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Flashcards in Meningitis Deck (62)
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1

Causes of meningitis

Bacterial
Fungal
Mycobacteral
Viral
Parasitic
Spirochetes
Drug-induced
-Sulfonamides, NSAIDs, IV immunoglobulin

2

Common bacterial pathogens

Strep pneumoniae
Neisseria meningitidis
Group B Strep
Hemophilus influenzae
Listeria monocytogenes

3

To discern what bugs to target, consider...

Environmental exposures (sick contacts, endemic fungi)
Recent infections
Immunosuppression
-HIV/AIDS (Cryptococcus)
-Asplenia
-Cancer
Surgery or trauma
Non-infectious causes

4

To discern what drugs to use, consider...

Age
Medication allergies
Medication properties
-CNS penetration
-Spectrum of activity
-Adverse effects
-Resistance patterns

5

Tx for CNS infections- characteristics of medications

Microcidal
High-dose
Parenteral
Low molecular weight
Lipophilic
Unionized at physiologic pH
Not highly protein bound

6

First steps of tx

Supportive care
LP
-Usually done prior to abx
-Do not delay abx is there is a delay getting LP
High dose, parenteral abx
-Age
-Risk factors for MDR bacterial, fungal, viral, etc infection

7

Lab results in nl pt: CSF

WBC <5
Differential: monocytes
Protein: <50
Glucose: 45-80 (50-60% of the blood glucose)
CSF: BG ratio: 50-60%
CSF stain: Neg
Opening pressure: <20 mm Hg

8

Bacterial CSF lab results

WBC: 1,000-5,000
Differential: Neutrophils
Protein: Elevated
Glucose: Low
CSF:BG ratio: Decreased
CSF stain (+) Gm stain
Opening Pressure: >20 mmHg

9

Viral CSF lab results

WBC: 5-500
Differential: Lymphocytes
Protein: Mild elevation
Glucose: Normal
CSF: BG ratio: Normal
CSF stain: Neg
Opening pressure: <20 mmHg

10

Fungal CSF lab results

WBC: 100-400
Differential: Lymphocytes
Protein: Elevated
Glucose: Low
CSF: BG ratio: Decreased
CSF stain: (+) Indian ink stain (Crytpo)
Opening Pressure: >20 mmHg

11

TB CSF lab results

WBC: 25-50
Differential: Variable
Protein: Elevated
Glucose: Low
CSF:BG ratio: Decreased
CSF stain: Pos AFB
Opening Pressure: >20 mmHg

12

Common therapy for bacterial meningitis for < 1 mo

Ampicillin + Cefataxime or Ampicillin + aminoglycoside

13

Common pathogens for bacterial meningitis <1 mo

S. agalactiae
E. coli
L. monocytogenes
Klebsiella species

14

Common pathogens for bacterial meningitis 1-23 mos

S. pneumoniae
N. meningitidis
S. agalactiae
H. influenzae
E. coli

15

Recommended therapy for bacterial meningitis 1-23 mos

Vancomycin
AND
Ceftriaxone OR Cefataxime

16

Common pathogens in bacterial meningitis for 2-50 yrs

S. pneumoniae
N. meningitidis

17

Recommended therapy for bacterial meningitis 2-50 yrs

Vancomycin
AND
Ceftriaxone OR Cefataxime

18

Common pathogens in bacterial meningitis for > 50 yrs

S. pneumoniae
N. meningitidis
L. monocytogenes
Aerobic gm-neg bacilli

19

Recommended therapy for bacterial meningitis for > 50 yrs

Vancomycin AND Ampicillin AND Ceftriaxone OR Cefotaxime

20

Ampicillin adult dose in meningitis

2 gm IV q4h

21

Side effects of ampicillin

Hypersensititvity
Rash
Interstitial nephritis

22

Adult dose in ceftriaxone

2 gm IV q12H

23

Side effects of ceftriaxone

Hypersensitivity
Pancreatitis
Gallbladder pseudolithiasis

24

Adult dose in cefotaxime

2 gm IV q4-6h

25

Side effects of cefotaxime

Hypersensitivty
Rash

26

Clinical pearls of ampicillin

Renal elimination

27

Clinical pearls of ceftriaxone

Avoid in neonates
Avoid use with Ca containing IV fluids
Hepatic elimination

28

Clinical pearls of cefotaxime

Preferred in neonates
Renal elimination

29

Adult dose for vancomycin

15-20 mg/kg IV q8-12h
Goal trough = 15-20 mg/dL

30

Side effects of vancomycin

Neurotoxicity
Infusion reactions
Nephrotoxicity
Ototoxicity