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Flashcards in Infectious Diseases Deck (11)
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1
Q

What is the clinical presentation for acute bacterial meningitis?

A

~45% of pts present with the “classic triad” of fever, headache and neck stiffness, but nearly all patient have at least 2 of 4 symptoms (fever, headache, nuchal rigidity and altered mental status).

Other symptoms may include vomiting, seizures, focal neurological findings and papiledema

2
Q

What are the most common organisms for different age groups for acute bacterial meningitis?

A

35 years: Pneumococcus, Meningococcus, Hemophilus, Listeria (25% of cases in pts over 60)

3
Q

What is the basic CSF profile (cell number and type, glucose, protein) for acute bacterial meningitis?

A
High (100-10,000) WBC
Cell type of PMN
Low glucose
Elevated Protein 
\+Bacterial cultures 
Gram stain is useful
4
Q

What is the basic medical management for bacterial

meningitis in different age groups?

A

Neonates (1-3mos.): Ampicillin and Cefotaxime

3mos-50years: Ceftriaxone OR Cefotaxime AND vancomycin

> 50years: Ceftriaxone or Cefotaxime, Vancomycin, Ampillin

Any age for hospital acquired, recent head trauma/neurosurgery, immunocompromised, alcoholics: Vancomycin and Meropenem +/-Ampicillin

Steroid shown to be beneficial for Pnuemococcus

5
Q

How do you distinguish the clinical features and most
common viruses in cases of viral meningitis and viral
encephalitis?

A

For diagnosis, look at CSF for lympthocytic pleocytosis (seen in TB, fungi, syphilis, inflammatory and neoplastic disease). Look at glucose levels (Low glucose can be seen in Mumps, LCMV and HSV 2).

PCR amplification of viral genomic material from CSF is most important diagnosis for viral meningitis

Viral cultures of CSF, throat swab, blood, urine, stool less frequently used

Serology of CSF IgM

6
Q

What are the clinical features for viral meningitis?

A

Clinical features are more mild than bacterial meningitis, include headache, fever, meningeal irritation

7
Q

What are the most common organisms for viral meningitis?

A

Enteroviruses
HSV-2
West Nile virus

8
Q

What is the basic CSF profile and key diagnostics for viral meningitis

A
10-2,000 WBC
Mononuclear cells (lymphocytes) present 
Normal glucose 
Normal or slightly elevated Protein 
\+Viral culture (neg. Bacterial)
PCR is useful
9
Q

What are the clinical features for viral encephalitis?

A

Altered consciousness, fever, headache. Seizures and focal neurological symptoms common, such as personality changes, alteration in mental status/consciousness, aphasia, hemiparesis, ataxia, cranial nerve palsies

10
Q

What are the most common organisms that cause viral encephalitis?

A

First of all, up to 60% of encephalitis cases do not have an identified cause.

HSV
EBV
CMV
West Nile Virus
Enterovirus 
Mumps
11
Q

What is the basic CSF profile and key diagnostics for viral encephalitis?

A
10-2,000 WBCs
Mononuclear cells (lymphocytes) present 
Normal glucose
Elevated Protein 
\+Viral culture, +/- Bacterial culture 
PCR and MRI most useful