Bacterial Meningitis part 1

Question 1

define bacterial meningitis

Answer 1

inflammation of meninges surrounding the brain and spinal cord due to bacterial invasion to the CNS

Question 2

what is ESSENTIAL to ensure beneficial outcomes for bacterial meningitis

Answer 2

prompt recognition and early treatment

Question 3

survivors of bacterial meningitis may experience one or more…..

Answer 3

neurologic disabilities (seizures)

Question 4

3 ways in which bacteria can get into the CNS and cause bacterial meningitis

Answer 4

-hematogenous spread (thru blood - most common)

-contiguous spread (from sinusitis or otitis media – spreads to CNS)

-direct inoculation (head trauma or neurosurgery)

Question 5

in one word, what is the clinical presentation of bacterial meningitis

Answer 5

ABRUPT

Question 6

name the 3 things in the “classic triad” for the clinical presentation of bacterial meningitis

Answer 6

fever
nuchal (neck) rigidity
altered mental status

Question 7

clinical presentation of bacterial meningitis specifically in infants

Answer 7

bulging fontanelle - skull not fully developed yet

Question 8

2 physical assessments that can be used to diagnose bacterial meningitis

Answer 8

Kernig’s sign – lifting leg

brudzinski’s neck sign – cant bring their head up while laying down without bending their knees bc of the inflammation

Question 9

what procedure can be done to get a CSF analysis to diagnose bacterial meningitis

Answer 9

a lumbar puncture

Question 10

what will be the “appearance” and “opening pressure” of a CSF culture with bacterial meningitis

Answer 10

appearance will be purulent and cloudy (should be clear)

opening pressure will be elevated from normal

Question 11

what will the WBC count be in cells/mm cubed in a CSF culture infected with bacterial meningitis

Answer 11

greater than 500 cells/mm cubed

Question 12

in a CBC with differential, which WBC will be very elevated in a CSF sample affected by bacterial meningitis

Answer 12

NEUTROPHILS

Question 13

how will the protein and glucose levels be in a CSF sample infected by bacterial meningitis

Answer 13

protein will be ELEVATED and glucose will be LOW (bc so many WBC being produced and bacteria itself all eat the glucose for food)

Question 14

in a CSF sample infected with bacterial meningitis, how will the CSF: blood glucose ratio be

Answer 14

DECREASED

Question 15

aside from bacterial, what other meningitis can a person have

Answer 15

fungal or viral meningitis

Question 16

in lab tests, a sample of CSF infected with bacterial meningitis will have leukocytosis with ______ shift

Answer 16

left

Question 17

in SEVERE cases of bacterial meningitis, what will happen to WBC count

Answer 17

will have leukopenia (decreased WBC)

Question 18

which 2 cultures are done in a suspected case of bacterial meningitis??

when are antibiotics given in relation to these cultures?

Answer 18

CSF and blood cultures

must do these cultures BEFORE starting antibiotics

Question 19

will platelet count be affected by bacterial meningitis

Answer 19

YES will have thrombocytopenia (dec platelet count)

Question 20

MOST bacterial meningitis cases are caused by which pathogen?

name 4 others

Answer 20

most - streptococcus pneumoniae

0thers - group b strep (agalactiae)
neisseria meningitidis
h. influenzae
listeria monocytogenes

others - gram negative organisms and staph

Question 21

streptococcus pneumonia is the leading cause of bacterial meningitis in _______ of age

Answer 21

greater then 2 months

Question 22

streptococcal meningitis typically occurs how

Answer 22

results as a secondary infection from a primary infection like ear or sinus infections

ie - strep pneumo goes from ear to the CNS to cause bacterial meningitis

Question 23

what are some predisposing factors to STREPTOCOCCAL MENINGITIS

Answer 23

pneumonia, endocarditis, CSF leak bc of head trauma, splenectomy, alcohol, sickle cell disease, bone marrow transplant

Question 24

what is the worldwide leading cause of NEONATAL meningitis

Answer 24

group B strep meningitis

bc of GI and genitourinary colonization in pregnant women, commonly by streptococcus agalactiae (25%0

Question 25

the term for a pregnant mother causing group b strep meningitis in her neonate is called....

Answer 25

vertical transmission

Question 26

what may be done to decrease the incidence of group B strep meningitis

Answer 26

universal prenatal screening intrapartum (during birth) -- give prophylactic group B strep antibiotics

Question 27

what is the leading cause of bacterial meningitis, PARTICULARLY in children and young adults?? what is the bacteria responsible?

Answer 27

MENINGOCOCCAL MENINGITIS caused by neisseria meningitidis

Question 28

what are the 5 primarily responsible serogroups of meningococcal meningitis

Answer 28

A, B, C, Y, W,-15

Question 29

Name some predisposing factors to MENINGOCOCCAL meningitis

Answer 29

smoking HIV asplenia complement deficiency

Question 30

how is meningococcal meningitis easily distinctable from the others

Answer 30

the presence of a PETECHIA RASH

Question 31

how is meningococcal meningitis spread

Answer 31

its VERY CONTAGIOUS can be spread person-person contact from respiratory droplets and pharyngeal secretions CLOSE CONTACTS INCREASED RISK OF GETTING --- NEED TO TAKE CHEMOPROPHYLAXIS TO PREVENT

Question 32

Which type of meningitis used to be the most common cause of bacterial meningitis in 6months-3years but has declined bc of vaccination?

Answer 32

haemophilus influenza type B meningitis

Question 33

haemophilus influenzae type b meningitis is associated with what 3 other conditions

Answer 33

middle ear infection paranasal sinus infection CSF leakage

Question 34

listeria monocytogenes is gram (+) or (-)??? what shape???

Answer 34

gram positive rod

Question 35

listeria monocytogenes primarily affects which populations?? how is it transmitted?

Answer 35

neonates, alcoholics, immunocompromised (inc pregnant), and elderly 50 and up transmitted by colonization of the GI tract - FOODBORNE ILLNESS can be caused by soft cheeses and unpasteurized raw produce, coleslaw, ready to eat foods, raw beef and poulty

Question 36

name some characteristics of gram negative meningitis

Answer 36

UNCOMMON - but increasingly its a cause of bacterial meningitis in NOSOCOMIAL SETTINGS

Question 37

what are the 2 most common gram negative organisms responsible for bacterial meningitis in adults? what about neonates?

Answer 37

adults - e. coli and pseduomonas neonates - e. coli and klebsiella pneumoniae

Question 38

what is the most important independent factor associated with higher risk of gram (-) meningitis in adults?

Answer 38

URINARY TRACT INFECTION

Question 39

3 main likely organisms to cause bacterial meningitis in NEONATES (less than 1 month)

Answer 39

group b strep enteric gram (-) - like e. coli listeria monocytogenes

Question 40

4 most likely pathogens to cause bacterial meningitis in infants and children (1 month-23 months)

Answer 40

step pneumoniae neisseria meningitidis h. influenzae group B strep (still some but not as many as neonates)

Question 41

2 pathogens most likely to cause bacterial meningitis in children and adults (2-50 yrs)

Answer 41

nesseria meningitidis streptococcus pneumoniae

Question 42

4 pathogens most likely to cause bacterial meningitis in adults greater than 50

Answer 42

listeria monocytogens streptococcus pneumonia neisseria meningitidis enteric gram negatives (bc of hospital exposure)

Question 43

when CSF and blood cultures are sent to be tested for suspected bacterial meningitis, empiric antibiotics are started based on what?????

Answer 43

AGE -- most likely organisms to affect based on age

Question 44

aside from age, there is also a chart for most likely pathogens based on CONDITION name the 3 conditions

Answer 44

closed head trauma penetrating trauma or post neurosurgery CSF shunt

Question 45

in penetrating trauma or post neurosurgery, name 5 organisms we would want to cover empirically

Answer 45

NOSOCOMIAL--- pseudomonas gram negative bacilli (e. coli and klebsiella) staph epi staph aureus

Question 46

in CSF shunt, name 4 organisms we would want to cover empirically

Answer 46

staph epi staph aureus gram negative bacilli p. acnes

Question 47

in closed head trauma, name 3 organisms we would want to cover empirically

Answer 47

step pneumoniae h. influenzae group A beta-hemolytic streptococci

Question 48

*in children <28 days of age and adults >50 years, empiric coverage of what pathogen is recommended

Answer 48

listeria monocytogenes!!