Group 6B

Pena, Mario Dante

Pilares, Felicia Ann
Pioquinto, Abigail
Plotena, Kim Jayea
Ponce, Jennica Celine

Ponce, Maria Clarice
Pua, Patricia Jarmin
Quidlat, Adrien Pierre
Quines, Mark Randell
Center for Disease Control and
Prevention
A 50 year old microbiology laboratory
technician has been complaining of a stuffy nose
and productive cough for the past 2 days. He then
suddenly developed high-grade fever with chills
and a severe headache, unrelieved by 2 tablets each
of Paracetamol and Mefenamic acid. At emergency,
he was toxic-looking with a temperature of 40C,
RR 24/min, PR 100/min, BP 120/80. There was
nuchal rigidity, no papilledema nor focal neurologic
deficit. Except for occasional crackles, lung and
heart findings were normal. Abdominal PE
unremarkable.
Center for Disease Control and
Prevention
Center for Disease Control and
Prevention
SUBJECTIVE OBJECTIVE
50 year old,
microbiology
laboratory technician
Stuffy nose and
productive cough
High-grade fever with
chills
Severe headache
Toxic-looking
Temp 40C, RR
24/min, PR 100/min,
BP 120/80
(+) nuchal rigidity
(-) papilledema nor
focal neurologic deficit
occasional crackles

Center for Disease Control and
Prevention
Center for Disease Control and
Prevention
PATIENTS
S/SX
ENCEPHALITIS BRAIN
ABSCESS
SUBARACHNOID
HEMORRHAGE
SUBDURAL
EMPYEMA
ACUTE
BACTERIAL
MENINGITIS
High grade
fever
Chills
Severe
headache
Headache
Fever
Altered
consciousness
Constant, dull
headache &
low grade
fever
Sudden severe
headache
Fever and
progressively
worsening
headache
High grade fever
with chills and
headache
Stuffy nose
Productive
cough
N/A Predisposing
conditions:
otitis media
and
mastoiditis,
paranasal
sinusitis
N/A Predisposing
condition:
sinusitis

*predilection
for young
males
Prodomal of
upper respiratory
infection
symptoms due to
nasopharyngeal
colonization
(+) nuchal
rigidity
(-) nuchal
rigidity
(-) nuchal
rigidity
(+) nuchal
rigidity, low back
pain and bilateral
leg pain
(+) nuchal
rigidity
(+) nuchal rigidity
(-)
papilledema
& focal
neurologic
deficit
(+) focal
neurologic
deficits
(+) focal
generalized
seizures
Hallucinations,
behavioral
disorders,
agitation
(+) focal
neurologic
deficit
(hemiparesis,
aphasia, visual
defects) and
generalized
seizures
(+) seizures and
loss of
consciousness

(+) focal
neurologic
deficit
(contralateral
hemiparesis or
hemiplegia)
and seizures

(-) focal
neurologic deficit
(-) papilledema
(present only
when
complication of
ICP is present)
(+) seizures,
decreased
consciousness Center for Disease Control and
Prevention
Acute Bacterial Meningitis
Center for Disease Control and
Prevention
Center for Disease Control and
Prevention
Center for Disease Control and
Prevention
Center for Disease Control and
Prevention
Center for Disease Control and Prevention
Most common cause of meningitis in adults
Predisposing conditions increase the risk:
1)Pneumococcal pneumonia
2)Co-existing acute or chronic pneumococcal sinusitis
or otitis media
3)Alcoholism
4)Diabetes
5)Splenectomy
6)Hypogammaglobulinemia
7)Complement deficiency
8)Head trauma
9)CSF rhinorrhea
Harrisons Principle of Internal Medicine 18
th
Edition
EMPIRIC THERAPY
Goal: start empiric therapy within 60 minutes
Initiated before microbiological tests are known
Combination of:
Dexamethasone + 3
rd
or 4
th
Generation Cephalosporin
+ Vancomycin
Harrisons Principle of Internal Medicine 18
th
Edition

Harrisons Principle of Internal Medicine 18
th
Edition
Initiated with cephalosporin and vancomycin
CSF isolates are subjected to culture and sensitivity
Cefotaxime and Ceftriaxone adequate if c/s turns
out susceptible
Resistant microorganisms : add vancomycin
2-week IV antimicrobial therapy (recommended)
Repeat lumbar puncture (24-36h) after the initiation
of antimicrobial therapy


Harrisons Principle of Internal Medicine 18
th
Edition