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Clinical 2.0 > Meningitis > Flashcards

Meningitis Flashcards

(48 cards)

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1
Q

risk factors for meningitis

A 
neonates 
advanced age
pregnancy 
nasopharyngeal colonization with n.meningitis, spneumoniae, h.influenzae 
prior URTI
choclear implants 
cranial anatomical defects
trauma
fracture
neruosurgery
prosthesis
drains 
IC
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2
Q

pathogenesis of meningitis

A

bug originates in nasopharyngeal cavity
adheres to cells and gets into bloodstream
have capsules to protect from bloodstream IS
cross the BB and gets into CSF where theres no IS
massive inflammatory response, bacteria lysis, release of exotoxins

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3
Q

most likely pathogens of meningitis

A

strep pneumo 50% = gram positive diplococci
niesseria menigitis = gram negative cocci
h.influenzae found in unimmunized
listeria monocytogenes 5% gram positive bacilli

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4
Q

most common pathogens in neonates

A

s. agalactiae

ecoli

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5
Q

most common pathogens in children

A

n. meningitidis

s. pneumoniae

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6
Q

most common pathogens in adults

A

s.pneumoniae
n.meningitidis (younger adults)
l.monocytogenes - pregnancy, >60, IC
s.aureus
gram negative bacilli - IC, health care associated

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7
Q

3 most common clinical signs of meningitis

A

fever >40 (90%)
nuchal rigidity or neck stiffness
CNS: headache, photophobia, confusion, siezures

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8
Q

clinical signs in infants

A

non specific symptoms

fever, seizure, resp distress, septic shock

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9
Q

what sign is highly suggestive of meningococcal infection

A

rash thats hemorrhagic

also disseminated - septic shock

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10
Q

3 complications of meningitis

A

herniation - diffuse swelling, hydrocephalus
infarcts - inflammatory occlusion of basal arteries
seizures - cortical inflammation

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11
Q

what is the prognosis affected by

A

pathogen
patient age
health status
treatment

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12
Q

mortality rates for

  1. penumoniae
  2. meningitidis
  3. monocytogenes
A
  1. 10-30%
  2. 10-40%
  3. 15%
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13
Q

3 fundamentals for AM therapy

A
  1. early prompt initiation
  2. CSF penetration
  3. rapid sterilization
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14
Q

what factors determine CSF penetrations

A 
antibiotic size
lipophilicity
ionization
protein binding
barrier inflammation
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15
Q

describe the blood/CSF barrier

A

tight junctions
thick wall
can pump out solutes
depend on the inflammation for drugs to get through

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16
Q

which drugs can achieve therapeutic concentrations with or without inflammation

A

chloramphenicol ( dont use toxic to blood cells)
metronidazole
rifampin

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17
Q

which drugs can acheive therapeutic concentrations in the CSF with inflammation

A 
penicillins
3rdGC and cefuroxime
daptomycin
fluoroquinolones
linezolid
meropenem
tmp-smx
vanco
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18
Q

which drugs is a therapeutic CSF concentration not achieved

A

aminoglycosides

other cephalosporins

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19
Q

empirical therapy for children under 1 month

A

cefotax
ampicillin
+/- gent (to make amp more cidal)

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20
Q

empirical therapy for 1mon to 17 years

Study These Flashcards
A

cefotax/ceftriax +vanco
vanco added initially to cover penicilllin resistant strep pneumo with reduced susceptibility to ceph until susceptibility determined

21
Q

empirical treatment for 18-50 years

Study These Flashcards
A

cefotax/ceftriax +vanco

22
Q

empirical therapy for >50

Study These Flashcards
A

cefotax/ceftriax + vanco + amp (risk of listeria)

23
Q

why must you treat empirically

Study These Flashcards
A

if miss the bug the patient dies

24
Q

cefotax menigitis dose

25
ceftriax dose
2g q12hr
26
ampicillin dose
2g q4hr
27
vanco dose
15-20mg/kg q8hr
28
nero dose
2g q8hr
29
pen G dose
4MU q4h (upper limit of normal dosing)
30
rifampin dose
600mg q24hr (same as normal dosing)
31
lab results in meningitis
increase WBC, mostly PMNs protein elevated bc increased permeability glucose in CSF low becuase bacteria using it as food, normally its 50% of what is in the serum
32
peak incidence of meningococcal meningitis
children and young adults | natural immunity usually by 20 yoa
33
treatment for n.meningitidis penicillin susceptible
pen G or amp 5-7days | cipro alternative
34
treatment for n.meningitidis penicillin resistant
cefotax/ceftriax | alternative chloram?
35
how has the conjugate vaccination affected streptococcal meningitis
declining incidence but increased incidence on non included serotypes
36
directed therapy for s.pneumoniae if penicillin sensitive
penG or amp cipro alternative 5-7 days
37
directed therapy for penicillin resistant streptococcal
cefotac/ceftriax 10-14 days | alternative levo/moxi +/- vanco chloram, linezolid??
38
directed therapy for strep pneumoniae with 3rdGC MIC >1
cefotax/ceftriax + vance | dont just do vanco bc not sure how much penetrates CSF
39
directed therapy for strep pneumoniae with 3rdGC MIC >2
cefotax/ceftriax + vanco + rifampin
40
directed therapy for l.monocytogenes
pen G or amp + gent 21 days for synergy may not pass into CSF but only need a little amount for synergy to occurs alternatives: TMP-SMX, linezolid
41
recommended guidelines for using adjunctive dexamethasone therapy
immunocompetent adults with suspected or proen pneumococcal meningitis infants or children with h.influenzae
42
dose of adjuvant dexamethasone
0.15mg/kg q 6hr x 2-4 days initiated 10-20min before or with 1st antibiotic dose bc when antibiotic kills the bacteria it explodes and thats when inflammation occurs
43
when should fever resolve
24-48 hours
44
when should neck stiffness resolve
48-72 hours
45
when should CSF values resolve
culture negative within 24 hours | normal glucose by 3 days and protein by 7-10 days
46
when should rash resolve
over 7 days
47
vaccines that reduce the incidence of meningitis
h.influenzae pneumococcal conjugate 13 valent meningococcal c conjugate penumococcal polysaccharide
48
meningococal infection should treat close contacts within 60 days prophylactically with what
cipro 500 1 dose oral children 10mg/kg rifampin 600mg q12 hour x 4 doses oral, children 10mg/kg ceftriaxone 250 im 1 dose, children 125

Clinical 2.0 (24 decks)

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