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Flashcards in meningococcus, pneumococcus, gonococcus Deck (23)
1

What is the antibiotic of choice for meningococcal septicaemia?

IV benpen 1.8g 4 hourly (high dose)

2

Who should have eradication of meningococcus when someone gets it?

Eradicate household asymptomatic carriage- because might have GIVEN it to the person who got sick
Ceftriaxone, cipro or rifampicin

3

What should you consider if there is recurrent N meningitidis infection?

Terminal complement deficiency states (C6,7,8)

4

What is the benefit and drawback of Meningococcus polysaccharide compared with Group C conjugate?

Tetravalent (covers A,C,Y,W 135 not just C)
But no long lasting immunity, need boosters, and doesn't reduce nasal carriage/transmission risk.

5

What is the evidence for steroids in meningitis?

Dexamethasone in acute meningitis before or with first antibiotic dose
Reduces case-fatality in pneumococcal meningitis 21%
So give 10mg IV then 6 hourly for 4 days

Don't give if have had a dose of abx in the ambulance

6

What should you do if gram stain show gram positive diplococci?

OR history otitis media or sinusitis or recently treated with a beta lactam....

OR if gram positive cocci resembling staph

OR if cannot do an LP - contraindicated

Could be Pneumococcal meningitis
ADD VANCOMYCIN

MIC to penicillin and ceftriaxone should be determined for all isolates- MIC over 0.125-->vanc + cef
MIC under 0.125 -->benpen

7

What is the value of a pneumococcal urinary antigen?

High negative predictive value

8

What is empirical therapy for meningitis?

Dex + ceftriaxone

If immunocompromised, over age 50, alcoholic, pregnant, or debilitated to cover listeria ADD BENZYLPENICILLIN

9

When should you add vanc in meningitis empirical?

Gram stain show gram positive diplococci

OR history otitis media or sinusitis or recently treated with a beta lactam....

OR if gram positive cocci resembling staph

OR if cannot do an LP - contraindicated

10

If immediate penicillin allergy in suspected meningitis-

Vanc + cipro or moxi

11

Listeria meningitis treatment-

benpen and if allergic then bactrim

12

What bug causes scarlet fever?

Strep

13

What bugs cause toxic shock syndrome?

Staph or strep

14

Treatment for disseminated gonococcus infection?

Ceftriaxone
Remember synovial cultures may initially be negative, later positive.

15

What organisms cause cellulitis?

beta haemolytic strep (group A,B,C,G)
S aureus
Pasteurella with dog or cat bite
Aeromonas wtih freshwater especially if male and have cirrhosis or cancer
Vibrio if seawater
Clostridia if immunocompromised
Mycobacteria marinum if water exposed
Erisepelothrix if shellfish

16

Cellulitic leg but pain much worse than the leg looks?

Necrotising myofascititis!!

17

Management of necrotising fasciitis?

surgical
broad spectrum antibiotics

IVIG improves mortality in s pyogenes

empirical is meropenem plus vanc plus clindamycin
clinda reduces bacterial toxin prodution. Dont need penicillin

18

Management of STAPH toxic shock syndrome?
(fever, rash, shock, vomiting, non purulent conjunctivitis)

BC usually negative!
Fluclox and clindamycin

19

Management of STREP TSS?

BC usually positive for strep pyogenes
Benpen and clindamycin

20

Effect of hydrocortisone in sepsis?

Shock reversed more quickly but more episodes superimposed infection.

21

How long do you have to isolate a meningococcus?

24 hours after antibiotics

22

What gives red man ?

Vanc
(works by binding to D-ALA-D-Ala moieties, preventing polymerisation of peptidoglycans)
Thought secondary to mast cell degranulation that is non IgE mediated

23

Types of nec fasc

Type 1 - mixed aerobes and anaerobes (often post surgery in diabetics)
Type 2 - Strep pyogenes