thera meningitis

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coal
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272585
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thera meningitis
Updated:
2014-05-02 01:35:55
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thera meningitis
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thera meningitis
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thera meningitis
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  1. risk factors
    • splenectomy
    • high-dose steroids
    • alcoholism
    • respiratory infection/otitis media
    • age extremes
    •   < 5
    •   > 60
    • immunosuppression
    • neurosurgical procedure
  2. etiology of bacterial meningitis
    • S. pneumonia (61%)
    • Neisseria meningitidis
    • group B strep
    • Hemophilus influenza
    • listeria monocytogenes
  3. who should receive the meningococcal vaccine
    • children 11-18
    • residents in college dorms up to age 21
    • travelers to endemic regions
    • complement deficiencies
  4. common S & S
    • stiff neck
    • fever
    • petiechial rash
    • altered mental status
  5. classic triad and other diagnosis symptoms
    • fever
    • nuchal rigidity
    • altered mental status

    • chills
    • vomiting
    • photophobia
    • severe headache
  6. values of WBC's in CSG
    • normal < 5
    • bacterial 1000-5000
    • viral 100-1000
  7. values of differential in the CSF
    • normal >90
    • bacterial 80 PMNs
    • viral 50
  8. values of protein in CSF
    • normal < 50
    • bacterial 100-500
    • viral 30-150
  9. levels of glucose in the CSF
    • normal -50%-66% of simultaneous serum value
    • bacterial <40% (60% of serum)
    • viral < 30-70
  10. flow of suspicion of bacterial meningitis in infants and children and extenuating circumstances
    • blood cultures STAT
    • dexamethasone + empiric
    • negative CT
    • lumbar puncture
  11. flow of suspicion of bacterial meningitis in infants and children w/o extenuating circumstances
    • blood cultures and LP STAT
    • dexamethasone + empiric therapy
    • CSF findings of bacterial
    • continue therapy
  12. extenuating circumstances for infants and children
    • focal neurologic deficit
    • immunocompromised
    • history CNS disease
    • papiledema
  13. extenuating circumstances for adults
    • new onset seizure
    • immunocompromise
    • history CNS disease
    • papiledema
    • focal neurologic deficit
  14. treatment of suspicion of meningitis in adults w/ extenuating circumstances
    • blood cultures STAT
    • dexamethasone + empiric treatment
    • negative CT
    • lumbar puncture
    • CSF findings of bacterial
    • positive CSF gram stain
    •   no - dexamethasone + empiric therapy
    •   yes - dexamethasone + targeted therapy
  15. treatment of suspicion of meningitis in adults w/o extenuating circumstances
    • blood cultures and LP STAT
    • dexamethasone + empiric treatment
    • CSF findings of bacterial
    • positive CSF gram stain
    •   NO - dexamethasone + empiric therapy
    •   YES - dexamethasone + targeted therapy
  16. most likely organisms in newborn - 1 mo
    • Group B
    • gram (-) enterics
    • listeria monocytogenes
  17. most likely organism for 1 mo - 4yr
    • S.pneumoniae
    • N. meningitidis
    • H. influenzae
  18. most likely organism for 5-50 yo
    • N. meningitidis
    • S. pneumoniae
  19. most likely organism for > 50, immunocompromised or alcoholsm
    • S. pneumoniae
    • N. meningitidis
    • L. monocytogenes
    • gram-negative enterics
  20. empiric therapy for newborn - 1mo
    ampicillin + cefotaxime
  21. empiric therapy for 1mo - 4 yo
    vancomycin and ceftriaxone
  22. empiric therapy for 5-50 yo
    vancomycin  and ceftriaxone
  23. empiric therapy for >50 immunocompromised or alcoholsm
    vancomycin and ceftriaxone and ampicillin
  24. Tx of S.pneumoniae
    • pen G or ampicillin PCN MIC < 0.1
    • ceftriaxone PCN MIC 0.1-1
    • vancomycin + ceftriaxone PCN MIC >2
  25. Tx of N. meningitidis
    ceftriaxone
  26. Tx of H. influenzae
    ceftriaxone
  27. Tx of S. agalactiae (group B Strep)
    ampicillin + gentamicin
  28. Tx of L. monocytogenes
    ampicillin (+/-) gentamicin
  29. Tx of enterobacteriaeceae
    • ceftriaxone, ceftazidine
    • or
    • cefepime +/- gentamicin
  30. what is the use for corticosteroids in children
    • H. influenzae
    • S. pneumoniae
    • not if Abx already given
    •       < 6 wks old
    • stop if meningitis is not bacterial or if organism other than H. influenza or S. pneumoniae
  31. what is the use for corticosteroids in adults
    S. pneumonia infection
  32. Tx of enterovirus
    supportive care only
  33. Tx of HSV
    acyclovir
  34. Tx of cytomegalovirus
    • ganciclovir
    • foscarnet
  35. criteria on lumbar punctures
    • not indicated if pt responds to therapy w/I 48 h
    • neonates repeat for length of therapy - test of cure means a sterile CSF
  36. possible sequelae
    • hearing loss 14%
    • hemiparesis 4%
  37. chemoprophylaxis for N. meningitidis
    • rifampin or cipro
    • indication = contact >8h w/ infected person
  38. chemoprophylaxis for H. influenza
    • rifampin
    • indication = living with unvaccinated children < 4 yo
  39. chemoprophylaxis for group B strep
    • PCN, vanco, cefazolin or clindamycin
    • indication = intrapartum

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