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Bacterial meningitis Flashcards

1
Q

risk factors fo meningitis

A

extremes in age <1 and >65
–infants at greater risk
unvaccinated individuals
anatomical or functional asplenia
pregnancy

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2
Q

what is bacterial meningitis

A

inflammation/ infection affecting the meninges with positive bacterial structures

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3
Q

causative pathogens for ages 2-50

A

s.pneumoniae
n.meninditidis

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4
Q

encapsulated pathogens

A

s.pneumoniae (GP)
n.meninditidis (GN)
h. influenza (GN)

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5
Q

virulence factor

A

polysaccharide encapsulated organisms

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6
Q

risk factors for listeria monocytogenes (GP) virulence

A

extreme age
alcoholism
malignancy
use of chronic corticosteroids
immunocompromised
diabetes
cirrhosis
pregnancy
CKD
unpasturized milk/cheese, raw meat

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7
Q

pathogenesis of bacterial meningitis

A

s.pneumoniae
n.meninditidis
h. influenza
colonize the nasopharynx –> massive production of CSF cytokines and chemookines

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8
Q

signs and symptoms of meningitis

A

classic triad**
–fever
–nuchal rigidity ( stiff neck)
–altered mental status
headache
photophobia
N/V
diffuse petechiaial rash
focal neurological defects
–positive brudzinkis sign
–positive kerning’s sign

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9
Q

signs and symptoms of encephalitis

A

fever
profound altered mental status **
–confusion
–behavioral abnormalities
–hallucination/psycosis
headache
photophobia
N/A
focal or generalized seizures**
focal neurologic disturbances**

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10
Q

brudzinski sign

A

severe neck stiffness causes patients hip and knee to flex when the neck is flexed

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11
Q

kernigs sign

A

severe stiffness of the hamstring causes an inability to straighten leg when the hip is flexed to a 90 degree angle

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12
Q

neonate/ infant presentation

A

changes in activity and poor feeding
vommiting, irritability, high-pitched crying
positive brudzinski and or kernigs sign

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13
Q

children presentation

A

similar to adultt ( neck stiffness, headache)

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14
Q

elderly presentation

A

lack the signs and symptoms of younger adults
– less notable neck stiffness and headache
altered mental status and focal neurological deficits - more common

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15
Q

diagnostic work up / tools

A

lumbar puncture
-determine opening pressure
-CSF analysis, gram stain, culture
-viral/bacterial polymerase chain reaction

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16
Q

lumbar puncture

A

insertion of a needle into the subarachnoid space in the lumbar area of the spine to obtain cerebrospinal fluid

normal RBS , 5x10^6

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17
Q

CSF interpretation of bacterial meningitis

A

CSF appearance: cloudy and turbid
opening pressure: >=250
CSF WBC: >=1000
dominate cell type: neutrophils
CSF protein: high
CSF glucose: low

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18
Q

how long may it take for csf culture

A

48-72 hrs

19
Q

no delay in performance of Lumbar puncture
obtain 2 sets of blood cx + perform LP

A

initiate dexamethasone + antimicrobial therapy

20
Q

delay in performance of lumbar puncture
obtain 2 sets of blood cx

A

initiate dexamethasone + antimicrobial therapy
perform head CT/MRI scan +?_ LP

21
Q

risks of dexamethasone

A

potential to reduce abx CSF penetration
poor antibiotic CSF con + treatment failure

22
Q

use of dexamethasone in pediatrics

A

insufficient data, not significant protection

23
Q

when is the first dose of dexamethasone recommended for administration

A

10-20 minutes before or at the time of antimicrobial administration

24
Q

empiric treatment for 2-50 years for s. pneumonia and n. meningitis

A

vancomycin + ceftriaxone

25
Q

dose for ceftriaxone

A

2 gram q 12 h
CSF 0-16% ( poor)

26
Q

dose of vancomycin

A

depends on BBB penetration
still target goals of 15 of 20 msg/mL
400-600mg
infusion reaction

27
Q

treatment for streptococcus pneumonia
penicillin susceptible

A

Pen G

28
Q

treatment for streptococcus pneumonia
penicillin resistant
ceftriaxone sus

A

ceftriaxone

29
Q

treatment for streptococcus pneumonia
penicillin resistant
ceftriaxone resistant

A

vancomycin

30
Q

treatment duration for streptococcus pneumonia

A

10-14 days

31
Q

neisseria meningitidis
penicillin susceptible

A

pen G
ampicillin

32
Q

neisseria meningitidis
penicillin resistant

A

ceftriaxone
cefotaxime

33
Q

treatment duration of neisseria meningitidis

A

7 days

34
Q

is dexamethasone recommended for neisseria meningitidis

A

no

35
Q

h. influenza
beta lactamane negative

A

ampicillin

36
Q

h. influenza
beta lactamane positive

A

ceftriaxone
cefotaxime

37
Q

treatment duration of h. influenza

A

7 days

38
Q

linsteria monocytogenes recommendation

A

ampicillin**
or
penicillin

3rd gen NOT recommended

39
Q

s. aureus
MRSA

A

vancomycin
duration 14-21 days

40
Q

s. aureus
MSSA

A

oxacillin
nafcillin
duration: 14-21 days

41
Q

what is the most powerful method to decrease incidence of meningitis

A

vaccination

42
Q

what is recommended for close contact of n. meningitidis and h. influenzae

A

chemoprophylaxs

43
Q

post exposure chemoprophylaxis
n. meningitis

A

ciprofloxacin x 1 dose
rifampin x 2 days
ceftriaxone x 1 dose

44
Q

post exposure chemoprophylaxis
h. influenza

A

rifampin x 4 days

ID (27 decks)

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