CNS infections

  1. what is the meningitis mortality with Haemophilus influenza
  2. what is the mortality rate for meningitits associated with strep pneumonia for patients > 65 yrs
    > 20%
  3. what % of pts with meningitis have moderate to severe permanent neurologic deficits
    > 50%
  4. what are some of the permanent neurologic deficits suffered form meningitis
    • cognitive or memory impairment
    • with or without seizure
    • hearing loss
    • development disabilities
  5. what are the signs and sx of meningitis
    • HA
    • photophobia
    • neck stiffness
    • fever
    • altered mental status
  6. what is empiric therapy for s. pneumoniae
    ceftriaxone or cefotaxime + vancomycin
  7. when can ampicillin be added to empiric therapy for s. pneumoniae
    when pt has a hx of alcoholism
  8. what is empiric therapy for N. meningitidis
    cefotaxime or ceftriaxone
  9. what is empiric therapy for h. influenza
    ceftazidime or cefepime + gentamicin
  10. what do you give a pt with meningitis caused by s. pneumonia who has intermediate resistance to penicillin
    ceftriaxone or cefotaxime
  11. what do you give a pt who has meningitis caused by s. pneumoniae that is fully resistant to penicillin
    ceftriaxone or vancomycin + rifampin
  12. if a pt is allergic to pen how will they react to meropenem
    9 - 11% cross reactivity
  13. which drugs can be given to pts with meningitis caused by s. pneumoniae if the pt is allergic to penicillin
    • meropenem
    • cefepime
    • moxifloxacin
    • zyvox (bactericidal)
  14. what is the benefit of using steroids in meningitis
    lower rate of hearing loss and neurologic sx
  15. when is corticosteroid use indicated in pts with meningitis
    • h. flu (infants and children)
    • s. pneumoniae (adults)
  16. what time frame should steroids be given if used for meningitis
    10 - 20 before or concomitantly with the first dose of abx
  17. which drug should not be used in pts with meningitis bc of seizures
    primaxin (imipenem/cilistatin)
  18. what are the monitoring parameters for corticosteroids
    • hyperclycemia
    • steroid induced psychosis
    • GI bleeding
    • blunting of fever curves
  19. which organisms cause for prophylactic treatment for those who come in contact with the infected pt
    • N. meningitidis
    • haemophilus influenza meningitis
  20. which agents are used to prophylactically treat n. meningitidis
    • cipro
    • ceftriaxone
    • rifampin
  21. which agent can be used to prophylactically treat n. meningitidis meningitis if the pt has high resistance to cipro
    • azithromycin 500 mg for > 15 yrs old
    • azithromycin 10 mg/kg
  22. which agents are used to prophylactically treat children and adults with h. influenza meningitis
  23. who are the high risk pts to be infected with GNB
    • neonates
    • elderly
    • debilitated individuals
    • open trauma to head
    • neurosurgical procedure
  24. How do you treat GNB meningitis
    • with a combination of:
    • AG
    • colistin (polymycin E or polumyxin B)
    • piperacillin
    • cefepime
    • cefotaxime/ceftriaxone
  25. what routes must AG be given for GNB meningits
    IT and IV
  26. what must the IT route of AG not contain
  27. the IV and IT routes of AGs should not be administered to which pts
    neonates with GNB
  28. AE of Colistin include
  29. what are the treatment options for enterobacter meningitis
    • carbapenem (imipenem, meropenem)
    • cipro
    • Bactrim
  30. pathogens involved in meningitis associated with neurosurgical procedure
    • coag-staph (75%)
    • s. aureus (25%)
  31. what is the clinical presentation of meningitis associated with neurosurgical procedure
    fever is common
  32. CSF finding for meningitis associated with neurosurgical procedure
    • WBC: not elevated
    • protein: slight increase or normal
    • glucose: decrease less pronounced
  33. empiric therapy for meningitis associated with neurosurgical procedure
    • removal of devices
    • vancomycin + cefepime or ceftazidime or meropenem
  34. who should be vaccinated with pneumococcal polysaccharide 23-valent vaccine (PPV23)
    • adults 19-64 with chronic disease exclude HTN
    • adults 19-64 and immunocompromised
    • all adults 65 and older should receive 1 dose and second dose is recommended 5 yrs after 1st for individuals 19-64 with immunocompromised conditions
  35. what is the mortality of Neisseria meningitidis
    about 11%
  36. what is Menomune
    • quad polysaccharide available over 25 yrs
    • can be give to all ages
  37. what is menactra and when can it be given
    • meningococcal conjugate
    • can be given to 11-55 yrs old
  38. who should be vaccinated for Neisseria meningitidis
    • all adolesvents >= 11 yrs old
    • students living in the dorm
    • pts with terminal complement deficiency
    • microbiologist routinely exposed to meningococcal isolates
    • military
Card Set
CNS infections
Exam II