Case Studies Flashcards
Tx of meningitis in LIC?
LP immediately unless CIs
Start abx within 2hrs
Do not necessarily wait for LP or CT
What abx do you avoid in bacterial Meningitis?
pipercillin Tazobactam
Macrolides
TCNs
1st and 2nd gen cephalosporins
Tx of bacterial meningitis?
Avoid steroids
Ceftriaxone ± Ampicillin ±Vancomyc
What is the main causative organism in bacterial meningitis?
Streptococcus Suis
Typically in pig raising areas of India and SE Asia
What vaccines are used in LMIC to prevent bacterial Meningitis
Monovalent A or C
Combine HIB
Quadravalent A, C, Y and W135
MenAfrVac
What is Listeria Meningitis?
Seen in immunocompromised
Assoc with contaminated milk products and processed meat
What are the main causes of subacute meningitis?
TB
Crypto
Syphilis
Most common causes of bacterial meningitis?
Used to be men A
Now other serotype and S Pneumonia
46y/o male with fever/joint pain, headache and myalgia in India in rainy season
Reduced GCS, thrombocytopenia, raised lactate
Orientia Tsutsugamushi
Clinical presentation of scrub typhus? Gold standard diagnosis? Tx?
Incubate for 6-21 days
55% Painless eschar
Fever, fatigue, frontal headache
Generalised maculopapular rash
IgG antibody assay
Doxycycline
54y/o farmer, diabetic, hypertension, CKD. Presents with 2/52 of right facial pain and frozen right eye
Mucormycosis 90 degree branching hyphae
Where is mucor found?
Worldwide, endemic particularly in India
Rhizopus spp/ Mucor Spp
What are main risk factors for mucor?
Diabetes
Prolonged neutropenia
Haematological malignancy
Iron overload
Steroid use
How does rhino-orbital mucormycosis present?
Facial pain and soft tissue swelling
Periorbital oedema, pain, proptosis, blurring
Can cause osteomyeltitis, multiple cranial nerve involvement, Periorbital destruction
Management of mucor?
Debridement
Anti fungal–ampho B can use Isavuconazole or Posaconazole
Reduce Immunosuppression
