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IM INFECTIOUS > BAC MENINGITIS > Flashcards

BAC MENINGITIS Flashcards

1
Q
  • Is an acute purulent infection w/in the subarachnoid space
  • associated w/ a CNS inflammatory reaction that may result in decrease consciousness, seizures, raised intracranial pressure and stroke
A

Meningitis

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2
Q

Involved in the inflammatory reaction of Meningoencephalitis

A
  • Meninges
  • SAS
  • brain parenchyma
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3
Q

Organisms most often responsible for community-acquired bacterial meningitis

A
  • S. pneumoniae
  • Neisseria meningitidis
  • GBS
  • L. monocytogenes
  • H. influenzae
  • N. meningitidis - causative agent of recurring epidemics of meningitits every 8-12 yrs.
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4
Q

Bacterial organism Most common in adults >20 years of age

A

Streptococcus pneumoniae

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5
Q

Bacterial organism Incidence has decreased with routine immunization of 11-18-years-old with quadrivalent meningococcal glycoconjugate vaccine.

A

Neisseria meningitidis

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6
Q

Bacterial organism Can cause meningitis in individuals with

chronic and debilitating diseases (diabetes, cirrhosis, chronic UTI) and can complicate neurosurgical procedures.

A

Gram (-) Bacilli

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7
Q

Bacterial organism Otitis, mastoiditis, and sinusitis are predisposing and associated conditions for meningitis

A
  • Haemophilus sp.
  • Enterobactereciae
  • Staphylococcus aureus
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8
Q

Bacterial organism Meningitis complicating endocarditis

A
  • Staphylococcus aureus
  • Streptococcus viridans, Strep. bovis
  • HACEK Group
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9
Q

Bacterial organism

  • Previously responsible for meningitis HACEK or. predominantly in neonates
  • Reported with increasing frequency in individuals aged >5O years
A

Group B Streptococcus

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10
Q

Bacterial organism

  • important cause of meningitis in neonates (<1 month of age), pregnant women, individuals >60 years, and immunocompromised individuals of all ages.
  • acquired by ingesting foods contaminated by Listeria.
A

Listeria monocytogenes

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11
Q

Bacterial organism causes meningitis in unvaccinated children and older adults

A

H Influenza

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12
Q

Classic clinical triad of BACTERIAL MENINGITIS

A
  • Fever
  • Headache
  • Nuchal rigidity
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13
Q

Clinical Manifestation of Bacterial Meningitis

A
  • Decrease level of consciousness (>75% of patients)
  • Fever, Headche
  • Nausea , Vomiting and Photophobia
  • Seizures (20-40%)
  • Raised ICP
  • Kernig’s sign
  • Brudzinski’s sign
  • Rash of meningococcemia
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14
Q
  • Major cause of obtundation and coma
  • > 90% CSF opening pressure >180 mmH20, 20%: >400 mmH20
    Signs: Deteriorating level of consciousness, papilledema, dilated poorly reactive pupils, sixth nerve palsies, decerebrate posturing and Cushing reflex (bradycardia, hypertensions and irregular respirations)
  • Cerebral herniation - most disastrous complication
A

Raised ICP

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15
Q

DIAGNOSIS of Bacterial Meningitis

A
  • Blood Culture
  • Lumbar puncture for CSF evaluation
  • CT scan or MRI
  • Biopsy of petechial skin lesions
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16
Q

CSF PATHOGEN PANELS OF BACTERIAL MENINGITIS

A
  • Latex Agglutination (LA) Test
  • CSF bacterial PCR assay
  • Limulus amebocyte lysate assay
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17
Q

Cerebrospinal Fluid (CSF) Abnormalities in Bacterial

  • Opening pressure:
  • White blood cells:
  • Red blood cells:
  • Glucose:
  • CSF/serum glucose:
  • Protein:
  • Gram’s stain:
  • Culture:
  • PCR:
  • Latex agglutination:
  • Limulus lysate:
A
  • Opening pressure: >180 mmH,0
  • White blood cells: 10/tL to 10,000/L; neutrophils predominate
  • Red blood cells: Absent in nontraumatic tap
  • Glucose: <2.2 mmol/L (<40 mg/dL)
  • CSF/serum glucose: <0.4
  • Protein: > 0.45 g/L
  • Gram’s stain: Positive in >60%
  • Culture: Positive in >80%
  • PCR Detects bacterial DNA
  • Latex agglutination: May be positive in patients with meningitis due to Streptococcus pneumoniae, Neisseria meningitis, Haemophilus influenzae type b, Escherichia coli, GBS
  • Limulus lysate Positive in cases of gram-negative meningitis
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18
Q

TREATMENT : Empirical Antibiotic Therapy

A
  • begin antibiotic therapy within 60 min of a patient’s arrival in the emergency room
  • initiated in patients with suspected bacterial meningitis before the results of CSF Gram’s stain and culture are known
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19
Q

Empirical therapy of community acquired suspected meningitis in children & adults

A
  • Combination of Dexamethasone, 34 or

- 4” gen cephalosporins, vancomycin plus acyclovir

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20
Q

good coverage for susceptible S. pneumoniae, group B streptococci, and H. influenzae and adequate coverage for N. meningitidis

A

Ceftriaxone or Cefotaxime

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21
Q

in vitro activity similar to that of cefotaxime or ceftriaxone against Sneumoniae and N. meningitidis andgreater activity against Enterobacter species and Pseudomonas aeruginosa

A

Cefepime

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22
Q

added to the empirical regimen for coverage of L. monocytogenesin individuals <3 months of age, those >55, or those with suspected impaired cell-mediated immunity

A

Ampicillin

23
Q

added to cover gram-negative anaerobes in patients with otitis, sinusitis, or mastoiditis.

A

Metronidazole

24
Q

hospital acquired meningitis (following neurosurgical procedures) tx

A

Combination of Vancomycin and Ceftazidime or Meropenem

25
Q
  • Highly active in vitro against L. monocytogenes
  • effective in cases of meningitis caused by P. aeruginosa
  • Shows good activity against penicillin-resistant pneumococci
A

Meropenem

26
Q

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections

INDICATION:
Preterm infants to infants <1month

A

Ampicillin + cefotaxime

27
Q

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections

INDICATION:
Infants 1-3 months

A

Ampicillin + cefotaxime or ceftriaxone

28
Q

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections

INDICATION:
Immunocompetent children >3 months and adults <55

A

Cefotaxime, ceftriaxone, or cefepime + vancomycin

29
Q

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections

INDICATION:
Adults >55 and adults of any age with alcoholism or other debilitating illnesses

A

Ampicillin + cefotaxime, ceftriaxone
or

cefepime + vancomycin

30
Q

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections

INDICATION:
Hospital-acquired meningitis, posttraumatic or postneurosurgery meningitis, neutropenic atients, or patients with impaired cell-mediated immunity

A

Ampicillin + ceftazidime, ceftriaxone
or

meropenem + vancomycin

31
Q

antibiotic of choice for susceptible strains

A

-Penicillin G

32
Q

Antibiotic for penicillin resistant strains

A

-Ceftriaxone or Cefotaxime

33
Q

days IV antibiotic therapy is adequate for uncomplicated Meningococcal Meningitis

A

7 days

34
Q

Chemoprophylaxis which through by Close contacts: individuals who have had =contact — with oropharyngeal
secretions, either through kissing or by sharing toys, beverages, or cigarettes.: 2 day regimen of

A

Rifampin

35
Q

alternative treatment for adults having Meningococcal Meningitis

A

-One dose Azithromycin (SOOmg) or Ceftriaxone IM (250mg)

36
Q
  • Pneumococcal Meningitis Antibiotic Use
  • ## week course of IV antimicrobial therapy is recommended
A

Cephalosporins and Vancomycin

37
Q

strains of S. pneumoniae meningitis should have a repeat LP performed ____ after the initiation of antimicrobial therapy to document sterilization of the CSF.

A

24-36 h

38
Q

Patients with penicillin- and cephalosporin-resistant strains
of S. pneumoniae who do not respond to intravenous vancomycin alone may benefit from the addition of ____ vancomycin.

A

intraventricular

39
Q

Specific Antimicrobial Therapy for Listeria Meningitis

A

Ampicillin: at least 3 weeks

40
Q

added in critically ill patient (2mg/kg loading dose , then 7.5
mg/kg per day given every 8 h and adjusted for serum levels and renal) with Listeria Meningitis

A

Gentamicin

41
Q

alternative in penicillin allergic patients with Listeria Meningitis

A
  • trimethroprin + sulfamethoxazole
42
Q

Specific Antimicrobial Therapy for Staphyloccocal Meningitis suspectible strains

A

Naficillin

43
Q

DOC for MRSA and patient allergic to penicillin for Staphyloccocal Meningitis

A

Vancomycin

44
Q

If the CSF is not sterilized after 48h of IV vancomycin, either
intraventricular or intrathecal vancomycin , ___ once daily can be added in treating Staphyloccocal Meningitis

A

20 mg

45
Q

Specific Antimicrobial Therapy for Gram-Negative Bacillary Meningitis

A

3rd-Gen cephalosporins:

  • Cefotaxime,
  • Ceftriaxone
  • Ceftazidime,
46
Q

Tx for meningitis due to P. aeruginosa

A

Ceftazidime or Meropenem

47
Q

course of intravenous antibiotic therapy is recommended for therapy for Gram-Negative Bacillary Meningitis

A

-3-week

48
Q
  • inhibits the synthesis of IL-1B and TNF-a at the level of mRNA
  • decreases CSF outflow resistance
  • Stabilize the blood-brain barrier
A

Dexamethasone

49
Q

Started Adjunctive therapy ____ before, or not later than concurrent with, the first dose of antibiotics.

A

20 min

50
Q

Emergency treatment of increased ICP:

A
  • elevation of the patient’s head to 30-45S°
  • intubation and hyperventilation (Paco2 25-30 mmHg)
  • Mannitol
51
Q

Highest Mortality rate causing BACTERIAL MENINGITIS

A
  • S. pneumoniae - 20%
  • L monocytogenes- 15%
  • H influenza, N meningitidis, GBS- 3-7%
52
Q

Risk of death from bacterial meningitis increases :

A
  • decreased level of consciousness on admission
  • onset of seizures within 24 h of admission
  • signs of increased ICP
  • young age (infancy) and age >SO
  • the presence of comorbid conditions including shock and/or the need for mechanical ventilation
  • delay in the initiation of treatment
53
Q

Decreased CSF glucose concentration _____ and markedly increased CSF protein concentration ____ have been predictive of increased mortality and poorer outcomes in some series.

A
  • (<2.2 mmol/L [<40 mg/dL])

- (>3 g/L [> 300 mg/dL])

54
Q

Sequelae OF BACTERIAL MENINGITIS

A
  • decreased intellectual function,
  • memory impairment,
  • seizures,
  • hearing loss and dizziness, and
  • gait disturbances.

IM INFECTIOUS (13 decks)

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