INFECTIOUS DISEASE
MENINGITIS
Headache + fever, shocked, confused
PromptExamination findings suggestive of meningitis
ResponseShock with cardiovascular collapse
ALOC with delirium and coma
Singis of meningism - neck stiffness, kernigās sign, brudzinskiās sign
Photophobia
Signs of increased ICP - Increased tone/hyperreflexia, Htn, papilloedema
Focal neurologic signs or cranial nerve lesions (only in about 15%)
Rash and arthritis - meningococcal = patechial/purpuric rash
ALOC with delirium and coma
Singis of meningism - neck stiffness, kernigās sign, brudzinskiās sign
Photophobia
Signs of increased ICP - Increased tone/hyperreflexia, Htn, papilloedema
Focal neurologic signs or cranial nerve lesions (only in about 15%)
Rash and arthritis - meningococcal = patechial/purpuric rash
PromptInitial management of meningitis
ResponseCeftriaxone 2g IV (Paeds 50-100 mg/kg) or cefotaxime 2g - treat pneumococcus, meningococcus, haemophylus -everyone gets this
Dexamethasone 0.15 mg/kg up to 10 mg -Decreased mortality in pneumococcus, reduces deafness stat then QID x 4 days
Benpen 2.4g IV or Bactrim 5/25 mg/kg - Listeria cover (debilitated, Etoh, age >50, immunocompromised, pregnant)
Vancomycin 30 mg/kg - if gram positive cocci on gram stain or pneumococcal antigen positive
Moxifloxacin 400 mg IV OD if anaphylaxis to penicillins/cephalosporins.
IV fluids 10-20 mg/kg - aim HR + BP normal (or close to it - list actual targets)
Dexamethasone 0.15 mg/kg up to 10 mg -Decreased mortality in pneumococcus, reduces deafness stat then QID x 4 days
Benpen 2.4g IV or Bactrim 5/25 mg/kg - Listeria cover (debilitated, Etoh, age >50, immunocompromised, pregnant)
Vancomycin 30 mg/kg - if gram positive cocci on gram stain or pneumococcal antigen positive
Moxifloxacin 400 mg IV OD if anaphylaxis to penicillins/cephalosporins.
IV fluids 10-20 mg/kg - aim HR + BP normal (or close to it - list actual targets)
PromptPros/cons for antibiotics in unconfirmed meningitis (LP equivocal for viral/bacterial)
ResponsePro:
Treat partially treated/early meningitis
Likely few side effects vs risk of untreated meningitis (high morbidity and mortality)
Con:
Adverse effects including anaphylaxis (rare but severe)
Bacterial resistance
Requires hospital stay (complications associated with this)
Treat partially treated/early meningitis
Likely few side effects vs risk of untreated meningitis (high morbidity and mortality)
Con:
Adverse effects including anaphylaxis (rare but severe)
Bacterial resistance
Requires hospital stay (complications associated with this)
PromptLumbar puncture - what to order
ResponseUrgent gram stain + Cell count
Protein
Glucose
Culture
Meningococcal PCR + pneumococcal PCR
Viral PCR - Enterovirus, HSV
Protein
Glucose
Culture
Meningococcal PCR + pneumococcal PCR
Viral PCR - Enterovirus, HSV
PromptNon LP investigations
ResponseBlood culture
Streptococcal antigen - Urine
Neisseria PCR - blood
urinary/csf antigen testing for pneumococcus
Streptococcal antigen - Urine
Neisseria PCR - blood
urinary/csf antigen testing for pneumococcus
PromptMeningitis LP results:
What is normal
What is Bacterial
What is Viral
Fungal for funsies
Ref: LITFL (was better than Questions)
Remember:
PMNās = Neutrophils/eosinophils/basophils
Monos = Lmactophates and dendritic cells
What is normal
What is Bacterial
What is Viral
Fungal for funsies
Ref: LITFL (was better than Questions)
Remember:
PMNās = Neutrophils/eosinophils/basophils
Monos = Lmactophates and dendritic cells
Response
Note partially treated bacterial looks like viral on LP
Note partially treated bacterial looks like viral on LP
PromptCauses of meningitis
ResponseN. meningitis
S. Pneumoniae
Haemophilus influenzae
E. Coli
Group B strep (neonates)
Listeria
Viral (enterovirus, measles, coxsackie, non paralytic polio)
Other (TB, Ricketsial, carcinoma, autoimmune, chemical)
My primary notes - Note answers should vary with age
S. Pneumoniae
Haemophilus influenzae
E. Coli
Group B strep (neonates)
Listeria
Viral (enterovirus, measles, coxsackie, non paralytic polio)
Other (TB, Ricketsial, carcinoma, autoimmune, chemical)
My primary notes - Note answers should vary with age
PromptLUMBAR PUNCTURE STUFF - SEE NEURO
Response