bacterial meningitis from NP
S. pneumo
bacterial meningitis assoc. w/ military/college
N. meningitidis
bacterial meningitis assoc. w/ head trauma
staph
bacterial meningitis assoc. w/ neuro procedures (2)
staph
gram-
bacterial meningitis assoc. w/ newborn - 1 mo. (3)
GBS
Listeria
E. coli
bacterial meningitis assoc. w/ 1-3 mo. (6)
GBS listeria E. coli S. pneumo H. flu N. meningitidis
bacterial meningitis assoc. w/ 3 mo.-55 years (3)
S. pneumo
H. flu
N. meningitidis
bacterial meningitidis > 55 years (4)
S. pneumo
H. flu
Listeria
G-
bacterial meningitis triad
Fever
nuchal rigidity
AMS
CSF lab findings bacterial meningitis (4)
> 1000 WBC
glucose less than 40
CSF:glucose less than 0.4
protein 100-500
indications for CT in bacterial meningitis (6)
immuncompromised hx CNS disease new onset seizure papilledema abn LOC focal neuro deficit
newborn empiric abx for bacterial meningitis
Ampicillin + Ceftoxamie (or gentamycin)
1 mo. - 50 years empiric abx for bacterial meningitis
Ceftriaxone + vancomycin
dexamethasone
> 50 y/o empiric abx for bacterial meningitis
Ceftriaxone + ampicillin + vanco
dexamethasone
immunosuppressed empiric abx for bacterial meningitis
Cefepime/Meropenem + ampicillin + vanco
dexamethasone
empiric abx for bacterial meningitis for the PCN allergic
vanco + moxifloxacin + bactrim
dexamethasone effect on bacterial meningitis (2)
decr. rate of hearing loss
decr. neuro sequelae
most common cause of aseptic meningitis
enterovirus
drug rxn causing aseptic meningitis (2)
NSAIDs
antibiotics
aseptic meningitis labs (5)
WBC less than 500 > 50% lymphocytes Normal glucose normal or mildly elevated protein negative gram/culture
gold standard for aseptic meningitis
viral cultures
aseptic meningitis treatment
symptomatic- analgesics, antipyretics
hallmark of encephalitis
abn brain function
bacterial assoc. w/ delivery (2)
E. coli
GBS
viral invasion of the CNS w/ neuronal involvement
primary encephalitis
immune-modulated, neuron-sparing inflammation of the CNS
postinfectious encephalitis
HA, AMS, seizures, hemiparesis, CN palsies, incr. DTRs, ulcers/vesicles
encephalitis
most common cause of encephalitis & where do you see it?
HSV-1
temporal lobe
encephalitis labs/imaging findings? (3)
CT/MRI: possible abnormalities of the temporal lobes
EEG: abn
CSF: consistent w/ aseptic meningitis (negative culture)
encephalitis tx (2)
Acyclovir 10 mg/kg IV q8h
seizure prophylaxis
direct spread sources of cerebral abscess (many)
otitis media, mastoiditis, meningitis, head trauma, sinusitis, dental infection, s/p neuro procedure
unilateral HA, fever, nuchal rigidity, vomiting, AMS, focal neuro deficits, seizures
cerebral abscess
MRI finding for cerebral abscess
ring-enhancing lesion
early cerebral abscess (1-2 weeks) (4)
lesion poorly demarcated
localized edema
acute inflammation
no tissue necrosis
late cerebral abscess (> 2 weeks) (2)
necrosis & liquefaction
lesion surrounded by fibrotic capsule
tx cerebral abscess (2)
CT-guided aspiration or surgical excision
abx for 4-8 weeks based on source
abx for cerebral abscess, oral/otogenic/sinus source?
Metronidazole + Pen G (oral source) or Ceftriaxone (otogenic or sinus source)
abx for cerebral abscess, hematogenous source
vanco + metronidazole
abx for cerebral abscess postop neurosurg pts
vanco + ceftazidime/cefepime/meropenem
abx for cerebral abscess, penetrating trauma source
vanco + ceftriaxone/cefotaxime
abx for cerebral abscess, unknown source?
vanco + ceftriaxone/cefotaxime + metronidazole
