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CDM 3 Exam 1 > Lecture 8 - CNS Infections > Flashcards

Lecture 8 - CNS Infections Flashcards

(52 cards)

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1
Q

CSF Shunts

A

essentially tube with valve implanted in skull and you drain the fluid to control the pressure in brain to somewhere else in the body

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2
Q

Meningitis

A

Inflammation of members of the spinal cord and brain, particularly leptomeninges

based by bacteria, viruses, meds, fungus

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3
Q

Encephalitis

A

inflammation of the brain

caused by viruses and bacteria

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4
Q

Transmission & Risk Factors of Meningitis

A
  1. Spread through blood
  2. Direct entry leading to contiguous spread

RF: immunosuppression, cig smoking, inc risk in prisons/dorms/barracks

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5
Q

top 5 bacteria for Meningitis

A
  1. Strep pneum
  2. Group B Strep
  3. N. meningitis
  4. H. Influ
  5. Listeria monocytogenes
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6
Q

top 5 bacteria for Meningitis > 60yrs old

A
  1. S. pneu
  2. L. mono
  3. N.meningitis
  4. Group B strep
  5. H. influ
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7
Q

Things that can cause Aseptic Meningitis?

A

Viral = HSV2, Varicella, HIV, flu
Meds = NSAIDs, sulfamethoxazole, aminopenicillins, carbamazepine, lamotrigine, ranitidine
Fungal
Parasites
Tuberculosis
Syphilis

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8
Q

Aseptic Meningitis means that….

A

from sample of CSF we cant find where its from

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9
Q

Pathophysiology of Meningitis

A
  1. Strep pneumo makes a protease that lets it go undetected by immune system.
  2. Bacteria can live in bloodstream, and it binds to receptors that allows it to pass through.
  3. Strep Pneumo, prevents interaction w/ C3b bc its encapsulated**
  4. Due to inflammation, tight junctions in BBB start to break apart
  5. this allows bacteria to pass through and into brain & CSF
  6. CSF has little to defend against bacteria
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10
Q

CSF markers of Meningitis

A

Increase CSF protein
Decreased CSF glucose
Increase CSF Lactate

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11
Q

Classic “Triad” for Meningitis

A

Fever**
Nuchal Rigidity**
Altered Mental Status**

Headache

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12
Q

Physical exams findings for Meningitis

A

Brudzinski Sign
Kernig’s Sign

Jolt accentuation

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13
Q

CSF Analysis from Lumbar Puncture

A

Glucose, protein, WBC, and lactate
Gram stain, culture, susceptibility

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14
Q

What sorts of values are we looking for in Bacterial Meningitis

A

Opening pressure > 250
Glucose % < 40% (Dec)
Protein > 200 (elevated)
WBC > 1000 (80-90% Neutrophils)
Lactate > 3.5

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15
Q

two barriers for medications when dealing with Meningitis

A

BBB and Blood-CSF barrier

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16
Q

To cross BBB/ Blood-CSF barrier, we need….

A

High Lipophilicity
Low degree of ionization
Small molecule weight
Low protein binding

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17
Q

Meningitis Goals of Therpy

A

** Prevention / Vaccines
eradicate infeciton
improve signs/symptoms
reduce morbidity and mortality

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18
Q

Empiric therapy < 1 month old common pathogens

A

Group B strep
E.coli
Klebsiella
Enterobacter
L.monocytogenes

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19
Q

Empiric therapy < 1 month treatment

A

Ampicillin + cefotaxime**/Ceftazidime/cefepime = due to shortage

Ampicillin + AG (Genta/Tobra)

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20
Q

Empiric therapy 1-23 month old common pathogens

A

S. pneum
N. Meningitidis
H. influ
S. agalactiae
E. coli

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21
Q

Empiric therapy 1-23 month old treatment

Study These Flashcards
A

Vanco + 3 Gen Ceph (Ceftriaxone or cefotaxime)

22
Q

Why give 2 things that cover gram +?

Study These Flashcards
A

Ceftriaxone-nonsusceptible strains of S.pneum occur about 10% of the time

23
Q

Empiric therapy 2-50 yrs old common pathogens

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A

S. pneumoniae
N. Meningitidis

24
Q

Empiric therapy 2-50 yrs old treatments

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A

Vancomycin + 3 Gen ceph (Ceftriaxone or Cefotaxime)

25
Empiric therapy > 50 yrs old common pathogens
S. pneum N. meningitides L. mono Aerobic GNR
26
Empiric therapy > 50yrs old treatments
Vancomycin + 3 Gen ceph (Ceftriaxone or Cefotaxime) + ampicillin
27
Antibiotic Dosing considerations
tend to be dosed higher than usual
28
Vancomycin Meningitis dosing
15-20mg/kg Q8-12hrs monitoring doing troughs or AUC
29
Big issue with Pneumococcal Meningitis?
Hearing loss
30
Pneumococcal Meningitis (PCN susceptible) TXM
PCN G 4mil units IV q4h or Ampicillin 2g IV q4h alternative: cefotaxime, ceftriaxone, cefepime, meropenem
31
Pneumococcal Meningitis (PCN resistant) TXM
Vancomycin (15-20mg/L) + ceftriaxone 2g q12h/cefotaxime 2g IV q4-6h Alternative: moxifloxacin
32
Meningococcal Meningitis (PCN Susceptible) Txm
PCN G 4mil units IV q4h or Ampicillin 2g IV q4h Alternative: 3rd Gen Ceph (Cefotaxime/ceftriaxone) chloramphenicol
33
Meningococcal Meningitis (PCN resistant) Txm
Ceftriaxone 2g q12h or cefotaxime 2g IV q4-6h Alternative: moxifloxacin, meropenem, chloramphenicol
34
N. Meningitidis Chemoprophylaxis close contact definition
ppl within 3 feet of patient for >8hrs during 7 days before and 24hrs after starting ABX
35
N. Meningitidis Chemoprohylaxis txm
Essential Rifampin for everyone in different doses Ceftriaxone preferred in pregnant
36
H. Flu type B (B-lactamages neg) Txm
Ampiclin 2g IV q4h
37
H.Flu type B (B-lactamase pos) Txm
Cefotaxime 2g q4-6h or ceftriaxone 2g IV q12h
38
H.Flu type B chemoprophylaxis
Rifampin in 4 doses **unvaccinated close contacts**
39
Listeria Monocytogenes TXM
PCN G 4mil units IV q4h + gent or Ampicillin 2g IV q4h + gent
40
Group B strep TXM
PCN G 4mil units IV q4h or Ampicillin 2g IV q4h
41
Group B Strep chemoprophylaxis
pregnant in labor should receive PCN or Ampicillin if... GBS carrier H/x of GBS bacteriuria Prev delivery of infant w/ GBS
42
S. pneumoniae length of therapy
10-14 days
43
N. meningitides or H.influ length of therapy
7-10 day, may extend to 14 days
44
GBS, S.aureus length of therapy
14-21 days
45
Enterobacteraceae, P.aeruginosa length of therapy
21 days
46
L. monocytogenes length of therapy
> 21 days
47
when to consider outpatient ABX treatment for meningitis?
can do after 7 days if.... low risk of neurologic complications able to adhere w/ close monitoring and follow-up
48
Children advantages with steroid treatment
less hearing loss w/ H.influ infection
49
Adult advantages with steroid treatment
dec mortality w/ S.pneum
50
Disadvanages of steroid treatment
dec ABX pen, so give before or w/ 1st dose (within 10-20min) guileless recommend starting for all adults w/ suspected bacterial meningitis
51
Encephalitis symptoms
Altered mental status Stupor Seizures more common
52
Common causes of Encephalitis
HSV1 in adults HSV2 in neonates

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