meningismus?
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nuchal rigidity
HA light sensitivity |
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List 10 s/s of meningitis in order of most frequently occuring to least freq occuring.
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1. HA (90%)
2. Fever (90%) 3. Meningismus (85%) 4. Altered sensorium (80%) 5 & 6. + Kernigs / Brudzinski (50% each) 7. vomiting (35%) 8. Seizure (30%) 9. Focal findings (10-20%) 10. papilledema (<1%) |
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List 4 major pathways that predispose someone to developing meningitis.
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1.Colonization by pathogens followed by mucosal invasion of nasophar. or neural pathways.
2. Fracture in area of cribiform plate with bacteria crossing over. 3. s/p a systemic infection such as bactermia (i.e post UTI, endocard, pneum). 4. Immune compromising conditions such as HIV, excess steroid use, apslenic |
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What is the Brudzinski sign?
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when neck is flexed, the hips spontaneously flex. Indicated nuchal rigidity
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What is Kernig's sign?
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When hip is flexed at 90 degrees and knee is flex, one attempts to extend knee and there is either reluctance or inability to do so.
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What are some specific clinical manifestations of infection with N. meningitides?
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-petechiae
- palpable purpura (look in "tight" spots under clothes) |
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What two blood tests should everyone have if suspicious of meningitis?
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CBC and Blood Cx
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What would you expect to see on CBC in bacterial meningitis?
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-WBC elevated with left shift
-plt possibly decreased with DIC or with meningococcal bacteremia. |
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What microbe yields the LOWEST positive BC in meningitis?
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Meningococcal
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When should you get a brain CT BEFORE an LP?
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if there are s/s of increased ICP or SAH
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Describe LP findings in bacterial meningitis.
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CSF glucose - <45 mg/dL
Protein >500 mg/dL WBC above 1000 /mm3 |
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When should empiric antimicrobial treatment be started?
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As soon as the dx is suspected
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What is the class of drug of choice for EMPIRIC treatment of meningitis?
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third generation cephalosporins such as cefotaxime or ceftriaxone
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What pathogen do cephalosporins NOT cover and who is more likely to have this?
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- Listeria
- >50 y/o's |
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What 2 drug combo should be used to begin empiric tx of bacterial meningitis (include doses)?
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Ceftriaxone 2 gm IV q12h OR Cefotaxime 2 gm IV q4-6hr AND Vanco 15 mg/kg q6-12 hr
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What drug should also be added to empiric tx regimens if the patient is 50 y/o? Why?
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Ampicillin 2 gm IV q4hrs
- b/c it provides listeria coverage |
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What was TRADITIONAL tx for s. pneumo meningitis and why is it problematic now?
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- IV PCN 4 million units q4hr
- problem due to drug resistant strains |
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With S. Pneumo and local beta lactam resistance or other reason to suspect DRSP, what med regimen should be started?
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Ceftriaxone or Cefotaxime AND Vanco.
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When can 3rd gen cepahlosporins be used to tx s. pneumo ( at what MIC)?
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when the MIC is less that 0.5 mcg/ml
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What is the usual duration of tx for s. pneumo meningitis?
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2 weeks
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If corticosteroids are used to treat meningitis, what other drug should be added and why?
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Rifampin; b/c it increases the efficacy of the other 2 drugs in the empiric regimen.
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What is the drug (s) of choice to treat H. influenzae meningitis (include doses and duration)
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Ceftriaxone 2 gm q12hr x 5-7 days OR
Cefotaxime 2 gm q6hr x 5 - 7 days |
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With H. influenzae meningitis, when might you need to add Rifampin and at what doses?
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b/c pharyngeal colonization persists for short time after tx, if there are other kids in home at risk for HIB infection, Rifampin should be used
Dose 20 mg/kg/D (max 600 mg/d) x 4 days |
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Describe tx for N.meningitides meningitis.
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- Drug PCN (3rd gen ceph is an alternative)
PCN resistance is rare Tx is for 5 days - Due to pharyngeal colonization, may need rifampin, fluoroquinolone, or cephalosporin |
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What drug are used for listeria meningitis treatment?
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Ampicllin 2 gm q4-6hr x 3 weeks minimum (primary drug) AND
Gentamicin (for synergy) |
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What an alternative to tx with ampicillin in listeria?
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Bactrim 10/50mg/kg/day in 2-3 divided doses for 3 weeks minimum
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How are gram negative enteric rods tx in meningitis?
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- High dose 3rd gen Ceph
- x 3 weeks minimum - repeat CSF sampling 2-4 days into tx to assess for efficacy |
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What year did HIB vaccination begin and how much has it reduced h. influenzae meningitis?
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-1987
-94% |
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What are the majority of meningococcal infections caused by (type) and is there a vaccine for it?
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type b
no |
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What are meningitis vaccines largely active against?
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N. meningitides strains
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Who should get vaccinated for type a meningococcal meningitis?
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travelers and American military to endemic areas
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What medications are used to eradicate pharyngeal carriage and for which causative agents?
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For HIB and meningococcal (not pneumococcal)
Rifampin 600 mg PO Q12 hr x 4 doses OR Cipro 500 mg PO x 1 (over 18 only) |
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Discuss survival advantage and neuro complications in PEDS with use of corticosteroids as adjuvant tx.
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- No proven survival benefit
- multiple studies show decreased hearing loss / deafness WITH CS - particularly for HIB infections |
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Discuss corticosteroid use for meningitis in adults.
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- no consensus on use
- Inf Dis Soc of American considers them unsupported for routine use in ADULTS |
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What are the 3 major families of arboviruses that can cause encephalitis?
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1. Togaviridae (Eastern, Western, and Venezualan Equine enceph)
2. Flaviviridae (West Nile, Dengue, Yellow fever) 3. Bunyaviridae (colorado tick fever, reoviruses, La Cross enceph) |
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When and where was west nile first isolated and when did it come to the western hemisphere?
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- isolated in Uganda in 1937
- Came to West 1999 - 2001 |
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What are two major carriers of West Nile Virus?
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Mosquitoes (culex pipiens)
Migratory birds (jays, crows, hawks) Ticks |
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What is the incubation peroid of West Nile?
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5-15 days
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What are 4 common symptoms in mild cases of West Nile and how long do they last?
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1. Fever
2. HA 3. Myalgias / arthalgias 4. anorexia LAST 3-6 days |
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What are less common symptoms of West Nile?
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- GI n/v/d
- maculopapular rash (trunk > extremities) |
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What are two rare but serious complications of West Nile?
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Pancreatitis
Myocarditis |
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Who recovers quicker in West Nile virus (Peds / adults)? What age group has most fatalities?
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PEDS recover quicker
> 50 y/o has highest mortality |
