Mikesell

Question 1

where is the cerebrospinal fluid located

Answer 1

subarachnoid space
(where infection takes place)

Question 2

compare the BBB and BCSF

Answer 2

BBB is 5000 bigger and harder to get into

Question 3

characteristics that would help penetration

Answer 3

lipid soluble
unionized
free drug (non-protein bound)
low molecular weight
enhanced meninges inflammation

Question 4

drugs able to get through without meninges inflammation

Answer 4

acyclovir
ganciclovir
TMP/SMX
fluconazole
voriconazole
linezolid
metronidazole
FQs

Question 5

drugs able to get through with meninges inflammation

Answer 5

penicillins
3rd/4th gen cephalosporins (ceftriax and cefepime)
aztreonam
meropenem
vancomycin

Question 6

drugs not able to get through the CSF

Answer 6

macrolides
aminoglycosides
beta lactamase inhibitors
1st/2nd gen cephalosporins
tetracyclines
clindamycin
echinocandins
ertapenem

Question 7

types of acute bacterial meningits

Answer 7

hematogenous
direct inoculation

Question 8

causative pathogens neonates <1 month

Answer 8

strep agalactiae
strep pneumo
neisseria
listeria

Question 9

causative pathogens infants (1-23 months)

Answer 9

strep agalactiae
strep pneumo
neisseria
h. flu

Question 10

causative pathogens children and adults <50

Answer 10

strep pneumo
neisseria

Question 11

causative pathogens older adults >50

Answer 11

strep pneumo
neisseria
listeria

Question 12

when do we start empiric antibiotics in acute bacterial meningitis?

Answer 12

after we get the lumbar puncture

Question 13

CSF interpretation of acute bacterial

Answer 13

WBC high >1000-5000
>80% neutrophils
protein high
glucose low
positive gram stain

Question 14

common pathogens in fungal meningitis

Answer 14

cryptococcus neoformans
cryptococcus gattii
soil fungus

Question 15

CSF interpretation of fungal meningitis

Answer 15

WBC increased 10-500
>50% lymphocytes
protein high
glucose low
high opening pressure

Question 16

common pathogens viral encephalitis

Answer 16

enteroviruses
arboviruses
CMV
VZV
HSV

Question 17

presentation of viral encephalitis

Answer 17

extreme altered mental status
confusion, personality changes, memory impairment

Question 18

CSF interpretation of viral encephalitis

Answer 18

WBC increased 5-300
50% lymphocytes
protein increased
glucose low

Question 19

acute bacterial meningitis empiric treatment

Answer 19

neonates: ampicillin + gentamycin/ceftriax/cefe
infants: vancomycin + ceftriaxone
children/adults: vancomycin + ceftriaxone
older adults/immunocompomised : vancomycin + ceftriaxone + ampicillin

Question 20

gram positive diplococci in pairs and chains

Answer 20

streptococci

Question 21

streptococcus treatment

Answer 21

ampicillin or penicillin G
- ceftriaxone or vancomycin if resistant
x10-14 days

Question 22

what should be adminstered before antibiotics

Answer 22

dexamethasone x 2-4 days

Question 23

gram positive cocci in clusters

Answer 23

staph aureus

Question 24

staph aureus treatment

Answer 24

MSSA: nafcillin
MRSA: vancomycin
x 14-21 days

Question 25

gram positive rod, non spore forming

Answer 25

listeria

Question 26

listeria treatment

Answer 26

ampicillin +/- gentamycin x 21 days

Question 27

gram negative intra cellular diplococci

Answer 27

neisseria

Question 28

neisseria treatment

Answer 28

penicillin G or ampicillin x 7 days or ceftriaxone

Question 29

gram negative coccobacillus

Answer 29

h. flu

Question 30

h. flu treatment

Answer 30

beta lactamase neg: ampicillin beta lactamase positive: ceftriaxone x 7 days

Question 31

other gram negative enterobacteriaceae treatment

Answer 31

ceftriaxone or cefepime x 21 days

Question 32

fungal meningitis induction treatment

Answer 32

amphotericin B + flucytosine (over 24h) x 2 weeks

Question 33

fungal meningitis consolidation treatent

Answer 33

fluconazole 400-800 mg PO or IV daily

Question 34

fungal meningitis maintenance treatment

Answer 34

fluconazole 200 mg PO one daily x 12 months

Question 35

do we hold art in cryptococcus

Answer 35

until 5 weeks after initiating treatment for crytpcococcus especially in CSF<5

Question 36

viral encephalitis treatmnt

Answer 36

supportive care if VZV, HSV: acyclovir if CMV: ganciclovir +/- foscarnet