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Flashcards in CNS Infections Deck (77)
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61

What are some non-infectious treatable causes of aseptic meningitis/encephalitis syndrome?

Carcinomatous
Sarcoidosis
Vasculitis
Dural venous sinus thrombosis
Migraine
Drug:
Co-trimoxazole
IVIG
NSAIDS

62

What are the adult bacterial meningitis guidelines?

Pre-hospital management
Early inpatient management
Antimicrobial adjunctive treatment
Supportive therapy
Prevention of secondary cases of meningitis
Screening for predisposing factors to meningitis

63

What management occurs in pre-hospital acute adult bacterial meningitis?

Look for indications for hospital admission
Pre-hospital antibiotics

64

What are some indications for hospital admission of acute adult bacterial meningitis?

Signs of meningeal irritation
An impaired conscious level
A petechial rash
Who are febrile or unwell and have had a recent fit
Any illness, especially headache, and are close contacts of patients with meningococcal infection, even if they have received a prophylactic antibiotic

65

What should happen immediately on hospital admission in acute adult bacterial meningitis, provided ABC is fine?

Bloods for culture and coag screen
Antibiotic treatment before pathogens are identified, and immediately after
Throat swab which should be plated soon as practical
Disrupt and swab/aspirate any petechial or purpuric skin lesion for microscopy and culture
CT/MRI for patients with papilloedema or focal neuro signs

66

Who should undergo CT prior to LP?

Immunocompromised
History of CNS disease
New onset seizure (within 1 wk of presentation)
Papilloedema
Abnormal level of consciousness
Focal neurologic deficit

67

What are some key warning signs in acute adult bacterial meningitis?

Marked depressive conscious level (GCS 2)
Focal neurology
Seizure before/at presentation
Shock
Bradycardia and HT
Papilloedema

68

Who should undergo an LP in acute adult bacterial meningitis?

All adults with suspected meningitis except when a clear contraindication exists, or if there is a confident clinical diagnosis of meningococcal infection with a typical rash

69

What is the empiric antibiotic therapy for acute adult bacterial meningitis?

IV Ceftriaxone 2g bd
Add IV Ampicillin/amoxicillin 2g qds if listeria suspected
(If pen allergic Chloramphenicol IV 25mg/kg 6-hourly with vancomycin IV 500mg 6-hourly or 1g 12 hourly

70

What treatment should be given in acute adult bacterial meningitis if listeria is suspected and patient is pen. allergic?

Co-trimoxazole

71

What additional drug therapy other than antibiotics should be given to all patients with suspected bacterial meningitis?

Steroids 10mg IV 15-20 min before or with first antibiotic dose, then every 6hrs for 4 days

72

When should steroids not be given in bacterial meningitis?

Post surgical meningitis, severe immunocompromised, meningococcal or septic shock or those hypersensitive to steroids

73

What indicates a poor prognosis on admission in meningococcal disease?

Haemorrhagic Diatheses
Deteriorating consciousness
Multi-organ failure
Rapidly developing rash
Age >60

74

What are key interventions in management of bacterial meningitis with low GCS (2)?

Admit to highly supervised area- baseline investigations
Secure airway and high flow O2
IV 2G Ceftriazone stat (+- amoxicillin if >55 to cover listeria)
IV corticosteroids
Do not wait for CT/LP

75

What is the standard contact prophylaxis regimen in bacterial meningitis?

600 mg rifampicin orally 12-hourly for four doses (adults and children over 12 years), 10 mg/kg orally 12-hourly for four doses (aged 3-11 months) (IV).

76

What vaccines against organisms which can cause meningitis exist?

Neisseria meningitidis: serogroups A and C (W135 & Y)- travel. Group C conjugate vaccine
H. influenza (HiB vaccine)
Strep. pneumoniae- pneumocccal vaccines-polysaccharide and conjugate

77

What indicates a poor prognosis on admission in all types of meningitis?

Tachycardia
GCS <12 on admission
Low GCS, cranial nerve palsy
Seizures within 24hr
Hypotension on admission
Age >60