Bacterial Meningitis

Question 0

Meningitis - clinical presentation

Answer 0

Fever
Stiff neck
Headache
Altered mental status
Seizures

Question 1

Meningitis - pathophysiology

Answer 1

Bacteria trigger inflammation
Reduced CSF drainage
Intracranial vessels expand 
Blood brain barrier disrupted and worsens swelling
Increased ICP -> ischemia

Question 2

Meningitis - physical exam

Answer 2

Signs of meningeal irritation (brudzinski sign, kernig sign)
Skin - purpura
Eyes - papilledema

Question 3

Why is dexamethasone given in bacterial meningitis treatment?

Answer 3

To decrease the long term Neuro effects

Should be within 10-20 minutes before abx, not much benefit after abx started

Question 4

When do you use amp in the meningitis treatment plan?

Answer 4

When suspect listeria monocytogenes (very young and old)

Question 5

Why should you consider a CT scan before a lumbar puncture?

Answer 5

There is a risk of herniating the brain stem.

Higher risk: immunocompromised, CNS disease, papilledema

Question 6

Which abx are used to pseudomonas in meningitis?

Answer 6

Cefepime (3rd gen ceph) and miripenem (carbopenem)

Question 7

Meningitis - <1 month

Answer 7

Amp + (cefotaxime or gent)

Question 9

Meningitis - 1 month to 50 years

Answer 9

Vanc + (Rocephin or cefotaxime)

Question 10

Meningitis >50 yrs

Answer 10

Vanc + amp + (Rocephin or cefotaxime)

Question 11

Meningitis (basilar skull fracture)

Answer 11

Vanc + (Rocephin or cefotaxime)

Question 12

Meningitis (penetrating trauma, post neurosurgery or CSF shunt)

Answer 12

Vanc + (Cefepime - pseudos, meropenem - pseudos or Rocephin)

Question 13

Meningitis - strep pneumo

Answer 13

Vanc + (Rocephin or cefotaxime)

10-14 days

Question 13

Meningitis - listeria or strep agalactiae

Answer 13

Amp +/- gent or PCN +/- gent
S.agalactiae x 14-21 days
Listeria >21 days

Question 14

Meningitis - neisseria meningitidis, h. Influenza or e.coli

Answer 14

Rocephin or cefotaxime
7 days (21 for E. coli)