BAC MENINGITIS

Question 1

• 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

Answer 1

Meningitis

Question 2

Involved in the inflammatory reaction of Meningoencephalitis

Answer 2

• Meninges
• SAS
• brain parenchyma

Question 3

Organisms most often responsible for community-acquired bacterial meningitis

Answer 3

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

Question 4

Bacterial organism Most common in adults >20 years of age

Answer 4

Streptococcus pneumoniae

Question 5

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

Answer 5

Neisseria meningitidis

Question 6

Bacterial organism Can cause meningitis in individuals with

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

Answer 6

Gram (-) Bacilli

Question 7

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

Answer 7

• Haemophilus sp.
• Enterobactereciae
• Staphylococcus aureus

Question 8

Bacterial organism Meningitis complicating endocarditis

Answer 8

• Staphylococcus aureus
• Streptococcus viridans, Strep. bovis
• HACEK Group

Question 9

Bacterial organism

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

Answer 9

Group B Streptococcus

Question 10

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.

Answer 10

Listeria monocytogenes

Question 11

Bacterial organism causes meningitis in unvaccinated children and older adults

Answer 11

H Influenza

Question 12

Classic clinical triad of BACTERIAL MENINGITIS

Answer 12

• Fever
• Headache
• Nuchal rigidity

Question 13

Clinical Manifestation of Bacterial Meningitis

Answer 13

• 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

Question 14

• 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

Answer 14

Raised ICP

Question 15

DIAGNOSIS of Bacterial Meningitis

Answer 15

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

Question 16

CSF PATHOGEN PANELS OF BACTERIAL MENINGITIS

Answer 16

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

Question 17

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:

Answer 17

• 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

Question 18

TREATMENT : Empirical Antibiotic Therapy

Answer 18

• 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

Question 19

Empirical therapy of community acquired suspected meningitis in children & adults

Answer 19

• Combination of Dexamethasone, 34 or

- 4” gen cephalosporins, vancomycin plus acyclovir

Question 20

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

Answer 20

Ceftriaxone or Cefotaxime

Question 21

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

Answer 21

Cefepime

Question 22

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

Answer 22

Ampicillin

Question 23

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

Answer 23

Metronidazole

Question 24

hospital acquired meningitis (following neurosurgical procedures) tx

Answer 24

Combination of Vancomycin and Ceftazidime or Meropenem

Question 25

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

Answer 25

Meropenem

Question 26

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections INDICATION: Preterm infants to infants <1month

Answer 26

Ampicillin + cefotaxime

Question 27

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections INDICATION: Infants 1-3 months

Answer 27

Ampicillin + cefotaxime or ceftriaxone

Question 28

Antibiotics Used in Emperical Therapy of Bacterial Meningtis and Focal CNS Infections INDICATION: Immunocompetent children >3 months and adults <55

Answer 28

Cefotaxime, ceftriaxone, or cefepime + vancomycin

Question 29

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

Answer 29

Ampicillin + cefotaxime, ceftriaxone or cefepime + vancomycin

Question 30

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

Answer 30

Ampicillin + ceftazidime, ceftriaxone or meropenem + vancomycin

Question 31

antibiotic of choice for susceptible strains

Answer 31

-Penicillin G

Question 32

Antibiotic for penicillin resistant strains

Answer 32

-Ceftriaxone or Cefotaxime

Question 33

days IV antibiotic therapy is adequate for uncomplicated Meningococcal Meningitis

Answer 33

7 days

Question 34

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

Answer 34

Rifampin

Question 35

alternative treatment for adults having Meningococcal Meningitis

Answer 35

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

Question 36

- Pneumococcal Meningitis Antibiotic Use - week course of IV antimicrobial therapy is recommended -

Answer 36

Cephalosporins and Vancomycin

Question 37

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

Answer 37

24-36 h

Question 38

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.

Answer 38

intraventricular

Question 39

Specific Antimicrobial Therapy for Listeria Meningitis

Answer 39

Ampicillin: at least 3 weeks

Question 40

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

Answer 40

Gentamicin

Question 41

alternative in penicillin allergic patients with Listeria Meningitis

Answer 41

- trimethroprin + sulfamethoxazole

Question 42

Specific Antimicrobial Therapy for Staphyloccocal Meningitis suspectible strains

Answer 42

Naficillin

Question 43

DOC for MRSA and patient allergic to penicillin for Staphyloccocal Meningitis

Answer 43

Vancomycin

Question 44

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

Answer 44

20 mg

Question 45

Specific Antimicrobial Therapy for Gram-Negative Bacillary Meningitis

Answer 45

3rd-Gen cephalosporins: - Cefotaxime, - Ceftriaxone - Ceftazidime,

Question 46

Tx for meningitis due to P. aeruginosa

Answer 46

Ceftazidime or Meropenem

Question 47

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

Answer 47

-3-week

Question 48

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

Answer 48

Dexamethasone

Question 49

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

Answer 49

20 min

Question 50

Emergency treatment of increased ICP:

Answer 50

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

Question 51

Highest Mortality rate causing BACTERIAL MENINGITIS

Answer 51

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

Question 52

Risk of death from bacterial meningitis increases :

Answer 52

- 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

Question 53

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

Answer 53

- (<2.2 mmol/L [<40 mg/dL]) | - (>3 g/L [> 300 mg/dL])

Question 54

Sequelae OF BACTERIAL MENINGITIS

Answer 54

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