133 - Acute Meningitis Flashcards
(45 cards)
General damage, usually due to a __ infection, will be treated as __, and local will be called __ or __, depending on the involvement of the capsule
viral
encephalitis
cerebritis
abscess
Neck stiffness is pathognomonic for __
meningeal irritation
Acute meningitis, empiric __ should be administered soon after __ was taken
Abx
cultures
What are the indications for performing imaging (CT/MRI) prior to LP?
recent trauma immunodepression CNS malignancy focal signs/papilledema decreased consciousness
Immunocompetent with normal consciousness, no previous Abx, typical viral meningitis CSF- should be treated as __. If no improvement after _ h, reevaluate including __
outpatients
48
LP
What is typical viral meningitis CSF sample? lymphocytosis _-_ protein _-_ mg/dL glucose \_\_ opening pressure _-_ \_\_ may be high in the first 48h
25-500 20-80 (normal) normal 100-350 (normal- slightly high) PMN
Acute bacterial meningitis=__
acute infection of the subarachnoid space
What are the common pathogens causing bacterial meningitis? 5
pneumococcus neisseria meningitis GBS Listeria Haemophilus (decreased thanks to vaccination)
What is the most common pathogen causing meningitis? what is the main risk factor? what is the prognosis under treatment?
S. pneumoniae
pneumococcus pneumonia
20%
Mention risk factors for S. pneumoniae meningitis beside pneumococcus pneumonia: 5
sinusitis/OM alcoholism diabetes splenectomy hypogammaglobulinemia/complement deficiency
What is the leading cause for acute bacterial meningitis in ages of 2-20? more in patients with __
neisseria meningitis
complement deficiency
What is the classical triad of bacterial meningitis?
fever
headache
neck stiffness
Acute bacterial meningitis if untreated will __ quickly within days, decreased __,nausea-vomiting, __, __ (focal/general), increased __.
deteriorate consciousness photophobia seizures ICP
Maculopapular rash might suggest __ infection
meningococcemia
When suspecting acute bacterial meningitis: __->__->__->__
blood cultures
LP
empiric treatment
dexamethasone
Diagnosing acute bacterial meningitis is based on: opening pressure >\_\_mmH20 WBC> \_\_ cells/uL (mostly\_\_) no \_\_ glucose \_\_ mg/dL G stain will be positive in \_\_% of cases culture will be positive in \_\_% of cases consider Latex agglutination test/PCR
180 100, neutrophils RBV 40 0.4 45 60 80
What is the best imaging test for meningitis?
MRI, better than CT
What are the 4 DDx you should consider when suspecting acute bacterial meningitis?
HSV encephalitis
rickettsia
focal inflammation (abscess)
non infectious process (subarachnoid hemorrhage)
In acute bacterial meningitis Abx should be given in the first __ minutes of arrival
60
What are the empiric Abx for acute bacterial meningitis?
Dexamethasone should always be added to reduce the edema
cephalosporins (3rd/4th gen)
vancomycin
acyclovir
doxycycline
Red man syndrome is a diffused__ when giving __ of __. To avoid it, choose __ drip.
erythema
IV
vancomycin
slow
Immunocompetent children >_ and adults
cefotaxime
ceftriaxone
cefepime + vancomycin
Adults > 55, any alcoholics, debilitating illness should receive the following Abx:
Ampicillin + cefotaxime/ceftriaxone
or
cefepime + vancomycin
Nosocomial meningitis, posttraumatic/post-neurosurgery op, neutropenic, impaired cell mediated immunity- should receive the following Abx:
Ampicillin + ceftazidime
or
meropenem + vancomycin
