Term
| Epidemiology of Meningitis |
|
Definition
Mortality rates: 2-75%
Morbidity 30-50% --> seizures, hearing loss, hydrocephalus;
Males > females;
Children > adults |
|
|
Term
|
Definition
|
|
Term
| Cerebrospinal Fluid (CSF) |
|
Definition
produced in 3rd, 4th, and lateral ventricles by choiroid plexus;
STERILE!!!
Typical presentation:
- clear
- protein < 50 mg/dL
- CSF glucose ~60% of peripheral serum glucose
- pH = 7.4
- WBC < 5 cells/mm^3 (100% monocytes) |
|
|
Term
| Risk Factors for Meningitis |
|
Definition
Breakdowns in Immune System:
- asplenia
- sickle cell disease
- neutropenia
- structural malformations/surgery
- B cell or T cell deficiencies
Preceding Bacterial Disease:
- otitis media
- mastoiditis
- sinusitis |
|
|
Term
| Blood Brain Barrier (BBB) |
|
Definition
composed of endothelial cells, tight junctions;
- restricts passsage of molecules/foreign bodies;
Factors affecting passage:
- size
- polarity
- lipophilicity
- ionization |
|
|
Term
|
Definition
| HA, fever, chills, Nuchal rigidity, photophobia, nausea, purpuric or petechial rashes, delirium/drowsiness/lethargy, seziures |
|
|
Term
|
Definition
Brudzinski sign;
Kernig sign |
|
|
Term
|
Definition
| neck flexion results in hip/knee flexion |
|
|
Term
|
Definition
| hamstring stiffness results in an inability to straighten leg when hip is flexed to 90 degrees |
|
|
Term
|
Definition
imaging/CT scan;
CSF analysis/gram stain/culture;
blood culture;
serum markers of infection |
|
|
Term
|
Definition
WBC < 5 cells/mm^3;
Differential: >90% monocytes;
Protein: < 50 mg/dL;
Glucose: 50-66% of serum value (mg/dL);
Pressure: < 20 cm H2O |
|
|
Term
| CSF Analysis indicating Bacterial Meningitis |
|
Definition
WBC: 1000 - 5000 cells/mm^3;
Differential: >=80% PMNs;
Protein: 100-500 mg/dL;
Glucose: <40 mg/dL (60% of serum);
Pressure: >20 cm H2O; |
|
|
Term
| CSF Analysis indicating Viral Meningitis |
|
Definition
WBC: 100-1000 cells/mm^3;
Differential: 50% lymphocytes;
Protein: 30-150 mg/dL;
Glucose: <30 - 70 mg/dL;
Pressure: <20 cm H2O |
|
|
Term
| Treatment of Viral Meningitis |
|
Definition
Most common Etiologies:
- Enteroviruses (Echoviruses, Coxsackieviruses A/B)
- Herpes Simplex
- HIV
- Lymphocyticchoriomeningitis virus;
- Arboviruses (West Nile)
- Mumps
- Poliovirus
Occurs typically in Summer/Fall;
Mainly supportive Care;
Diagnosis:
- CSF analysis/culture
- PCR
- antivirals NOT effective |
|
|
Term
| Treatment of Herpes Simplex Viral Meningitis |
|
Definition
| Acyclovir + Supportive Care |
|
|
Term
| Tx of Fungal Meningitis caused by Cryptococcus neoformans |
|
Definition
Amphotericin B + flucytosine
OR
fluconazole + flucytosine |
|
|
Term
| Treatment of Fungal Meningitis caused by Coccidioides immitus |
|
Definition
|
|
Term
| Treatment of Fungal Meningitis caused by Histoplasma capsulatum |
|
Definition
|
|
Term
| Common Pathogens in Pts < 1 month old with Bacterial Meningitis |
|
Definition
Streptococcus agalactiae;
E. coli;
Listeria monocytogenes;
Klebsiella pneumoniae; |
|
|
Term
| Common Pathogens in Pts 1-23 months old with Bacterial Meningitis |
|
Definition
Streptococcus agalactiae;
E. coli;
Haemophilus influenzae;
Streptococcus pneumoniae;
Neisseria meningitidis; |
|
|
Term
| Common Pathogens in Pts 2-50 yrs old with Bacterial Meningitis |
|
Definition
Strep. pneumoniae;
Neisseria meningitidis; |
|
|
Term
| Common Pathogens in Pts >50 yrs old with Bacterial Meningitis |
|
Definition
S. pneumoniae;
N. meningitidis;
L. monocytogenes;
Aerobic Gram-Neg Bacilli; |
|
|
Term
| Common Pathogens in Immunocompromised Pts with Bacterial Meningitis |
|
Definition
S. pneumoniae;
N. meningitidis;
L. monocytogenes;
Aerobic Gram-Neg bacilli (including PSA) |
|
|
Term
| Common Pathogens in Pts with Basilar Skull Fractures with Bacterial Meningitis |
|
Definition
S. pneumoniae;
H. influenzae;
Grp A Beta-hemolytic Streptococci |
|
|
Term
| Common Pathogens in Pts with Head trauma or post-neurosurgery with Bacterial Meningitis |
|
Definition
Staph. aureus;
Staph. epidermidis;
Aerobic Gram-Neg bacilli (including PSA) |
|
|
Term
| Treatment in Pts < 1 month old with Bacterial Meningitis |
|
Definition
Ampicillin + cefotaxime (NOT ceftriaxone!!!)
OR
ampicillin + AMG |
|
|
Term
| Treatment in Pts 1-23 months old with Bacterial Meningitis |
|
Definition
| Vancomycin + 3rd Gen. Cephalosporin |
|
|
Term
| Treatment in Pts 2-50 yrs old with Bacterial Meningitis |
|
Definition
| Vancomycin + 3rd Gen. Cephalosporin |
|
|
Term
| Treatment in Pts >50 yrs old with Bacterial Meningitis |
|
Definition
| Vancomycin + Ampicillin + 3rd Gen. Cephalosporin |
|
|
Term
| Treatment in Pts with Basilar Skull Fractures with Bacterial Meningitis |
|
Definition
| Vancomycin + 3rd Gen. Cephalosporin |
|
|
Term
| Treatment in Pts with Penetrating Head trauma or Post-Neurosurgery with Bacterial Meningitis |
|
Definition
Vancomycin + Cefepime
OR
Vancomycin + ceftazidime
OR
Vancomycin + meropenem |
|
|
Term
| Treatment in Pts with CSF Shunt with Bacterial Meningitis |
|
Definition
vancomycin + Cefepime
OR
Vancomycin + Ceftazidime
OR
Vancomycin + meropenem |
|
|
Term
| Most Common Pathogens for Bacterial Meningitis |
|
Definition
Strep. pneumoniae;
Neisseria meningitidis;
Listeria monocytogenes;
Haemophilus influenzae |
|
|
Term
|
Definition
Gram-Pos diplococcus;
Most common pathogen in adults;
Increasing resistance --> Vancomycin;
PCN Allergy --> Chloramphenicol;
IF PCN MIC is:
<0.1 --> Standard: Penicillin G or ampicillin; Alternative: 3rd gen. Cephalosporin or chloramphenicol;
PCN MIC 0.1-1.0: Standard: 3rd Gen. Cephalosporin; Alternative: Cefepime or Meropenem;
PCN MIC >= 2.0 --> Standard: Vancomycin + 3rd Gen. Cephalosporin; Alternative: Fluoroquinolone;
If Cefotaxime or Ceftriaxione MIC is >=1.0 --> Standard: vancomycin + 3rd Gen. Cephalosporin; Alternative: fluoroquinolone
Duration of Therapy: 10-14 days |
|
|
Term
|
Definition
Gram-Neg diplococci;
2nd most common adult pathogen;
often presents with SKIN RASH;
Spread by direct contact;
PCN Allergy --> chloramphenicol;
If PCN MIC is:
<0.1 --> Standard: penicillin G or Ampicillin; Alternative: 3rd Gen. Cephalosporin or Chloramphenicol;
If PCN MIC is 0.1-1.0 --> Standard: 3rd Gen. Cephalosporin; Alternative: chloramphenicol, FQN, Meropenem
Duration of Therapy: 7 days |
|
|
Term
|
Definition
Gram-Pos rod;
Sourse: food --> enters gut & disseminates hematogenously;
- isolated in raw veggies, unpasteurized milk, soft cheeses, deli meats, raw beef & poultry, & butter;
Infection seen at extremes of age (young & old) - deficits in cell-mediated immunity;
Standard Therapy: Ampicillin OR Penicillin G;
Alternative Therapies: TMP/SMX, Meropenem
Duration of Therapy: >= 21 days |
|
|
Term
|
Definition
Gram-Neg coccobacilli;
Type B: most common cause of this type of meningitis;
Used to be most common cause in children (vaccine now used);
30-40% ampicillin-resistance;
Spread by close contact with infected individuals;
Beta-Lactamase Neg. - Standard: Ampicillin; Alternatives: 3rd Gen. Cephalosporin, Cefepime, Chloramphenicol, OR FQN;
Beta-Lactamase Pos. - Standard: 3rd Gen. Cephalosporin; Alternatives: Cefepime, Chloramphenicol, or FQN
Duration of Therapy: 7 days |
|
|
Term
|
Definition
Start ASAP!!! --> improves morbidity & mortality w/ early ABX;
Bactericidal > bacteriostatic;
Dose aggressively;
Penetration into CSF |
|
|
Term
| Therapeutic Antibiotic Penetration into CSF WITHOUT Inflammation |
|
Definition
sulfonamides;
trimethoprim;
rifampin;
chloramphenicol;
metronidazole;
isoniazid |
|
|
Term
| Therapeutic Antibiotic Penetration into CSF WITH Inflammation |
|
Definition
PCNs;
Ceftriaxone;
Ceftazidime;
Aztreonam;
Carbapenems;
Vancomycin;
Linezolid;
Colistin;
Ciprofloxacin;
Fluconazole;
Flucytosine;
Acyclovir;
Ganciclovir;
Foscarnet |
|
|
Term
| NEVER Therapeutic Antibiotic Penetration into CSF |
|
Definition
Aminoglycosides (AMGs);
1st & 2nd Gen. Cephalosporins;
Clindamycin;
Amphotericin B;
Ketoconazole;
Itraconazole |
|
|
Term
|
Definition
used to reduce inflammation;
Concern: drug may prevent antibiotic penetration;
In Children: studies showed improved penetration w/ H. influenzae type B meningitis;
In Adults:
- studies showed improved outcomes with S. pneumoniae;
Dosing:
- 0.15 mg/kg IV q6 hr x 2-4 days, Initiate 10-20 min prior to or at same time of 1st ABX dose |
|
|
Term
| Indications for IntraVENTRICULAR ABX |
|
Definition
- bypasses BBB (blood-brain barrier);
failure of conventional therapy;
hardware (i.e. shunts);
- reaches high concentrations: vancomycin 10 mg/150 mL CSF = ~67 mg/L;
- instill for at least 1 hr; |
|
|
Term
| Indications for Post-Exposure Prophylaxis |
|
Definition
People in "close contact (household members, day-care contacts, exposure to oral secretions, HCPs)" with pts with:
- H. influenzae type B
- N. meningitidis |
|
|
Term
| Chemoprophylaxis of H. influenzae type B Meningitis |
|
Definition
Infants <1 month old:
- rifampin 10 mg/kg/day x 4 days;
Children (1 month - 12 yrs):
- rifampin 20 mg/kg/day (MAX 600 mg)x 4 days;
Adults:
- rifampin 600 mg/day x 4 days |
|
|
Term
| Chemoprophylaxis of Close-Contacts to N. meningitidis Meningitis |
|
Definition
Infants <1 month:
- rifampin 5 mg/kg/day x 4 days;
Children (1 mo - 12 yrs):
- rifampin 10 mg/kg q12 hr x 4 doses;
Adults:
- rifampin 600 mg q12 hrs x 4 doses;
OR
- ciprofloxacin 500 mg PO x 1 dose;
OR
- ceftriaxone 125-250 mg IM x 1 dose |
|
|
Term
| Indications for 7-valent conjugate vaccine (Prevnar) |
|
Definition
all children <23 months;
Children 24-59 months w/ high risk status:
- chronic dx
- Alaska native, American Indian
- African American
- day care attendees |
|
|
Term
| Indications for 23-valent polysaccharide vaccine (Pneumovax) |
|
Definition
immunocompromised people;
people 2-64 yrs old w/ funtional/anatomical asplenia;
people >=65 yrs old (2nd dose if received vaccine >=5 yrs prior & was <65 yrs old at that time) |
|
|
Term
| Indications for Meningococcal Vaccine (lack B coverage) |
|
Definition
young adolescents;
college freshmen;
military recruits;
travel to Africa, Asia, Saudi Arabia;
people with asplenia;
people with complement deficiencies;
outbreaks; |
|
|
Term
| Indications for H. influenzae type B Vaccine |
|
Definition
all children;
pts w/ asplenia (functional or anatomical);
Sickle cell disease;
Hodgkin disease;
Hematologic neoplasms;
Solid-organ transplantation;
Immunocompromised pts; |
|
|
