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Flashcards in Meningitis Deck (31):
1

Mortality of meningitis

25%
*depends on organism*

2

Pathogens causing meningitis

Strep pneumo ('95 -> 46%)
Haemophilus influenzae ('85 45%)

3

Other pathogens associated w/ meningitis

Listeria
Aerobic gram negative bacilli
Streptococcus agalactiae (52% of cases in neonates)
Staphylococcus aureus (trauma, CSF shunts)

4

Classic triad of meningitis

Fever
Neck stiffness
Altered mental status

5

How many pts have all 3 of the classic triad

2/3

6

Possible long term complications

Hearing loss 10%
Seizure disorders
Learning difficulties
Neurologic problems: spasticity, paresis, ataxia

7

Occupying lesions may displace brainstem downward. What increases this?

Lumbar puncture increases this process

8

What might lumbar puncture precipitate w/ meningitis

Brain herniation

9

What meningitis pts benefit from CT?

Immunocompromise
History of CNS disease
New onset seizures
Papilledema
Altered consciousness or focal neurologic deficit

10

How do we diagnose meningitis

Cerebral spinal fluid examination by lumbar puncture
We will do a gram stain, culture and sensitivities, cell count w/ differential, CSF protein, CSF glucose

11

CSF opening pressure w/ bacterial meningitis

180 mm H2O

12

CSF w/ bacterial meningitis WBC count

1000-5000/mm^3

13

CSF w/ bacterial meningitis % of neutrophils

>80%

14

CSF w/ bacterial meningitis proteins

100-500 mg/dL

15

CSF w/ bacterial meningitis glucose

< 40 mg/dL
normally 2/3 of normal plasma glucose

16

CSF w/ bacterial meningitis gram stain

+ in 60-90% of cases

17

CSF w/ bacterial meningitis culture

+ in 70-85% of cases

18

Abx for pts 1 month - 50 years old

Ceftriaxone 2g IV q12h
Dexamethasone
Vancomycin

19

Abx for pts > 50 years

Pt at increased risk for L. monocytogenes (ETOH; other debilitating diseases)
Rx = Ampicillin + ceftriaxone, dexamethasone, and vancomycin

20

Therapy for Gram + diplococci S. pneumoniae

Ceftriaxone 2g IV q12h
Vancomycin

21

Therapy for Gram - diplococci N. meningitidis

Pen G4 Mu IV q4hr x 5-7d

22

Therapy for Gram + bacilli or coccobacilli: L monocytogenes

Ampicillin
Gentamicin (used for synergy against Gram +s)

23

N. meningitidis length of therapy

7 days

24

H. influenzae length of therapy

7 days

25

S. pneumoniae length of therapy

10-14 days

26

S. agalactiae length of therapy

14-21 days

27

Aerobic Gram – bacilli length of therapy

21 days

28

L. monocytogenes length of therapy

> 21 days

29

Dexamethasone findings

Reduction of unfavorable outcomes
Reduction in mortality
Even better findings in pts w/ S. pneumoniae meningitis

30

Dexamethaosne recommendations

Use adjunctive dexamethasone in adults w/ documented or suspected S. pneumoniae meningitis
Give w/ or 15 min BEFORE first abx dose
DONT start if abx if already started
DON’T use in pts w/ septic shock
Discontinue dexamethasone if meningitis is found not to be caused by S. pneumoniae

31

Dexamethasone dose and length of tx

10 mg q6 hours x4 days