Meningitis

Question 1

What are the common viral culprits for meningitis?

Answer 1

Enterovirus, Arboviruses, Herpes

Question 2

What is the leading cause of Meningitis?

Answer 2

Viruses

Question 3

Bacterial Meningitis is caused by?

Answer 3

S. Pneumoniae and N. Meningitidis

Question 4

Who is susceptible to Listeria Monocytogenes Meningitis?

Answer 4

Pregnant women, newborns, old ppl (generally ppl with weak immune system)

Question 5

What two tests can help diagnose meningitis?

Answer 5

Brudzinski’s neck sign and Kerning’s sign

Question 6

What does the CSF sample reveal for those with bacterial meningits?

Answer 6

Elevated WBC (above 400mm3), Neutophilic WBC, protein over 80, Decreased glucose,

Question 7

How do you differentiate fungal from viral infections based on CSF samples?

Answer 7

You can’t really. They share similar characterstics: WBC range up to 500mm3, lymphocytic, protein up to 150 and glucose up to 70mg/dL

Question 8

What are the normal CSF limits?

Answer 8

glucose up to 60% of serum glucose, WBC

Question 9

What diagnostic test could you use to r/o bacterial etiology?

Answer 9

Enzyme immunoassay or CSF gram stain and culture

Question 10

What single test could differentiate viral from fungal meningitis?

Answer 10

PCR. Can also evaluate for mycobacteria

Question 11

How soon should you start and continue empiric therapy of meningitis?

Answer 11

within 30min of presentation and continued for 48-72 hours until r/o

Question 12

Your pt’s LP doesn’t take to stain: how do you treat?

Answer 12

50yo or immune system suppressed(listeria)-Tx. same as

Question 13

If you suspect Listeria what should you always add to your tx?

Answer 13

Ampicillin

Question 14

The LP takes to the gram stain technique. What bacteria should come to mind?

Answer 14

Strep Pneumoniae>Neisseria Meningitidis>Haemophilus influenzae or listeria monocytogenes if pt is 50yo or immunocomp

Question 15

The LP gram stain came back gram - diplococci: what bacteria and how do you treat?

Answer 15

Nessiera Meningitids Tx: IV PCN G or cefotaxime or ceftriaxone or chloramphenicol

Question 16

Lp reveals a gram - bacilli: bacteria and tx?

Answer 16

H.Influenza Tx: ceftriaxone or cefotaxime+/- gentomycin

Question 17

LP reveals a gram + diplococci

Answer 17

S. Pneumoniae tx: Ceftriaxone or cefotaxime(x10-14days)+vancomycin(if beta lactam resistant) + dexamethasone

Question 18

LP reveals a gram + baccilli

Answer 18

Listeria Monocytogenes Tx: IV ampicillin and gentomycin(aminoclycoside)

Question 19

What drug do you use to treat the inflammation with meningitis?

Answer 19

Dexamethasone: inhibits cytokines

Question 20

When should you administer dexamethasone?

Answer 20

before antibiotics

Question 21

How many days do you have a dexamethasone administered for in children >2mo? adults?

Answer 21

2 days for pediatrics/ 4 days for adults

Question 22

When should you avoid dexamethasone?

Answer 22

with patients that have septic shock and meningitis

Question 23

What is the prophylaxis regimen for meningitis contact?

Answer 23

adults: Rifampin 600mgx4, 1mo-12yo 10mgx4,

Question 24

what meningitis patients might have a purpuric rash?

Answer 24

Neisseria Meningitidis and rarely in H.Influenza pts

Question 25

What is pneumococcal meningitis?

Answer 25

Streptococcus pneumoniae(most common)

Question 26

what is meningococcus meningitis?

Answer 26

Neisseria Meningitidis

Question 27

What vaccinations can be given to prevent meningitis?

Answer 27

Prevar(Pneumoccal meningitis) Hib vaccine(Haemophilus influenzae)

Question 28

Does gram + or - meningitis have worse post-infection outcomes?

Answer 28

gram - meningitis is associated with more complications

Question 29

Psudomonas aeruginosa meningits?

Answer 29

Gram - bacilli, tx IV ceftazidime + gentamicinx3weeks

Question 30

treatment of other gram - bacilli?

Answer 30

3rd gen cephalosporin x 3 weeks

Question 31

What should always be your first line of treatment initiated?

Answer 31

Ceftriazone or cefotaxime and vancomycin