Meningitis

Question 1

Common organisms for <1mo meningitis

Answer 1

S. agalactiae
Listeria monocytogenes
Strep pneumo
Neisseria meningitidis

Question 2

Common organisms for 1-23 mo meningitis

Answer 2

S. pneumo
Neisseria meningitidis
H. influenzae
S. agalactiae

Question 3

Common organisms for 2-50 y/o meningitis

Answer 3

N. meningitidis
S. pneumo

Question 4

Common organisms for >50 y/o meningitis

Answer 4

S. pneumo
N. meningitidis
L. monocytogenes

Question 5

N. meningitidis meningitis common symptom

Answer 5

Petechiae or purpura

Question 6

Physical signs of meningitis

Answer 6

Brudzinski sign (involuntary flexion of hips/knees when neck flexed)
Kernig sign (pain or resistance when leg moved from 90 degree to 135 degree)
Bulging fontanel (infants)

Question 7

Bacterial meningitis CSF culture

Answer 7

Glucose: <50 (<=0.4 CSF:blood)
Protein: >150
WBC: >1000-5000 (neutrophils)
pH:: 7.1
Lactic acid: >35

Question 8

Viral meningitis CSF culture

Answer 8

Glucose: normal (30-70; 2/3 peripheral)
Protein: normal-slightly elevated (<50 is normal)
WBC: 5-300 (lymphocytes)
pH: normal (7.3)
lactic acid: normal (<14)

Question 9

C reactive protein in meningitis

Answer 9

High negative predictive value (if negative, unlikely meningitis)

Question 10

Empiric meningitis therapy for neonate

Answer 10

Ampicillin + aminoglycoside
OR
ampicillin + cefotaxime

Question 11

Empiric meningitis therapy for 1-23 mo/old

Answer 11

Ceftriaxone + vancomycin

Question 12

Empiric meningitis therapy for 2-50 y/o

Answer 12

Ceftriaxone + vancomycin

Question 13

Empiric meningitis therapy for >50 y/o

Answer 13

Ceftriaxone + vancomycin + ampicillin

Question 14

Empiric meningitis therapy if head trauma, neurosurgery, or CSF shunt

Answer 14

Vanco + cefepime, ceftazidime, or meropenem

Question 15

Vancomycin purpose in empiric meningitis therapy

Answer 15

Activity against highly resistant S. pneumoniae

Question 16

S. pneumoniae meningitis therapy if MIC to PCN <=0.1

Answer 16

Penicillin G 4 million units q4h
Ampicillin 2gm q4h

alt: ceftriaxone 2gm q12h
alt: chloramphenicol 1-1.5g q6h

Question 17

S. pneumoniae meningitis therapy if MIC to PCN 0.1-1.0

Answer 17

ceftriaxone

alt: cefepime 2gm q8h
alt: meropenem 2gm q8h

Question 18

S. pneumoniae meningitis therapy if MIC >=2.0

Answer 18

Vancomycin + ceftriaxone

alt: moxifloxacin 400 q24

Cephalosporin resistant: add rifampin; linezolid; vanc + moxifloxacin

Question 19

N. meningitidis meningitis therapy if MIC to PCN <0.1

Answer 19

Pen G
Ampicillin

Alt: 3rd gen cephalosporin
Alt: chloramphenicol

Question 20

N. meningitidis meningitis therapy if MIC to PCN 0.1-1.0

Answer 20

Ceftriaxone

Alt: chloramphenicol
Alt: FQ
Alt: meropenem

Question 21

H. influenzae meningitis therapy if B lactamase negative

Answer 21

Ampicillin

Alt: 3rd gen cephalosporin
Alt: cefepime
Alt: chloramphenicol
Alt: FQ

Question 22

H. influenzae meningitis therapy if B lactamase positive

Answer 22

3rd gen cephalosporin

Alt: cefepime
Alt: chloramphenicol
Alt: FQ

Question 23

S. agalactiae meningitis therapy

Answer 23

Penicillin G
Ampicillin

Alt: Bactrim 5mg/kg q6-12h
Alt: meropenem

Question 24

HSV meningitis therapy

Answer 24

Acyclovir 10mg/kg/dose over 1 hour every 8 hours

Alt: cidofovir
Alt: foscarnet

Question 25

Meningitis duration of treament

Answer 25

7 days (N. meningitidis, H. influenzae) 10-14 days (S. pneumo, HSV) 14-21 days (S. agalactiae) >=21 days (L. monocytogenes)

Question 26

Dexamethasone for meningitis

Answer 26

0.15mg/kg or 10mg q6h x2-4 days Start 10-20 min before or with first dose of ABX children: H. flu, prevents hearing loss adults: S. pneumo, reduces mortality

Question 27

Chemoprophylaxis for N. meningitidis meningitis

Answer 27

Close contacts and exposure to oral secretions: RIFAMPIN Q12H X4 DOSES Adults: 600mg Children: 10 mg/kg Neonates: 5mg/kg OR Adults: cipro 500mg PO once OR Ceftriaxone 125-250mg IM once

Question 28

Chemoprophylaxis for H. influenzae meningitis

Answer 28

Close contacts with unvaccinated or immunocompromised children RIFAMPIN DAILY FOR 4 DAYS Adults: 600mg daily Children (<12 y/o): 20mg/kg/day Neonates: 10mg/kg/day

Question 29

Brain abscess

Answer 29

Generally cover for streptococcus and anaerobes