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3151 - nat > IC17 Bacterial Meningitis and Cdiff > Flashcards

IC17 Bacterial Meningitis and Cdiff Flashcards

1
Q

Examples of Septic and Aseptic Meningitis

A

Septic: Bacteria

Aseptic:
Virus
Fungal
Parasitic
Mycobacterium
Syphilis

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2
Q

What is the classic triad of bacterial meningitis symptoms?

A

Headache
Backache
Neck rigidity

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3
Q

3 physical signs of bacterial meningitis

A

Kernig sign
Lift one leg while lying, back pain

Brudzinski sign
Flexing neck will cause reflex of hip and knee

Bulging fontane (in infants)

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4
Q

Special symptoms for Neisseria meningitis

A

Petechiae: Widespread red spots on body

or Purpura: Bigger red, purple spots

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5
Q

What can be inferred from Lumbar puncture? (4 points)

A
  1. Elevated opening pressure
  2. CSF composition
  3. CSF gram stain and culture
  4. CSF PCR
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6
Q

What are the components tested in CSF?

A

Glucose
Protein
WBC

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7
Q

What is the normal CSF glucose level?

What is the level in bacterial and viral meningitis?

A

2.6-4.5

Bacterial: Very low
Viral: Slightly low

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8
Q

What is the protein in normal CSF?

VS Bacterial, viral

A

Should be low, <0.4g/L

Bacterial: Raised, >1.5g/L
Viral: Mildly raised

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9
Q

Normal WBC level in CSF?

Amount in bacterial and viral, mainly which type of wbc?

A

< 5 cells/mm3

Bacterial: >100, mainly neutrophils

Viral: up to 1000, mainly lymphocytes

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10
Q

What are the 2 likely pathogens for BM? Which patient population is different?

A

Strep Pneumo
Neisseria meningitidis

These not present in Neonates (<1 month)

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11
Q

Which patients need to be covered by Listeria and E.coli

A

Listeria: Adults > 50yo, Neonates

E.coli: everybody except Children and Adults (2 - 50yo)

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12
Q

What is grp B strep?

Which patients need to be covered by Group B Strep?

A

Strep Agalactiae

Neonates to Children

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13
Q

What is the main drug for empiric treatment of bacterial meningitis?

A

Ceftriaxone

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14
Q

What is Ampicillin used for?

A

Listeria

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15
Q

What is Vancomycin used for?

A

Cover Strep Pneumo that is resistant to Ceftriaxone

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16
Q

Duration of Culture directed therapy for Bacterial Meningitidis (what is the acronym?)

A

NSBL

Neisseria - 5-7 days
Strep Pneumo - 10-14 days
Grp B Strep (Strep Agalactiae) - 14-21 days
Listeria - >21 days

17
Q

Culture directed therapy principles (if culture shows NSBL)

A

For NSBL, use Ampicillin or Penicillin G
If Penicillin resistant or mild allergy, go back to Ceftriaxone (as used in empiric)

(special cases)
for Listeria
BUT Ceftriaxone cannot cover Listeria, (cos only Ampicillin can), so use Co-trimox OR Meropenem

for strep pneumo
If bug is penicillin and cephalosporin resistant, use Vancomycin + Rifampicin

18
Q

What infection is adjunctive corticosteroid indicated for?

What corticosteroid is used + dose?

A

Strep Pneumo and Haem Influenzae bacterial meningitis

Dexamethasone 10mg Q6 x 4 days

19
Q

Why does Dexamethasone interact with drugs?

A

Decrease antibiotic penetration due to decreased meninges inflammation

20
Q

Chemoprophylaxis is suitable for which infection by which bug?

A

Neisseria Meningitidis infection

21
Q

What can adults take for chemoprophylaxis?

What can children take?

A

Rifampicin (4 doses)
Adults: 600mg Q12
Children: 10mg/kg Q12
Neonates: 5mg/kg Q12

Ciprofloxacin (1 dose)
Adult only: 500mg

IM Ceftriaxone (1 dose)
125 - 250mg

22
Q

Antibiotics that have highest risk for C.diff (3 points)

A

Clindamycin
3rd, 4th gen cephalosporins
Fluoroquinolones

23
Q

Antibiotics with lowest risk of C.diff (2 points)

A

(protective) Doxycycline or Tigecycline

IV Vancomycin
Does not reach gut
But some IV drugs may still reach gut due to enterohepatic circulation eg. IV Metronidazole

24
Q

Symptoms of moderate C.diff infection (3 points)

A

Abdominal cramps and distension
Leukocytosis (high WBC count)
Hypovolemia

25
Q

Requirement for Severe CDI

A

WBC > 15 X 10^9
SCr > 133umol/L

26
Q

Symptoms of Fulminant

A

Hypotension
Ileus (gut dont move anymore)
Megacolon (gut inflamed)

27
Q

What are 2 requirements for diagnosis of C.diff

A

1) Presence of diarrhea (3 episodes in 24hrs) OR Radiographic evidence of ileus or megacolon
2) (+) stool test for C.diff or toxins OR Obtain tissue from colonoscopy to show colitis

28
Q

Treatment for non-severe C.diff

A

(WBC < 15 X 10^9 and SCr < 133umol/L)

First line
PO Vancomycin 125mg QDS
PO Fidaxomicin 200mg BD

2nd line
PO Metronidazole 400mg TDS

29
Q

Treatment for severe C.diff

A

Same as non-severe, just that no metronidazole

PO Vancomycin 125mg QDS
PO Fidaxomicin 200mg BD

10-14 days

30
Q

Treatment for fulminant C.diff

A

Must have either hypotension, ileus, or megacolon

IV Metronidazole 500mg TDS
+ PO Vancomycin 500mg QDS
+ Rectal Vancomycin 500mg QDS

31
Q

What is the duration of C.diff treatment

A

10-14 days

32
Q

Treatment for First recurrence of C.diff

A

Need to swap agents eg. If used Fidaxomicin initially, use Vancomycin for recurrence

If Vancomycin used in initial episode
PO Fidaxomicin 200mg BD for 10 days
OR
PO Fidaxomicin 200mg BD x 5 days then 200mg EOD x 20 days

If Fidaxomicin used in initial episode
Use PO Vancomycin tapered dose

If Metronidazole used in initial episode
PO Vancomycin 125mg QDS x 10 days

33
Q

What to cover for Bacterial Meningitidis in Neonates?

Hence what is the empiric therapy?

A

Grp B Strep, E.coli, Listeria Monocytogenes

Ceftriaxone + Ampicillin

34
Q

What to cover for Bacterial Meningitidis in Infants?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis, Grp B strep, E.coli

Ceftriaxone + Vancomycin

35
Q

What to cover for Bacterial Meningitidis in children and adults?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis

Ceftriaxone + Vancomycin

36
Q

What to cover for Bacterial Meningitidis in adults > 50?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis, Listeria, E.coli

Ceftriaxone + Vancomycin + Ampicillin

3151 - nat (22 decks)

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