MeningitisC

Question 1

What are viral pathogens in meningitis?

Answer 1

Enterovirus, arbovirus, herpes

Question 2

What are parasitic pathogens in meningitis?

Answer 2

Naeglaria sp, Acanthameoba sp

Question 3

What are bacterial pathogens in meningitis

Answer 3

Step pneumo, neisseria meningitidis, h influenzae, listeria monocytogens

Question 4

What are fungal pathogens in meningitis

Answer 4

Cryptococcus neoformans

Question 5

What is meningitis most commonly caused by and how it it treated?

Answer 5

Virus, Empirically w/acyclovir until results are back , Tx symptoms

Question 6

What is the most common bacterial meningitis?

Answer 6

Strep pneumo

Question 7

Why is HIB making a comeback?

Answer 7

People arenít vaccinating! ESTUPIDOS!

Question 8

Clinical presentation of meningitis in adults is typically what?

Answer 8

HA, fever, stiff neck, photophobia, change in mental status, obtundation, seizures, and vomiting

Question 9

Clinical presentation of meningitis in infants is typically what?

Answer 9

Irritability, altered sleep, vomit, high pitch cry, decreased oral intake

Question 10

Clinical presentation of meningitis in children is typically what?

Answer 10

Lethargy, confusion, somnolence

Question 11

What are the 2 ìsignsî you can test for in meningitis?

Answer 11

Brudzinski neck sign and kernigs sign

Question 12

What are the characteristics of normal CSF?

Answer 12

Clear, 50-60% serum glucose, pH 7.4,

Question 13

What type of infection has the highest WBC count, neutrophilic differential, 80-500 mg/dL protein, and

Answer 13

Bacterial

Question 14

Viral and fungal causes of meningitis both have what differential?

Answer 14

Lymphocytic

Question 15

How do you diagnose meningitis?

Answer 15

CSF evaluaton w/ gram stain and culture, enzyme ammunoassay for bacteria, and PCR for virus, mycobacteria and fungal

Question 16

When is empiric therapy started and how long is it continued for?

Answer 16

w/in 30 minutes of presentation regardless, 48-72 hrs or until diagnosis of meningitis is ruled out, if ID causative agent, stop empirical and start specific

Question 17

If the CSF gram stain has nothing growing, is meningitis ruled out?

Answer 17

NO , Start empirical tx until ruled out by other more definitive testing

Question 18

If clinical presentations are in an infant

Answer 18

Listeria monocytogens

Question 19

What other pt population is more likely to be infected by listeria?

Answer 19

> 50 or alcoholic

Question 20

What drug do you add to tx if you suspect listeria?

Answer 20

Ampicillin

Question 21

What anti-inflammatory is used in meningitis?

Answer 21

Dexamethasone

Question 22

Should dexamethasone be given before or after antibiotics?

Answer 22

BEFORE

Question 23

What are concerns associated with use of dexamethasone?

Answer 23

Increased GI bleeds, decreased antibiotic penetration

Question 24

What drug penetration is NOT affected by dexamethasone?

Answer 24

vancomycin

Question 25

What type of adult pt should NOT be given dexa?

Answer 25

Meningitis with septic shock

Question 26

What pt population most often gets N meningitidis and when?

Answer 26

Kids and young adults in the winter and spring

Question 27

What is the drug of choice for n. meningitidis and alternatives?

Answer 27

High dose IV PCN G , Cefotaxime, ceftriaxone, and chloramphenicol are, alternatives for allergy

Question 28

Do pt with n. meningitidis need to have prophylaxis tx of all close contacts? If so what is given and when?

Answer 28

YES!, Rifampin w/in 24 hours is ideal, after 14 days no effect

Question 29

Strep pneumo is the most common cause of meningitis is what pt population?

Answer 29

Adults but also in kids

Question 30

What is a condition commonly seen in survivors?

Answer 30

Neurologic sequelae

Question 31

How is meningitis from strep pneumo treated?

Answer 31

IV 3rd generation ceph for 10-14 days. Cefotaxime or ceftriaxone

Question 32

What if the meningitis from strep pneumo is resistant to beta lactam drugs? What do you treat with?

Answer 32

Vancomycin

Question 33

How can you prevent meningitis from strep pneumo?

Answer 33

Vaccine- >65, immunocompromised, asplenic or have a cochlear implant. Also prevnar vaccine as a infant

Question 34

What is the tx of choice for H influenzae meningitis?

Answer 34

Ceftriaxone or cefotaxime bc lots of ampicillin resistance, Vaccinate your children then they wont be at risk for this- duhhhh

Question 35

Do pt with H influenzae induced meningitis need prohylaxis tx for close contacts?

Answer 35

Yes unless fully vaccinated before 2y/o

Question 36

When do cases of meningitis from listeria peak?

Answer 36

Summer/ early fall

Question 37

What is the D.O.C for listeria meningitis?

Answer 37

IV ampicillin x14 -21 days +/-aminoglycosides x10 days

Question 38

What type of meningitis are neonates most at risk for?

Answer 38

E.coli and klebsiella

Question 39

What are the risk factors for gram neg bacilli meningitis?

Answer 39

Cranial trauma, neurosurgery, immunosuppressant, hospitalization, and elderly

Question 40

How do you treat gram ñ bacilli meningitis?

Answer 40

IV ceftazidime WITH gentamicin x3weeks for pseudo aeruginosa Other bacteria 3rd gen ceph for 3 weeks