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Bacterial Meningitis Board Review

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Neuroscience and Behavior USMLE Review

Bacterial Epidemiology
Neonates E. Coli Group B Strep Listeria Infant (<6 mo) Children E. Coli Strep Pneum Group B Neisseria Strep Strep Pneum 2yr 19yr 20yr 60yr >60yr Neisseria Strep Pneum Strep Pneum Strep Pneum Neisseria Group B Strep Listeria

Look for USMLE questions involving Neisseria to affect military recruits or college students

Spinal Fluid Formula

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Board Favorite Be able to easily differentiate bacterial from viral meningitis.

Bacterial Viral Fungal TB

Leukocytes >100, mainly neutrophils 10-500 50-500 mainly lymphs 100-500 mainly lymphs

Proteins 100-500 Slightly elevated 50-150 100-500, possibly higher

Glucose <40 Normal Low Low

* Tables borrowed from Dr. Lesses lecture on Bacterial Meningitis Quick Hit

Treatment: Initial therapy often involves broad coverage, such as Ceftriaxone. If the patient is very young (<3mo), then use Ampicillin. Can add vancomycin for additional coverage.

Meningeal Pathogens Review

A. Streptococcus pneumoniae (pneumococcus) - Gram positive, alpha hemolytic bacteria in pairs most common cause of pneumonia in adults, most common cause of meningitis is adults >20 yrs old, and most common cause of otitis media - major virulence factor is its polysaccharide *http://www.meddean.luc.edu/lumen/DeptWebs/ capsule, which protects it from phagocytosis microbio/med/gram/slides/slide8.htm - Pneumococcal vaccine Pneumovax, contains polysaccharides from the 23 most prevalent antigens; should be given to elderly, immunocompromised, aplenics, HIV+ pts

Know how to differentiate pneumococcus from S. viridans; Optochin will inhibit growth of pneumococcus and NOT viridans Alpha = partial Beta = complete Gamma = none
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B. Neisseria meningitidis (meningococcus) If you see abrupt - Gram negative, bean shaped diplococci; polysaccharide capsule, IgA protease+ onset hypotension - classic growth media: Thayer-Martin VCN media (chocolate agar) and tachycardia, *http://embryology.med.unsw.edu.au/Defect/ leading cause of meningitis in young adults, can release an images/Neisseria-meningitidis2.jpg along with endotoxin (LPS) which can cause petechiae and damage petechial lesions, adrenal glands think Waterhouse - Meningococcemia intravascular multiplication of - Friderichsen syndrome meningococcus can cause spiking fevers, chills, arthralgias, (adrenal muscle pains, and petechial rash hemorrhage) meningitis begins suddenly, with severe headache, fever, +kernigs sign, photophobia, and sometimes petechiae Quick Hit
Endotoxin is Lipid A. It is only present in Gram-negative bacteria, except Listeria

C. Listeria monocytogenes - Gram positive, non-spore forming, motile rod ***the only gram-positive organism with endotoxin (LPS-Lipid A) causes meningitis in immunocompromised, neonates, and elderly - can grow at extremely low temperatures; associated with milk products
*Images taken from Loyola University Microbiology and Immunology, and the University of New South Wales Embryology websites