Term
| Approach to Bacterial Meningitis |
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Definition
1. Early Recognition
2. Rapid Diagnostic Evaluation
3. Emergent Antimicrobial Therapy
4. Emergent Adjunctive Therapy
Mortality Rate is 20%, 10-30% have neurological impairment |
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Term
| What symptoms are needed for a Bacterial Meningitis Diagnosis in 95% of pts? |
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Definition
95% present with at least two of:
HA, Fever, Neck Stiffness, and Altered Mental Status |
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Term
| Menigococcal Meningitis patients show what symptom? |
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Definition
| 63% of patients have a petechial rash |
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Term
| Bacterial Meningitis Symptoms |
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Definition
| High Fever, Nonblanching petechial rash (sepsis), HA, Vomiting or Nausea, Confusion, Seizures, Lethargic Child. |
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Term
| Bacterial Meningitis Signs |
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Definition
Stiff Neck-Kernig and Brudzinski signs, Papilledema, Photphobia.
In Children- Apnea, Bulging Fontanel, Purpuric Rash |
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Term
| What tests do you run if Meningitis is Suspected? |
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Definition
Order a CT to detect a brain shift before the LP
Lumbar puncture is mandatory, but if deferred get a blood culture |
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Term
| Bacterial Meningitis Lumbar Punture Results |
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Definition
pleocytosis- Elevated WBC>1000
ElevatedProtein Levels- >100
Decreased Glucose <10
Gram Stain
Lactate >4.2 indicate bacterial rather than viral |
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Term
| Test for Specific Bacteria in Bacterial Meningitis? |
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Definition
| PCR- Polymerase Chain Reaction |
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Term
| What are the Gram Positive bacteria suspected in Bacterial Meningitis |
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Definition
| Listeria Monocytogenes, Group B Streptococcus, Streptococcus pneumoniae (pneumococcus) |
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Term
| What are the Gram Negative Bacteria suspected in Bacterial Meningitis |
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Definition
| Neisseria meningitidis, E. coli, Hemophilus influenzae, Enterobacter spp, Klebsiella spp |
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Term
| Bacterial Meningitis bacteria with Terrorist Activity. What bacteria is this? |
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Definition
| Bacillus anthracis- aerobic gram positive bacteria |
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Term
| Treatment for Bacillus anthracis |
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Definition
| Ciprofloxacin +Vancomycin |
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Term
| When do you initiate empirical treatment for Bacterial Meningitis? |
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Definition
| within an hour and before you send them to imaging |
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Term
| Antimicrobial Therapy for Newborn-1 month |
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Definition
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Term
| Antimicrobial Therapy for 1 month-60 years |
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Definition
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Term
| Antimicrobial Therapy for >60 years or 50 if immunocompromised |
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Definition
| ampicillin+ceftriaxone+vancomycin |
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Term
| Examples of an immunocompromised patient |
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Definition
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Term
| Ceftriaxone dosage for Peds with Bacterial Meningitis |
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Definition
80-100 mg/kg/day IV q12-24h x 7-21days
Start with 100mg/kg IV x1
Max: 4g/24 hr |
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Term
| Ceftriaxone dosage in Adults with Bacterial Meningitis |
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Definition
1-2g IM/IV q24h or .5-2g IM/IV q12
MAx 4g/24h |
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|
Term
| Vancomycin dosage with Bacterial Meningitis |
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Definition
<50kg=500mg IV q12h
50-69kg= 750 mg IV q12h
>70kg= 1000mg IV q12h
In Elderly start at 10-15mg IVq12-24h |
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Term
| Treatment for patients with basilar skull fracture |
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Definition
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Term
| Treatment for patients with penetrating trauma, postneurosurgery, CSF shunt |
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Definition
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Term
| Prophylaxis dosing using ceftriaxone |
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Definition
Children < 1 month= 125 mg IM once
Children > 1 month= 125 mg IM once
Adults > 15 years= 250 mg IM once |
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Term
| Things that can occur with inflammation in the subarachnoid space |
|
Definition
| cerebral edema, altered cerebral blood flow, neuronal injury, increased intracranial pressure |
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Term
| Dexamethasone used as Adjunctive Therapy |
|
Definition
Use if S. pneumonia infection in adult
Controversial effect on vancomycin
infants and children 2 month or older- .15mg/kg q6h x4d
adults- 10mg q6h x4d |
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Term
| Bacterial Meningitis Prevention |
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Definition
Immunization
Prophylaxis with ceftriaxone |
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Term
| Bacterial Meningitis most commonly occurs in seronegative persons with what? |
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Definition
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|
Term
| Which serogroup does the immunization not cover? |
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Definition
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|
Term
| How long does the immunization last? |
|
Definition
1-3yr in children <5yr
3-5 yr in adults
No memory T cells made |
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Term
| What ages are recommended for the immunization Menomune? |
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Definition
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Term
| Meningococcal Polysaccharide Conjugate Vaccine (Menactra) |
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Definition
11 to 55 years
Reduce nasophayngeal colonization allowing for herd immunity
Preferred for revaccination
More durable |
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Term
| Menigococcal oligosaccharide conjugate vaccine (Menveo) |
|
Definition
2-55 years
In children 2-5yr at high risk- give a second injection after 2 months |
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Term
| 60 year old female diagnosed with Streptococcus Pneumoniae. What tests were run and what drug was used? |
|
Definition
Blood culture, and LP, gram stain
Gave her ceftriaxone IV |
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Term
| Fungal CNS infection S & S |
|
Definition
| Fever, hx of HA, Immunocompromised pts, elevated Intracranial PRessure, low WBC in CSF (5-500), elevated proteins (50-150), glucose suppressed (10-45) |
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Term
| Fungal CNS infection treatment |
|
Definition
Amphotericin B +flucytosine
MOst likely pathogen is cryptococcus |
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Term
| Tuberculosis Meningitis CSF analysis results |
|
Definition
Moderate lymphocytic pleocytosis (100-500)
elevated proteins (100-500)
low glucose (10-45)
CSF culture takes 4-6 wks
CSF PCR for tuberculosis in 58% sensitive and 98% specific |
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Term
| Tuberculosis Meningitis Therapy components |
|
Definition
9 to 12 months
isoniazid, rifampin, pyrazinamide, and ethambutol for 2mo
then isoniazid, rifampin for 7 to 10 months
Adjunct therapy with dexamethasone for first 6 to 8 weeks decreases mortality |
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Term
| Viral Meningitis Herpesviruses |
|
Definition
HSV-1 and HSV-2
Epstein Barr Virus (EBV)
Cytomegalovirus (CMV)
Varicella-zoster virus (VZV) |
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Term
| Viral Meningitis Flavivirus |
|
Definition
Japanese encephalitis complex
St Louis encephalitis
Tick borne encephalitis
WEst Nile virus
dengue fever and yellow fever |
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Term
| Viral Meningitis Treatment Drugs |
|
Definition
acyclovir
ganciclovir
interferon-alpha-2b |
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Term
|
Definition
IV 10mg/kg q8h x2-3 wks
HSV
VZV
Mortality Rate of 20% |
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|
Term
|
Definition
IV 5mg/kg q12 x 2 weeks
CMV
significant renal toxicity |
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Term
|
Definition
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|
Term
| Acyclovir mechanism of action |
|
Definition
| inhibits virus DNA polymerase and can cause early chain termination |
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