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IOS 10 Exam 3

CNS infections

QuestionAnswer
Describe the pathophysiology of bacterial meningitis nasopharyngeal colonization, mucus barrier deterioated, pili of pathogen attached to host surface, release of LPS, endotoxins, tecichoic acid, body responds by release of IL1, IL6, PG, TNF, inflammation allow permeability to BBB, influx of albumin-edema
CNS infections develop in 3 ways Hematogenous, Contigueous, Inoculation (trauma, surgery)
Increased Risk factors for meningitis Alcoholism, cigarette smoking, Cochlear implants, cigarette smoking, head trauma, High dose steroids, IgG deficiency, Immune suppression, Otitis media, respiratory tract infections, Splenectomy, sickle cell disease
Bacterial meningitis s/s HA, fever, altered mental status, Kernigs signs, Brudzinski's sign, Vomiting, Seizures, Focal deficits
Shunt Infection clinical presentation fever, altered mental status, shunt in CSF (200-100 WBC), normal glucose, variable protein
Shunt pathogens Staph Epi. 50%, Staph aureus 25%, klebsiella, E.coli and proteus 10%
Brain Abscess clinical presentations Fever, HA, focal neurological deficits, vomiting, altered mental status, CSF may be normal (lumbar puncture not helpful)
What are four properties of a drug that affect anttimicrobial action Low molecular weight (pass through membranes easier, Lipid solubility, pH-unionized, protein binding only free drug passess BBB
Ways to increase CSF concentrations High dose ceftriaxone 2g q12, vancomycoin 30-40mg/kg, AMpicillin 2g IV q4, or direct instillation into CSF or block drug transport out of the CNS
Shunt infections- treatment (WBC 20-100) "vancomycin" +- via intraventricular and intraventricular administration
Brain abcess treatment Remove abcess and IV ceftriaxone + metronidazole
Treatment of meningitis ages 0-4 weeks of age Ampicillin and cefotaxime or gentamicin (PCN All- Vancomycin +Chloramphenicol + TmP/SMX (Listeria Monocytogenes)
Treatment of meningitis ages 1month -4 years Cefotaxime +- Vancomycin or rifampan + Dexamethasone 0.6mg/kg/d
Treatment of meningitis 5-29 years old Ceftriaxone+- Vancomycin or rifampin (PCN ALL vancomycin +Chloramphenicol +TMP/SMX) + dexamethasone 10mg IV 15 minutes before antimicrobial (N.meningitis)
Treatment of meningitis 30-60yo Ceftriaxone + - Vancomycin or rifampin (S. Pneumoniae)
Treatment of meningitis >60yo Ampicillin +Ceftriaxone or Aminoglycosides + - Vancomycin or rifampin + Dexamethasone 10mg IV (Listeria meoncytogenes)
Treatment of meningitis immunocompromised individual Vancomycin + ceftazidime or cefepime+ - rifampin+ - fluconazole + - acyclovir Plus Dexamethasone 10mg IV
Meningitis treatment duration 7-14 days 21 days if gram -or viral infection
Treatment of Mycobacterium Tuberculosis 2 months4 drugs- Isonaizid, Pyrazinamide, Rifampin, Ethambutol, then 9months 2 drugs- Rifampin + isonaiazid plus 4 wweks of Dexamethasone
Treatment of Viral Encephalitis-Cytomegalovirus Ganciclovir 5 mg/kg IV q12 h x 14 days
Treatment of Fungal Meningitis- Cryptococcus Neoformans-AIDS patient Amptotercin B 1mg/kg/day + flucytosine 100mg/kg/day for 14 days then Fluconazole 400mg IV/PO qd for 8 weeks
Treatment of Fungal Meningitis- Cryptococcus Neoformans-non-aids Amphotercin B 0.5-1 mg/kg/day + flucytosine 150mg/kg/day for 4-6 weeks
H. Influenzae Close contact risk treatment Rifampin 20mg/kg/day up to 600mg PO QD Adults- Minocycline
N. Meningitidis Close contact risk t(home and daycare)reatment Rifampin 10mg/kg q12 up to 600mg PO Q12 x 48 hours
Strep agalactiae Close contact risk treatment (high risk delivery) Ampicillin 1-2 g q 6hrs until delivery
Drug induced aseptic meningitis caused by TMP/SMX, OKT3, cyclosporine, azothiopurine, NSAIDS
Created by: liza001
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