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PR3151 > Management of Meningitis > Flashcards

Management of Meningitis Flashcards

1
Q

How are bacteria able to enter the central nervous system?

A
  • 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
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2
Q

What are the triad of symptoms for meningitis?

A

Headache, backache, neck rigidity

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3
Q

What is a sign of meningitis caused by Neisseria meningitidis?

A

Petechiae or purpura

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4
Q

What are the physical signs of meningitis?

A
  • Kernig sign
  • Brudzinski sign
  • bulging fontane
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5
Q

What is normal CSF like?
- Appearance
- Glucose
- Protein
- WBC

A
  • Appearance: clear
  • Glucose: 2.6-4.5mmol/L (CSF:blood >0.66)
  • Protein: <0.4g/L
  • WBC: <5 cells/mm3
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6
Q

What is CSF from bacterial meningitis like?
- Appearance
- Glucose
- Protein
- WBC

A
  • Appearance: turbid
  • Glucose: v low, CSF:blood <0.4
  • Protein: raised (>1.5g/L)
  • WBC: raised (>100 cells/mm3), mainly neutrophils
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7
Q

What is CSF from viral meningitis like?
- Appearance
- Glucose
- Protein
- WBC

A
  • Appearance: clear
  • Glucose: Normal to slightly low
  • Protein: Normal to mildly raised
  • WBC: raised (5-1000 cells/mm3), mainly lymphocytes
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8
Q

What are the organisms that need to be covered for meningitis in neonates?

A

Group B Streptococcus (S. agalactiae), E.coli, Listeria monocytogenes

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9
Q

What is the empiric regimen for neonatal meningitis?

A

Ceftriaxone + Ampicillin

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10
Q

What are the organisms that need to be covered for meningitis in kids <2yo?

A

S.pneumoniae, Neisseria meningitidis, S.agalactiae, E.coli

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11
Q

What is the empiric regimen for meningitis in kids<2yo?

A

Ceftriaxone + Vancomycin

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12
Q

What are the organisms that need to be covered for meningitis in 2-50yo?

A

S.pneumoniae, Neisseria meningitidis

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13
Q

What is the empiric regimen for meningitis in 2-50yo?

A

Ceftriaxone + Vancomycin

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14
Q

What are the organisms the need to be covered for meningitis in >50yo?

A

S.pneumoniae, N.meningitidis, Listeria monocytogenes, aerobic gram-negatives bacilli (eg E.coli, Klebsiella spp)

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15
Q

What is the empiric regimen for meningitis in >50yo?

A

Ceftriaxone + Ampicillin + Vancomycin

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16
Q

How long should culture directed regimen for Streptococcus pneumoniae be?

A

10-14 days

17
Q

How long should culture directed regimen for Neisseria meningitidis be?

A

5-7 days

18
Q

How long should culture directed regimen for Listeria monocytogenes be?

A

Min 21 days

19
Q

How long should culture directed regimen for Streptococcus agalactiae be?

A

14-21 days

20
Q

What are the alternative options for S.pneumoniae Tx in meningitis?

A

Ceftriaxone if cephalosporin susceptible
Vancomycin + Rifampicin if beta-lactam resistant

21
Q

What are the alternative options for Neisseria meningitidis Tx in meningitis?

A

Ceftriaxone

22
Q

What are the alternative options for Listeria monocytogenes Tx in meningitis?

A

Co-trimoxazole or meropenem

23
Q

What are the alternative options for Streptococcus agalactiae Tx in meningitis?

A

Ceftriaxone

24
Q

What kinds of patients can adjunctive steroid be used in meningitis treatment for?

A

> 6 weeks old

25
Q

What is the steroid dosing for meningitis?

A

IV dexamethasone 10mg Q6H for up to 4 days

26
Q

When should steroids be started for meningitis?

A

10-20min before or at the same time as the first dose of meningitis Abx

27
Q

What are the options for Neisseria meningitidis meningitis chemoprophylaxis?

A

Rifampicin, Ciprofloxacin, Ceftriaxone

28
Q

What are the rifampicin doses for Neisseria meningitidis meningitis chemoprophylaxis?

A

→ Adults: 600mg Q12H, 4 doses
→ Children: 10mg/kg Q12H, 4 doses
→ Infants (younger than 1 month): 5mg/kg Q12H, 4 doses

29
Q

What is the ciprofloxacin dose for Neisseria meningitidis meningitis chemoprophylaxis?

A

Adults: 500mg PO, 1 dose

30
Q

What is the ceftriaxone dose for Neisseria meningitidis meningitis chemoprophylaxis?

A

125-250mg IM, 1 dose

PR3151 (14 decks)

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