Management of Meningitis Flashcards
(30 cards)
How are bacteria able to enter the central nervous system?
- Invasion of mucosal surface, then hematogenous spread to brain
- Spread from para-meningeal focus
- Penetrating head trauma
- Anatomical defects in the meninges
- Previous neurosurgical procedures
What are the triad of symptoms for meningitis?
Headache, backache, neck rigidity
What is a sign of meningitis caused by Neisseria meningitidis?
Petechiae or purpura
What are the physical signs of meningitis?
- Kernig sign
- Brudzinski sign
- bulging fontane
What is normal CSF like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: clear
- Glucose: 2.6-4.5mmol/L (CSF:blood >0.66)
- Protein: <0.4g/L
- WBC: <5 cells/mm3
What is CSF from bacterial meningitis like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: turbid
- Glucose: v low, CSF:blood <0.4
- Protein: raised (>1.5g/L)
- WBC: raised (>100 cells/mm3), mainly neutrophils
What is CSF from viral meningitis like?
- Appearance
- Glucose
- Protein
- WBC
- Appearance: clear
- Glucose: Normal to slightly low
- Protein: Normal to mildly raised
- WBC: raised (5-1000 cells/mm3), mainly lymphocytes
What are the organisms that need to be covered for meningitis in neonates?
Group B Streptococcus (S. agalactiae), E.coli, Listeria monocytogenes
What is the empiric regimen for neonatal meningitis?
Ceftriaxone + Ampicillin
What are the organisms that need to be covered for meningitis in kids <2yo?
S.pneumoniae, Neisseria meningitidis, S.agalactiae, E.coli
What is the empiric regimen for meningitis in kids<2yo?
Ceftriaxone + Vancomycin
What are the organisms that need to be covered for meningitis in 2-50yo?
S.pneumoniae, Neisseria meningitidis
What is the empiric regimen for meningitis in 2-50yo?
Ceftriaxone + Vancomycin
What are the organisms the need to be covered for meningitis in >50yo?
S.pneumoniae, N.meningitidis, Listeria monocytogenes, aerobic gram-negatives bacilli (eg E.coli, Klebsiella spp)
What is the empiric regimen for meningitis in >50yo?
Ceftriaxone + Ampicillin + Vancomycin
How long should culture directed regimen for Streptococcus pneumoniae be?
10-14 days
How long should culture directed regimen for Neisseria meningitidis be?
5-7 days
How long should culture directed regimen for Listeria monocytogenes be?
Min 21 days
How long should culture directed regimen for Streptococcus agalactiae be?
14-21 days
What are the alternative options for S.pneumoniae Tx in meningitis?
Ceftriaxone if cephalosporin susceptible
Vancomycin + Rifampicin if beta-lactam resistant
What are the alternative options for Neisseria meningitidis Tx in meningitis?
Ceftriaxone
What are the alternative options for Listeria monocytogenes Tx in meningitis?
Co-trimoxazole or meropenem
What are the alternative options for Streptococcus agalactiae Tx in meningitis?
Ceftriaxone
What kinds of patients can adjunctive steroid be used in meningitis treatment for?
> 6 weeks old
