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PHRM 865: Theraputics V > Lecture 34: CNS infections > Flashcards

Lecture 34: CNS infections Flashcards

1
Q

What are some of the types of CNS Infections?

A
  • Meningitis, Encephalitis, Brain Abscess, Ventriculitis, Subdural Empyema, CSF shunts, etc…
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2
Q

What is the Cerebronspinal Fluid and what are some of the normal characteristics of it?

A
  • CSF is a made from chorid plexus; acts a “shock absorber”; based on age
  • Characteristics: Clear, pH = 7.4, protein < 50, Glucose < 50-66%, WBC < 5 wbc/ml
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3
Q

What is the meninges and what are the 3 separate membranes?

A
  • Ensheathed Protective covering
  • Dura Mater: outer layer connecting to skull
  • Arachnoid: middle layer Subarachnoid Spaces = meningitis happens
  • Pia Mater: Innermost layer connecting to brain
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4
Q

Whare are the Two Distinct barriers within the CNS?

A
  • Blood Brain Barrier
  • Blood-CSF Barrier
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5
Q

What is the Blood Brain Barrier?

A
  • Tightly joined capillary cells; Drugs can enter brain through these
  • BBB is > 5000 times bigger than BCSFB
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6
Q

What is the Blood-CSF Barrier?

A
  • Tightly fused epednymal cells; resticts drugs into the CSF
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7
Q

What are some of the antibiotics characteristics that affect the CNS/CSF penetration?

A
  • Lipid Solubility: highly lipid = high pen
  • Degree of Ionization: dependent on pKa & pH = diffusion
  • Protein binding: ONLY free drug can
  • Molecular Weight: low MW = pentration
  • Meningeal Inflammation: increased inflammation = increased penetration
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8
Q

What is the pathogensis of Meningitis?

A
  • Inflammation of Meninges by pathogens
  • Once bacteria gets into CSF then body cannot conatin it
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9
Q

What are the 3 ways that bacteria gets into the CSF?

A
  • Hematogenous Spread: blood to subarachnoid space most common; comes from nasopharyngeal
  • Contiguous Spread: Parameningeal focus
  • Direct Inoculation: from head trauma or surgery

Blood CSF = Meningitis
Blood Brain = Brain Abcess

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10
Q

What are some of the common pathogens that can cause the Hematogenous Spread?

A
  • N. Meningitidis
  • H. Flu
  • S. Pneumoniae

They have Pili [holds on better], Capsule [incresaes resistance], IgA [enhacne coloincation]

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11
Q

What is the etiology that depends on the age of the patient in Meningitis ?

Neonates? Infants? Childern/young adults? Adults? Elderly? Post-neurosugery? Head Tramua? immunocompormised?

A
  • Neonates: Group B Strep, E. Coli, Listeria
  • Infants: H. Flu, S. Pneumo, N. Meningitidis
  • Childern: N. Meningitidis, S. Pneumo
  • Adults: S. Pneumo, N. Meningitidis
  • Elderly: S. Pneumo, N. Meningitidis, GNR, Listeria
  • Post-Surgery: S. Aureus, GNR, S. Epidermidis
  • Head Trauma: S. Aures, GNR
  • Immunocom: S. Pneumo, N. Meningitidis, Listeria, GNR
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12
Q

What is the characteristics of H. Fluenzae for Meningitis?

A
  • Hib vaccine has decreased it vaccine preventable disease
  • Coma and seizure are common early in infection
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13
Q

What is the characteristics of N. Meningitids in Meningitis?

A
  • Happens in clusters [dorms, high schools, military…] that happens in winter and spring
  • 5 Groups: A, B, C, Y, W-135
  • Meingoccemia: petechial or purpuric rash
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14
Q

What are the characteristics of S. Pneumoniae in Meningitis?

A
  • Highest fatalit rate = 19-26%
  • Risk Factors: pneumonia, Endocarditis, CSF leaky
  • Could cause seizures, facial palsy, visual problems
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15
Q

What are some of the clinical signs and symptoms of Meningitis in Adults, Infants, Elderly, Older Childern?

A
  • Adult: ABRUPT; Fever, Headache, Stiff Neck, Photophobia
  • Infants: Fever
  • Elderly: Low fever, Stiff neck
  • Older Childern: Confusion, Lethargy

Petechial RASH

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16
Q

Where does the CSF get sent to for evaluation and what happens at each place?

A
  • Chemistry: CSF cloudy, Glucose low [increased glycolsis and transport], Protein high
  • Hematology: WBC high, >80% neutrophils
  • Microbiology: Stain of CSF is (+), Culture (+), BioFire PCR
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17
Q

What are the general principles of treatemtn for acute bacterail meningitis?

A
  • Mortality within 24 -48h of onset; prompt treatment ESSENTIAL
  • Start Empiric antibiotics
  • High dose IV to help with penetration
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18
Q

What is the goal for the treatment of Bacterail Meningitis?

A
  • Rapid Sterilization of CSF
  • Resolve Signs and Symptoms
  • Decrease Mortailty
  • Prevent neuro issues
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19
Q

What is the empiric therapy for neonates in Bacterial Meningitis?

Pathogens?

A
  • Ampicillin + Cefotaxime

E. Coli, Group B Strep, Listeria

20
Q

What is the empiric therapy for Children in Bacterial Meningitis?

Pathogens?

A
  • Ceftriaxone + Vancomycin

H. Flu, S. Pneumo, N. Meningitidis

21
Q

What is the empiric therapy for Young Adults in Bacterial Meningitis?

Pathogens?

A
  • Ceftriaxone + Vancomycin

N. Meningitidis, S. Pneumo

22
Q

What is the empiric therapy for Elderly & Immunosppressed in Bacterial Meningitis?

Pathogens>?

A

Ceftriaxone + Vancocmycin + Ampicillin [+/- Cefepime]

S. Pneumo, GNR [Pseudo], Listeria

23
Q

What is the empiric therapy for Neruosurgery in Bacterial Meningitis?

Pathogens?

A
  • Ceftriaxone or Cefepime + Vancomycin

S. Aures, GNR

24
Q

What is the empiric therapy for Head Trauma in Bacterial Meningitis?

Pathogens?

A
  • Ceftriaxone or Cefepime + Vancomycin

S. Aures, GNR

25
Q

What is the Directed Therapy for S. Pneumoniae in Bacterial Meningitis?

PSSP? PRSP? Durtation?

A
  • PSSP: Pen G or Ampicillin
  • PRSP: Vancomycin + Ceftriaxone
  • Duration: 10-14 days
26
Q

What is the Directed Therapy for Group B Strep in Bacterial Meningitis?

Duration?

A
  • Amipicillin +/- Gentamicin
  • Duration: 14-21 days
27
Q

What is the Directed Therapy for S. Aureus in Bacterial Meningitis?

MSSA? MRSA> Duration?

A
  • MSSA: Nafcillin [NOT Cefazolin]
  • MRSA: Vancomycin
  • Duration: 14-21 days
28
Q

What is the Directed Therapy for L. Monocytogenes in Bacterial Meningitis?

Duration?

A
  • Ampicillin +/- Gentamicin
  • Duration: 21 day
29
Q

What is the Directed Therapy for N. Meningitidis in Bacterial Meningitis?

Duration?

A
  • Penicillin or Ceftriaxone
  • Duration 7-10 days
30
Q

What is the Directed Therapy for H. Influenzae in Bacterial Meningitis?

B-Lactamase (-) or (+)? Duration?

A
  • bL(-): Ampicillin
  • bL(+): Ceftriaxone
  • Duration: 7-10 days
31
Q

What is the Directed Therapy for Gram-negatives in Bacterial Meningitis?

Duration?

A
  • Ceftriaxone or Cefepime
32
Q

What is the role of steroids in the treatment of Bacterial Meningitis?

A
  • Dexmethasone for S. pneumoiae
  • Inhibits IL-1 and TNF
  • Good in pediatrics; give with 1st does of antibiotics or 10-15 mins before
33
Q

What is important to know about the Prophylaxis against Bacterial Meningitis?

Regimens?

A
  • Given to those with Close contact [200-1000 times higher with H. Flu or N. Men]
  • N. Men & H. Flu: Adults = Rifampin 600mg & Children = Rifampin 10mg/kg
34
Q

What is the pathogensis of Brain Abscess?

A
  • Contiguous Spread: bacteria into brain tissue by close infections [COMMON]
  • Hematogenous Spread: Travels from distant infection
  • Direct Inoculation: Trauma or Surgery
35
Q

What is the etiology that depends on the Predisposing Factors of the patient of Brain Abscess?

Otitis Media? Sinusitis? Dental Sepsis? Head Trauma? Endocarditis? Lung Abscess? HIV?

A
  • Otitis: Strep, Bacteroides, Prevotella, GNR
  • Sinusitis: Strep, Bacteroides, GNR, S. Aureus, H. Flu
  • Dental: Viridans
  • Head trauma: S. Aureus, Strep, GNR
  • Endocarditis: S. Aureus, Viridians
  • Lungs: Viridians
  • HIV: Toxo
36
Q

What are some of the Clinical Presentaions of Brain Abscess?

A
  • Headache
  • Altered Mental Status
  • Focal Neurologic Deficits
  • Fever
  • Seizures
  • N/V
37
Q

What is the Treatment for Otitis Media in Brain Abscess?

A
  • Ceftriaxone + Metro
38
Q

What is the Treatment for Sinusitis in Brain Abscess?

A
  • Ceftriaxone + Metro
39
Q

What is the Treatment for Dental Sepsis in Brain Abscess?

A
  • Pencillin + Metro
40
Q

What is the Treatment for Trauma or Neurosurgery in Brain Abscess?

A
  • Vancomycin + Ceftriaxone or Cefepime
41
Q

What is the Treatment for Endocarditis in Brain Abscess?

A
  • Vancomycin + Gentamicin
42
Q

What are the most comon etiologies Viral Encephalitis?

A
  • Enteroviruses: Coxsackie Virus A & B; Echovirus, Poliovirus Fecal Oral
  • Arbovirus: West Niles Virus, St. Louis Encephalitis; Mosquitoes & Birds
  • Herps: HSV 1 & 2, CMV, VZV; sexual activity people
43
Q

What are the Clinical Presentations of Viral Encephalitis?

A
  • Fever
  • Headache
  • Altered Mental Status
44
Q

What is the Diagnosis of viral encephalitis?

Opposite to Meningitis?

A
  • Open pressure
  • Chemistry: CSF clear; Glucose Low; Protein High
  • Hematology: WBC High; Increasedm Lymphocytes
  • Mircobiology: (-) stains; BioFire

West Nile Virus is a Separate test

45
Q

What is the treatment and duration for Viral Encephalitis?

A
  • MOST are self-limiting with full recovery in 7-10 days; given supportive carem fluids, analgesics, antipyretices
  • HSV or VZV: Acyclovir 10mg/kg q8h x 2-3w
  • CMV: Gancicolvir + Foscarent IV

PHRM 865: Theraputics V (42 decks)

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