CNS Infections – Assignment

Catherine Van, PharmD, BCPS Assistant Professor, Pharmacy Practice PHAR 839 – CNS Infections – Assignment 1. Match the CSF results with the possible diagnosis (normal CSF, viral meningitis, or bacterial meningitis). 3 WBC (cells/mm ) Differential CSF Glucose Blood Glucose Protein CSF 1 1245 Neutrophil predominant 23 78 62 CSF 2 4 Lymphocyte predominant 65 110 21 CSF 3 190 Lymphocyte predominant 48 87 55 CSF 1 = Bacterial meningitis CSF 2 = Normal CSF CSF 3 = Viral meningitis 2. FM, 45-year-old male, presents to ED this morning with fever, neck stiffness, and headache since last night. Patient stated he took couple doses of acetaminophen without much help. Physical exams reveal positive Kernig’s and Brudzinski’s signs. His past medical history is significant for HIV, DM type 2, and hyperlipidemia, all of which are being managed with appropriate therapy. Medical team orders blood cultures STAT and CT scan of head. Lumbar puncture will be performed once there is negative CT result. Lab work reveals a blood glucose of 100 and WBC 15,000; other labs are within normal limit. Patient has stable vital signs. FM experienced hives and SOB when he was given amoxicillin for a past infection. He weighs 70 kg. a. Patient presents with signs and symptoms consistent with meningitis. What are some common bacteria that may cause meningitis in this patient? Some of the bacteria that may cause meningitis in this patient are Streptococcus pneumoniae, Group B streptococcus, Neisseria meningitis, H.Influenzae type listeria monocytogenes b. Your team do not want to delay treatment for patient’s meningitis. What would you recommend for FM’s condition? Vancomycin +Bactrim+aztreonam c. CT scan later comes back negative. Lumbar puncture is performed with CSF findings consistent with bacterial meningitis. Blood Cx results are still pending. If Gram stain later reveals gram + bacilli, what is the presumptive pathogen for patient’s condition? How would you tailor patient’s treatment regimen (knowing that patient is improving clinically)? What is the suggested treatment duration for FM’s meningitis? • L.monocytogenes • Discontinue vancomycin and aztreonam Catherine Van, PharmD, BCPS Assistant Professor, Pharmacy Practice • • Continue Bactrim At least 21 days or more