Term
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Definition
–Bacteria
•N. meningitides, S. pneumoniae, H. influenzae, L. monocytogenes, etc.
–Viruses
•HSV, enteroviruses, etc.
–Fungi
•Cryptococcus neoformans, etc.
–Parasites |
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Term
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Definition
•Classic triad
–fever, nuchal rigidity, altered mental status
•Chills, vomiting, photophobia, severe HA
•Kernig and Brudzinski signs
–may be present
•Irritability, delirium, drowsiness, lethargy, coma, seizures (less common in adults) |
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Term
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Definition
•Lumbar puncture
–CSF chemistry, gram stain, and culture
–PCR for detection of viruses, tuberculosis, N. meningitides, S. pneumoniae, Hib, L. monocytogenes
•CT scan or MRI prior to lumbar puncture
–Immunocompromised state, history of CNS disease, new-onset seizures, papilledema, abnormal level of consciousness, focal neurologic deficit
•Blood cultures |
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Term
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Definition
•Eradication of infection
•Amelioration of signs and symptoms
•Prevention of neurologic sequelae |
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Term
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Definition
Supportive care
–fluids, electrolytes, antipyretics, analgesics, etc.
•Antibiotics
–Empiric: vancomycin + third generation cephalosporin (ceftriaxone or cefotaxime)
–Do not delay antibiotics even if LP is delayed
•Changes in CSF after antibiotic administration usually take 12-24 hours
–Once pathogen identified, tailor antibiotics |
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Term
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Definition
•Signs and symptoms
•Adverse drug reactions
•Microbiologic findings
•CSF examination
–Only if patient’s condition has not improved after 48 hours of appropriate antimicrobial therapy |
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Term
| Common bacterial pathogens 2-50 years |
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Definition
N. meningitidis, S. pneumoniae
Vancomycin + 3rd generation cephalosporin |
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Term
| Common bacterial pathogens >50 years |
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Definition
S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram negative bacilli
Vancomycin + 3rd generation cephalosporin + ampicillin |
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Term
| Targeted Therapy Streptococcus pneumoniae |
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Definition
Recommended therapy
Vancomycin plus a third- generation cephalosporin
Alternative therapies
Meropenem (C-III), fluoroquinolone (B-II) |
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Term
| Targeted Therapy Neisseria meningitidis |
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Definition
Recommended therapy
Third-generation cephalosporin
Alternative therapies
Penicillin G, ampicillin, chloramphenicol, fluoroquinolone, aztreonam |
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Term
| Targeted Therapy Listeria monocytogenes |
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Definition
Recommended therapy
Ampicillin or penicillin G (consider adding aminoglycoside)
Alternative therapies
Trimethoprim-sulfamethoxazole, meropenem (B-III) |
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Term
| Targeted Therapy Streptococcus agalactiae |
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Definition
Recommended therapy
Ampicillin or penicillin G (consider adding aminoglycoside)
Alternative therapies
Third-generation cephalosporin (B-III) |
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Term
| Targeted Therapy Haemophilus influenzae |
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Definition
Recommended therapy
Third-generation cephalosporin (A-I)
Alternative therapies
Chloramphenicol, cefepime (A-I), meropenem (A-I), fluoroquinolone |
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Term
| Targeted Therapy Escherichia coli |
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Definition
Recommended therapy
Third-generation cephalosporin (A-II)
Alternative therapies
Cefepime, meropenem, aztreonam, fluoroquinolone, trimethoprim-sulfamethoxazole |
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Term
| Antibiotic Penetration into CSF |
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Definition
•Inflammation of meninges
–Damage to tight junctions between capillary endothelial cells
–Decreases activity of an energy-dependent efflux pump in the choroid plexus responsible for movement of penicillins and to a much lesser extent fluoroquinolones and aminoglycosides
•Low molecular weight
•Nonionized at physiologic pH
•Highly lipid-soluble
•Not extensively protein bound in the serum
–larger free fraction
•Large polar antibiotic may be assisted by a carrier transport system |
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Term
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Definition
| •Maximize dosing to optimize penetration into the CSF |
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Term
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Definition
Gram negative diplococci
•Leading cause of meningitis in children and young adults in US
•Patients may behave aggressively and often are maniacal
•May develop deafness (more common bilaterally)
Immune reaction occurs 10-14 days after onset of disease and despite successful treatment
–Fever, arthritis (usually involving large joints), and pericarditis
•Synovial fluid – large number of PMNs, elevated protein concentrations, normal glucose concentration and sterile cultures
–Reaction may last 1 week or longer
–Do not give additional antibiotics
–NSAIDs for pain and supportive care |
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Term
| Neisseria meningitidis Household contacts |
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Definition
•Household contacts may be at 500-800 times the risk of the general population for acquiring N. meningitidis meningitis
•Secondary cases of meningitis usually develop within 1 week after exposure but may take up to 60 days
•Prophylaxis
–Consult local health department first
–Rifampin 600 mg PO every 12 hours x 2 days
–Alternatives
•ceftriaxone 250 mg IM x 1
•ciprofloxacin 500 mg PO x 1 |
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Term
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Definition
•Gram positive diplococci
•Leading cause of meningitis in adults
•Common neurologic complications
–Coma
–Seizures
•50% of cases due to primary infection of parameningeal focus (ear or paranasal sinuses) |
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Term
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Definition
•Gram negative coccobacillus
•May be indication of parameningeal focus (middle ear or paranasal sinus infection, or CSF leakage)
•Close contacts may be at 200-1000 times the risk of the general population for acquiring H. flu meningitis
•Prophylaxis
–Protect close contacts by eliminating nasopharyngeal and oropharyngeal carriage of H. influenzae
–Consult local health department first
–Rifampin 600 mg daily x 4 days |
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Term
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Definition
•Gram positive diphtheroid-like organism
•8% of all cases of meningitis
•Affects
–Alcoholics
–Immunocompromised adults
•75% of Listeria infections result in transmission to the CNS
–Elderly
•20% of meningitis cases in pts > 60 years old
–15% mortality
•Colonization of GI tract occurs first
•Bacteria then penetrate gut lumen
•Food-borne pathogen
•Sources
–Coleslaw
–Unpasteurized milk and cheeses (such as Mexican-style soft cheese, brie, feta, etc.)
–Ready-to-eat foods
–Raw beef and poultry |
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Term
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Definition
•Most common fungal CNS infection in US
•Soil fungus acquired by inhalation of spores from the environment leading to pneumonia
•85% of cases occur in HIV infected patients
•Treatment
–Amphoteracin B 0.5-1 mg/kg/day + flucytosine 100 mg/kg/day
•Amphoteracin penetrates CNS poorly
•Flucytosine is poorly tolerated
–Bone marrow suppression
–GI distress |
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Term
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Definition
•Herpes simplex virus (HSV)
–detect in CSF via PCR
–Acyclovir 10 mg/kg IV every 8 hours for 14-21 days
–Needs to be renally adjusted
•Other viral infections
–Treatment is supportive |
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Term
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Definition
•Rationale for use based on animal models of infection
–Subarachnoid space inflammatory response contributes to morbidity and mortality
•Controversy
–dexamethasone inhibits meningeal inflammation and therefore antibiotic penetration
•Data to support use in adults is scarce
•If pneumococcal meningitis is suspected or proven, give dexamethasone 0.15 mg/kg every 6 hours x 2-4 days
•First dose administered 10-20 minutes prior to first dose of antibiotics |
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Term
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Definition
•Pneumococcal
–>65 years old
–Age 2-64 with risk factors
•Chronic illness
•Live in high risk environments (e.g. Alaskan Natives, residents of LTC facilities)
•Lack a functioning spleen (sickle cell disease, splenectomy)
•Immunocompromised (including HIV) |
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Term
| Haemophilus influenzae Vaccines |
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Definition
•Haemophilus influenzae (Hib)
–Children
–> 5 years old with risk factors
•Lack a functioning spleen (sickle cell disease, splenectomy)
•Immunocompromised (including HIV) |
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Term
| Meningococcal conjugate vaccine |
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Definition
•Meningococcal conjugate vaccine (MCV)
–Asplenia (anatomic or functional)
–Other high risk groups (age 11-12) |
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