Infectious Disease > CNS infections > Flashcards

CNS infections Flashcards

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1
Q

Define meningitis

A

Inflammation of the subarachnoid space or spinal fluid

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2
Q

What are the two types of meningitis?

A
  • Bacterial

- Aseptic

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3
Q

What is the cause of aseptic meningitis?

A
  • TMP/SMX
  • OKT3 antirejection monoclonal Ab
  • Azathioprine
  • NSAIDs
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4
Q

Define encephalitis

A

Inflammation of the brain

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5
Q

What are the predisposing risk factors for CNS infections?

A
  • Immunosuppression
  • Head trauma
  • Neurosurgical patients
  • Local infection
  • Exposure to someone with meningitis
  • Anatomical or functional asplenia
  • Complement deficiency
  • Recent travel to area with endemic meningococcal disease
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6
Q

What are the early classical signs/Sx of meningitis?

A
  • Fever
  • Nuchal rigidity
  • Altered mental status
  • Severe HA
  • Positive Brudzinski’s and Kernig’s sign
  • Photophobia
  • Petechial rash
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7
Q

Which early sign/Sx is only found when patient is exposed to N. meningitidis organism?

A

Petechial rash

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8
Q

What are the late classical signs/Sx of meningitis?

A
  • Irritability
  • Drowsiness
  • Seizures
  • Coma
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9
Q

What are the diagnostic tests or procedures for meningitis?

A
  • History and physical exam
  • Lumbar puncture
  • CSF gram stain and culture
  • Rapid identification latex-agglutination
  • Polymerase chain reaction (PCR)
  • CT scan
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10
Q

Rapid identification latex agglutination is helpful to detect which organism antigens in the CSF?

A
  • H. influenzae
  • S. pneumoniae
  • N. meningitidis
  • E. coli
  • Group B streptococci
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11
Q

(T/F) - Rapid identification latex agglutination is not useful if the gram stain comes out negative

A

FALSE - it is useful

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12
Q

When doing a lumbar puncture there are 5 things that need to be checked in order to diagnose a bacterial or viral meningitis. What are they?

A
  • Opening pressure (mmHg)
  • WBC count (cells/mm^3)
  • Differential (%)
  • Proteins (mg/dL)
  • Glucose (mg/dL)
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13
Q

What is a normal opening pressure in a patient?

A

75-175

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14
Q

What is a normal WBC count in a patient?

A

< 5

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15
Q

What is a normal differential in a patient?

A

> 90 monos

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16
Q

What is a normal protein in a patient?

A

< 50

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17
Q

What is a normal glucose in a patient?

A

50-66% simultaneous serum value

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18
Q

What is the bacterial opening pressure value in a patient?

A

Elevated

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19
Q

What is the bacterial WBC value in a patient?

A

1000-5000

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20
Q

What is the bacterial differential value in a patient?

A

> 80 PMNs

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21
Q

What is the bacterial protein value in a patient?

A

100-500

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22
Q

What is the bacterial glucose value in a patient?

A

< 40-60

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23
Q

What is the viral opening pressure value in a patient?

A

Elevated

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24
Q

What is the viral WBC count value in a patient?

25
What is the viral differential value in a patient?
50 lymphs
26
What is the viral proteins value in a patient?
30-100
27
what is the viral glucose value in a patient?
< 30-70
28
Bacterial meningitis is treated depending on the age group and bacterial organism that is contributing to it. What are the divided age groups?
< 1 month 1-23 months 2-50 yo > 50 yo
29
Which is the only age group that is not affected by N. meningitidis?
< 1 month
30
Which is the only age group that is not affected by S. pneumoniae?
< 1 month
31
Which age groups can be affected by L. monocytogenes?
< 1 month | > 50 yo
32
Which age groups can be affected by Streptococcus. agalactiae?
< 1 month | 1-23 months
33
Which age group is affected by H. influenzae?
1-23 months
34
Which age group is affected by Klebsiella spp?
< 1 month
35
Which age group is affected by aerobic gram (-) bacilli?
> 50 yo
36
Which age groups are affected by E. coli?
< 1 month | 1-23 months
37
What are the favorable characteristics of antibiotics that penetrate the CSF well?
- LMW - Non-ionized at physiologic pH - Non-protein bound - Lipid soluble
38
What is the empiric treatment for < 1-month patients with bacterial meningitis?
- Ampicillin + cefotaxime OR | - Ampicillin + aminoglycoside
39
What is the empiric treatment for 1-23 months patients with bacterial meningitis?
Ceftriaxone (or cefotaxime) + vancomycin
40
What is the empiric treatment for 2-50 yo patients with bacterial meningitis?
Ceftriaxone (or cefotaxime) + vancomycin
41
What is the empiric treatment for > 50 yo patients with bacterial meningitis?
Ceftriaxone (or cefotaxime) + vancomycin + ampicillin
42
(T/F) - The duration of empiric treatments for bacterial meningitis depends on the pathogen in the patient
TRUE
43
How long should an empiric treatment be given for H. influenzae?
7 days
44
How long should an empiric treatment be given for N. meningitidis?
7 days
45
How long should an empiric treatment be given for S. pneumoniae?
10-14 days
46
How long should an empiric treatment be given for S. agalactiae?
14-21 days
47
How long should an empiric treatment be given for aerobic gram-negative bacilli?
21 days
48
How long should an empiric treatment be given for L. monocytogenes?
At least 21 days
49
(T/F) - Adjunctive dexamethasone is highly controversial for the use in meningitis
TRUE
50
(T/F) - Dexamethasone can decrease the neurologic sequelae in some patients
TRUE
51
Which patients can dexamethasone decrease neurologic sequelae?
- Infants and children with H. influenzae type B meningitis | - Adults with suspected S. pneumoniae meningitis
52
How is dexamethasone administered and for how long?
Either 10-20 mins before the 1st dose of the antibiotic OR at the same time as the 1st dose of the antibiotic for 2-4 days
53
(T/F) - There is a disadvantage to the use of dexamethasone with antibiotics because it could reduce the amount of drug penetrating the CSF
TRUE
54
How can H. influenzae type B meningitis be prevented?
Vaccination - Hib conjugate vaccine (starts at 2 months)
55
How can N. meningitidis meningitis be prevented?
- Chemoprophylaxis: Use of rifampin for 2 days | - Vaccination: Hib-MenCY, Menactra, Menveo
56
Which meningococcal vaccine is given to infants?
Hib-MenCY
57
How can S. pneumoniae meningitis be prevented?
Vaccination - PPSV23 or PCV13
58
(T/F) - PPSV23 is given to patients ages 55 and older
FALSE - given to 65 and older
59
(T/F) - PCV13 is given to patients starting at 2 months old
TRUE
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