Goljan vs. FA2008 - Meningitis issue

[Time]

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Goljan and FA2008 differ on most common cause of bacterial meningitis based on age groups. I tried to look up other resources, but neither harrisons nor principles of neurology actually 'ranks' bacteria, only saying that both s. pneumoniae and n. meningitides are commonly involved. and the only thing all books agree on is the neonatal meningitis.

so.... who is right? do we just do an SDN poll?😕

 

[PeepshowJohnny]

If I had to guess, S. Pneumo is probably "top" except in the high risk groups of Neisseria (college kids, military baracks). However, the question is academic and pointless. You're going to be covering for both with Vanc, Ceftriaxone regardless. Only reason they care so much about neonates is because you start messing with empirical therapy because of the addition of Listeria.

 

[Time]

If I had to guess, S. Pneumo is probably "top" except in the high risk groups of Neisseria (college kids, military baracks). However, the question is academic and pointless. You're going to be covering for both with Vanc, Ceftriaxone regardless. Only reason they care so much about neonates is because you start messing with empirical therapy because of the addition of Listeria.

You could get a case asking you which organism it is based on the case ONLY. What do you do then? Think of Goljan or the FA2008?

 

[DrFraud]

If you see a question stem for meningitis, here is my advise for how to attack it, but remember, the hints in the question stem should be your primary guide:

(1) First try and see if it is chronic (weeks to months) or an acute infection. If it is chronic, always keep in the back of your mind that the primary infection might be HIV, and so check your answer choices. Also remember crytococcus for immunocompromised pts.


(2) you will likely get some hints about CSF changes - and this will get us to bacterial which is what you asked about.

(3) Identify the age of the patient and the county of origin of the patient. In the US., because of vaccination against Hem I, you would lower this on your differential unless the stem has a qualifier that clearly suggests the pt has not been immunized (eg - born and raised in a developing country) .

-For under age 1 - lysteria and strep a..(the question stem should give you some hints about the culture or hx to help you differentiate.)
-For a high school age, collage age, and military person to about 25 years old- N. men. should be on top of your differential.
-Over age 40 suspect Strep P. first.

and Naegleria for kids diving in lakes. (I know its a parasite, but I wanted to through it in.)

 

[Time]

my question was rhetorical.

i do not quite agree with strep pneumoniae in 40yo, though. i may be wrong but 40 is not elderly by definition. N. meningitides is still #1 in this age group.

Thanks for chiming in, though. Appreciate.

 

[MSKalltheway]

i do not quite agree with strep pneumoniae in 40yo, though. i may be wrong but 40 is not elderly by definition. N. meningitides is still #1 in this age group.

I respectfully disagree. Its not so much about age as it is having living arrangements with many people in close quarters (which is why they always talk about college students in dorms and military personnel in barracks). The assumption is that if you are not in the military or are beyond college age, you are unlikely to be in a situation where N. meningitidis would be at the top of your differential. If you get a question on the boards about an adult presenting to clinic with signs of meningitis who is not college age or in the military from the Hx, pneumococcus should be at the top of your list.

And from CMMRS, "Group B Strep is for Babies". Neonates need B Strep, Listeria, and E. coli coverage.

 

[Doctor Bagel]

I respectfully disagree. Its not so much about age as it is having living arrangements with many people in close quarters (which is why they always talk about college students in dorms and military personnel in barracks). The assumption is that if you are not in the military or are beyond college age, you are unlikely to be in a situation where N. meningitidis would be at the top of your differential. If you get a question on the boards about an adult presenting to clinic with signs of meningitis who is not college age or in the military from the Hx, pneumococcus should be at the top of your list.

And from CMMRS, "Group B Strep is for Babies". Neonates need B Strep, Listeria, and E. coli coverage.

This is what I've read too.

 

[Time]

I respectfully disagree. Its not so much about age as it is having living arrangements with many people in close quarters (which is why they always talk about college students in dorms and military personnel in barracks). The assumption is that if you are not in the military or are beyond college age, you are unlikely to be in a situation where N. meningitidis would be at the top of your differential. If you get a question on the boards about an adult presenting to clinic with signs of meningitis who is not college age or in the military from the Hx, pneumococcus should be at the top of your list.

And from CMMRS, "Group B Strep is for Babies". Neonates need B Strep, Listeria, and E. coli coverage.

Thanks. My bad. I should have done this first - quote from Harrison's Online:
"Etiology

S. pneumoniae is the most common cause of meningitis in adults >20 years of age, accounting for nearly half the reported cases (1.1 per 100,000 persons per year).
...
N. meningitidis accounts for 25% of all cases of bacterial meningitis (0.6 cases per 100,000 persons per year) and for up to 60% of cases in children and young adults between the ages of 2 and 20."

I have no disagreements or questions regarding the neonates and neither have any of the books I mentioned in my op.

If I understand Harrison's correctly, both Kaplan AND FA2008 are wrong. And Goljan is right.

However, Adam's and Victors Principles of Neurology says, "Meningococcal meningitis occurs most often in children and adolescents but is also encountered throughout much of adult life, with a sharp decline in incidence after the age of 50. Pneumococcal meningitis predominates in the very young and in older adults. " Kaplan wrong, Goljan wrong, FA2008 closest.

I will stick with harrison's.

 

[lankysudanese]

And from CMMRS, "Group B Strep is for Babies". Neonates need B Strep, Listeria, and E. coli coverage.

this is good for the boards, but not for the wards. Nowadays, we see more Group B strep bacteremia/meningitis in eldery (>50yr) than neonates (which was significantly reduced by testing and prophylactic PCN).