Meningitis???? Q from USMLE world

[harv1212]

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I gotta be missing something here ....

One q bank q just said that the most common cause of community acquired meningitis is S. pneumoniae ..... it said that N. Meningitis is the second most common in under 60 ... UWorld took said that N. Meningitis only happens in dorms/army places ... The stem just said it was a 45 year old man with sx's that led us to meningitis ....

Is that right???? Unless they say dorm/army we are to assume S. Pneumoniae is the cause .... that is not what FA says and not what I learned in my microbio course

 

[HTxFrog]

I don't know what you are asking exactly, but here is everything you ever wanted to know about it: http://emedicine.medscape.com/article/232915-overview#table2
Neisseria: #1 from 3 months-18yrs and then S. pneumo takes over as #1 from 18 on. Strep pneumoniae is also the leading cause when all age groups are combined. That is a crappy question if you just had to know the leading cause without any other info., and I doubt you'd get something like that on your real test w/o them telling you about the gram stain at least so you know gram pos. or neg.

 

[turkeyjerky]

yeah, strep pnemo is responsible for about half of all meningitis cases overall. neisseria doesn't only cause disease in people living in dorms, but that is a r/f.

I think the whole most common cause of meningitis think is a little overblown. Know GBS>E. coli>listeria for babies, pneumococcus is most common overall in adults. I also think empiric treatment is fair game, that's vancomycin + ceftriaxone, with ampicillin thrown in if they're a baby, over 60 or immunocompromised (to cover for listeria, which, remember, is transmitted by food)

 

[omarm]

Yea I saw that question too!! Got it wrong too because in First Aid they said the most common cause of meningitis between 6 years and 60 years is N. meningitidis!!! While USMLEWORLD said in that question that S. pneumonia is the most common in adults!!!! confusing.. maybe this is an error in FA as emedicine confirms UW answer!!

 

[username456789]

Yea I saw that question too!! Got it wrong too because in First Aid they said the most common cause of meningitis between 6 years and 60 years is N. meningitidis!!! While USMLEWORLD said in that question that S. pneumonia is the most common in adults!!!! confusing.. maybe this is an error in FA as emedicine confirms UW answer!!

I'm not even sure those meningitis lists are at all in order (in First Aid). I remember reading them and thinking "what the hell?"

 

[PokerDoc]

remember that shot you got before you went to college? That was for meningococcal meningitis, not strep


so the point they were making is that even though strep pneumo is most common overall, in those close contact specific situations, gonnococcal is the major concern.

 

[DrTacoElf]

I'm not even sure those meningitis lists are at all in order (in First Aid). I remember reading them and thinking "what the hell?"

That link above clears everything up. I've been battling with this stupid order for awhile now 😛

 

[harv1212]

Hmmm ... ok wierd ....

I for sure learned in my micro class that under 60 was N. meningitis and that S. Pneumoniae didn't come on as a major player in meningitis until you get to the elderly ( > 60) .... so I guess .... unless it says dorms/army/close quarters I should go with S. Pneumoniae????? Is that what people are doing???

 

[PokerDoc]

Hmmm ... ok wierd ....

I for sure learned in my micro class that under 60 was N. meningitis and that S. Pneumoniae didn't come on as a major player in meningitis until you get to the elderly ( > 60) .... so I guess .... unless it says dorms/army/close quarters I should go with S. Pneumoniae????? Is that what people are doing???

I would say so.. unless the stem gives you a major clue pointing toward some specific entity (gram stain -, fungal, immunocompromised, etc) Strep P is the safe answer in someone that age

 

[Sol Rosenberg]

yeah, strep pnemo is responsible for about half of all meningitis cases overall. neisseria doesn't only cause disease in people living in dorms, but that is a r/f.

I think the whole most common cause of meningitis think is a little overblown. Know GBS>E. coli>listeria for babies, pneumococcus is most common overall in adults. I also think empiric treatment is fair game, that's vancomycin + ceftriaxone, with ampicillin thrown in if they're a baby, over 60 or immunocompromised (to cover for listeria, which, remember, is transmitted by food)

Why would you need vanc to treat meningitis? Ceftriaxone has excellent coverage of S. pneumo, Neisseria, and E. coli. For babies or to cover Listeria you would just have to add Ampicillin (good GBS, Listeria coverage.)

 

[username456789]

Why would you need vanc to treat meningitis? Ceftriaxone has excellent coverage of S. pneumo, Neisseria, and E. coli. For babies or to cover Listeria you would just have to add Ampicillin (good GBS, Listeria coverage.)

Because I'm pretty sure the bolded is incorrect.

 

[Sol Rosenberg]

Because I'm pretty sure the bolded is incorrect.

Interesting. I looked it up, and FA doesn't mention it as covered, but in CMMRS (which is what I'm pretty much using as my primary for micro.) p. 159 S. pneumo (and other streptococci) get 3 daggers (the max) along with gram negatives for coverage by 3rd gen. cephs.

 

[PokerDoc]

Interesting. I looked it up, and FA doesn't mention it as covered, but in CMMRS (which is what I'm pretty much using as my primary for micro.) p. 159 S. pneumo (and other streptococci) get 3 daggers (the max) along with gram negatives for coverage by 3rd gen. cephs.

I recall MMS saying first gen were good for gram+, 2nd gen were good for aneorobes and 3rd gen were good for gram-

 

[Sol Rosenberg]

Just got a UW question about this today (Qid 1393, if that helps anybody....can you search by Qid?) and it states that third-generation cephalosporins are first-line agents against S. pneumoniae.

 

[turkeyjerky]

Just got a UW question about this today (Qid 1393, if that helps anybody....can you search by Qid?) and it states that third-generation cephalosporins are first-line agents against S. pneumoniae.

yeah, that's true--once the organisms have been shown to be susceptible. for meningitis, vancomycin is used empirically to guard against the possibility of resistant pneumococci.

 

[HTxFrog]

turkeyjerkey is right about the vancomycin thing, I didn't know that. Here is the recommended Tx: http://emedicine.medscape.com/article/232915-treatment#table6

 

[greg1184]

Just wanted to thank you guys for helping me answer a question in my real test. I had a 40 year old with meningitis. I had 10 choices with both meningococcal and strep pneumo as 2 of them. I obviously chose the latter.

 

[NRAI2001]

I don't know what you are asking exactly, but here is everything you ever wanted to know about it: http://emedicine.medscape.com/article/232915-overview#table2
Neisseria: #1 from 3 months-18yrs and then S. pneumo takes over as #1 from 18 on. Strep pneumoniae is also the leading cause when all age groups are combined. That is a crappy question if you just had to know the leading cause without any other info., and I doubt you'd get something like that on your real test w/o them telling you about the gram stain at least so you know gram pos. or neg.

Wow the link you posted is really pretty good..

 

[xanthomondo]

Why would you need vanc to treat meningitis? Ceftriaxone has excellent coverage of S. pneumo, Neisseria, and E. coli. For babies or to cover Listeria you would just have to add Ampicillin (good GBS, Listeria coverage.)

I wanted to thank you for this post. LITERALLY saved my ass on a question that I wouldn't have known if not for reading this. 👍

 

[purplelife]

This post is from 2010, but I was looking for list for clarification for types of meningitis. I don't see any list on the link, can anyone help?

 

[AlejMZ]

Just be familiar with pathogens for Meningitis according Age group and/or special circumstances, heres the list that helped me:

1. Neonates : GBS > E.Coli > Listera (mom will be screened in 3rd semester for GBS)
2.Children and teenagers: N. Meningitis (including the Military recruits and college dorm scenario)
3.Adults and Elderly: S. Pneumoniae
4.Non-Vaccinated Infants: H. influenza (supposedly they like to go after this one with all the vaccines controversies..)
5.Fecal-oral-route-virus: Coxsackie Virus
6.Immunocompromissed: Fungi

With this list you should get tricked on any questions regarding Meningitis, also know how to interpret CSF findings..