Term
typically VIRAL:
HSV, Enterovirus, EBV, Adenovirus, Arbovirus, HIV |
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Definition
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Term
Disturbances in brain function:
psychiatric symptoms, emotional lability, altered sensorium, ataxia, movement disorders, focal neurologic deficit, paresis, stupor, coma, seizures
fever
headache
personality change or irritability lasting for hours to days
lethargy: coma and death in severe cases |
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Definition
| Clinical presentation of encephalitis |
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Term
CSF cell count normal to slightly elevated
protein normal to slightly elevated
glucose normal
pleocytosis (increase in cell count) of mononuclear cells
high protein level + polymorphonuclear pleocytosis = brain necrosis |
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Definition
| encephalitis CSF findings |
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Term
EMPIRIC ACYCLOVIR
neonates are most likely to develop encephalitis from HSV
neonatal dosing: 20 mg/kg/dose IV q8h for 21 days |
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Definition
| encephalitis treatment for neonates |
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Term
High fever
headache
nuchal rigidity
N/V
photophobia
confusion
sleepiness
seizures
children: lethargic, irritable, vomiting or feeding poorly |
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Definition
| signs and symptoms of meningitis |
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Term
#1 bacterial cause = Streptococcus pneumoniae
#1 viral cause = Enteroviruses (no treatment b/c usually resolves on its own) |
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Definition
| common causes of meningitis |
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Term
normal:
WBC: <5 (adults); <20 (newborns)
Diff: ~70% lymphocytes, ~30% monocytes
Protein: <50
Glucose: 2/3 serum
bacterial:
WBC: 400-100,000
Diff: 80-90% neutrophils (PMNS), left shift
Protein: mild to marked elevation (80-500)
Glucose: <1/2 serum |
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Definition
| normal CSF results and CSF infected with bacteria for WBC, Diff, Protein, and Glucose |
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Term
| highly contagious through droplets |
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Definition
| how is Meningococcal meningitis acquired? |
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Term
| gram + cocci in pairs/chains |
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Definition
| gram stain of Streptococcus pneumoniae (causes Pneumococcal Meningitis) |
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Term
|
Definition
| gram stain of N. meningitidis (causes Meningococcal meningitis) |
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Term
highly contagious through droplets
characteristic petechial rash or purpuric lesions
advances rapidly and can be fatal
becomes limb threatening within hours |
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Definition
| signs/symptoms of Meningococcal meningitis (caused by N. meningitidis) |
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Term
|
Definition
| gram stain of Haemophilus influenzae (causes meningitis) |
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Term
| Gram + coccus in pairs or chains |
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Definition
| gram stain of group B strep (Streptococcus agalactiae), most common cause of meningitis in neonates |
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Term
| gram + bacilli or coccobacilli |
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Definition
| gram stain of Listeria monocytogenes (causes meningitis) |
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Term
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Definition
| gram stain of enterics and Pseudomonas aeruginosa (causes meningitis) |
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Term
common pathogens:
Streptococcus agalactiae (gram + cocci)
E. coli (gram - bacilli)
Listeria monocytogenes (gram + bacilli)
Klebsiella (gram - bacilli)
SELK
empiric treatment:
Ampicillin
PLUS
Cefotaxime
OR
Aminoglycoside |
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Definition
| common pathogens and empiric therapy age < 1 month |
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|
Term
common pathogens:
S. penumoniae
Neisseria meningitidis
S. agalactiae
H. influenza type B
E. coli
HENSS
empiric therapy:
Vancomycin
PLUS
3rd generation cephalosporin (Ceftriaxone, Cefotaxime) |
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Definition
| common pathogens and empiric therapy for meningitis age 1-23 months |
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|
Term
common pathogens:
N. meningitidis, S. pneumoniae
empiric treatment:
Vancomycin
PLUS
3rd generation cephalosporin (Ceftriaxone, cefotaxime) |
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Definition
| common pathogens and empiric treatment of meningitis age 2-50 years |
|
|
Term
common pathogens:
S. pneumoniae
N. meningitidis
L. monocytogenes
aerobic gram negative bacilli
SNL
empiric treatment:
Vancomycin
PLUS
ampicillin
PLUS
3rd generation cephalosporin (Ceftriaxone, Cefotaxime) |
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Definition
| common pathogens and empiric treatment of meningitis > 50 years |
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|
Term
penetrating head trauma, post-neurosurgery, CSF shunt
treatment:
Vancomycin PLUS Cefepime
OR
Vancomycin PLUS Ceftazidime
OR
Vancomycin PLUS Meropenem |
|
Definition
| for what conditions should pseudomonas be considered for causing meningitis and what is the treatment? |
|
|
Term
Vancomycin
PLUS
3rd generation cephalosporin (ceftriaxone, cefotaxime)
for 10-14 days |
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Definition
| targeted meningitis therapy against Streptococcus penumoniae (gram + coccus) |
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Term
3rd generation cephalosporin
for 7 days |
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Definition
| targeted meningitis treatment caused by N. meningitidis (gram - coccus) |
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Term
Ampicillin
OR
Penicillin G
(consider adding aminoglycoside)
for >/= 21 days |
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Definition
| targeted meningitis treatment caused by L. monocytogenes (gram + bacillus) |
|
|
Term
Ampicillin
OR
Penicillin G
(consider adding aminoglycoside)
for 14-21 days |
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Definition
| targeted therapy of meningitis caused by S. agalactiae (gram + coccus) |
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|
Term
3rd generation cephalosporin
for 7 days |
|
Definition
| targeted meningitis treatment caused by H. influenzae (gram - bacillus) |
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|
Term
3rd generation cephalosporin
for 21 days |
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Definition
| targeted therapy of meningitis caused by E. coli (gram - bacillus) |
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Term
(SCAR)
sulfa/TMP
chloramphenicol
anti-TB
rifampin |
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Definition
| which antibiotics reach therapeutic concentrations in the brain? |
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Term
CACA
1st and 2nd generation cephalosporins
aminoglycosides
clindamycin
most anti-fungals |
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Definition
| which antibiotics do not reach therapeutic concentrations in the CSF? |
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Term
PAC CAFF V
penicillins
azetreonam
3rd generation cephalosporins
carbapenems
anti-virals
fluconazole
fluoroquinolones
vancomycin |
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Definition
| which antibiotics reach the CSF if inflammation is present? |
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Term
meningitis is a life threatening emergency
longer duration of symptoms increases possibility of adverse outcomes
no prospective trails exist
draw blood cultures and administer antibiotics as soon as possible
wait for antibiotics until after lumbar puncture if done within 30-60 minutes |
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Definition
| timing of meningitis therapy |
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Term
dexamethasone prevents an increase in cerebral edema, intracranial pressure and neuronal injury
DO NOT GIVE AFTER ANTIBIOTICS
clear benefit with H. influcenzae
possible benefit with Streptococcus pneumoniae |
|
Definition
| when should you give adjunctive dexamethasone with meningitis treatment? |
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|
Term
close contact should receive prophylaxis
household members, school/dorm classmates, coworkers in the same office
healthcare workers not included
drugs:
rifampin, ciprofloxacin, ceftriaxone IM |
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Definition
| who should receive N. meningitidis prophylaxis and what are the drugs? |
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|
Term
unvaccinated children age 4 years or younger in close contact with H. influenzae
no need to vaccinate household if no one is under 4 years old
However, if there is an unvaccinated young child, entire family needs prophylaxis
drug: rifampin |
|
Definition
| who should receive H. influenzae prophylaxis and what is the drug? |
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