Meningitis

Question 1

Diagnostic Workup:

Answer 1

1st Step: Blood culture*; but it take time for results, so
meanwhile do
2nd Step: is there indication for CT or not ? ;
if NOT → LP =lumbar puncture
3rd Step: Give antibiotics without any delay , even before LP
results !

Question 2

CT indications before LP:

Answer 2

1. Immunocompromised state [e.g. HIV , under chronic Steroid
   Tx. , Anti-TNF drugs]
2. Px. With previous CNS disease , mass in brain or ↑ICP
3. New onset seizure, px. With papilledema
4. Altered mental status [ abnormal consciousness]
5. or focal neurological deficits ; infection of skin at site of LP

Question 3

signs of meningitis

Answer 3

rigid neck,fever ,kernig’s sign ,brudzinski’s sign

Question 4

treatment of 2-50 yr caused by N.meningitidis ,S.pneumonia

Answer 4

vancomycin +third generation cephalosporins

Question 5

tx: of > 50 yr ,caused by
S.pneumoniae,N.meningitidis, listeia

Answer 5

vancomycin+ampicillin+third generation cephalosporins

Question 6

tx:if neurosurgery /shunt
caused by : gram - rods ,S.aureus, coagulase - staph

Answer 6

vancomycin +cefepime

Question 7

tx if immunocompromised caused by :pneumococcus,N.meningitidis , listeria,gram-rods

Answer 7

vancomycin+ampicillin +cefepime

Question 8

tx if penetrating ingury to skull caused by s. aureus ,coagulase - staph,gram-rods

Answer 8

vancomycin+cefepime