Here’s another table with
acute bacterial meningitis,
but this time, we’re
dealing with trauma.
In the previous table, we looked at
common causes of acute meningitis,
And the parameter that we
used there was age groups.
And we began with very young
and very old, two extremes.
And then you had
everything in the middle.
Remember with the age between,
let’s say 2 and 50 years of age,
we’re looking at
organisms such as
neisseria meningitidis and
maybe Streptococcus pneumoniae
Now, in this table, what we’re
paying attention to is,
well, what if there is an external type
of damage taking place to the skull?
So as opposed to age groups,
let’s say that there was a
basilar skull fracture,
and what kind of common bacterial
pathogens could be seen.
Now, once again, Haemophilus influenzae.
For convenience sake, I have
grouped everything together here,
please forgive me.
Now, here vancomycin and plus your
third generation cephalosporin
is what you’re thinking.
If there’s a penetrating trauma,
what kind of organisms are going to make
it into the brain or into the cavity.
Well, here, it could be Staph
aureus or coagulase-negative
such as your Staphylococcus
We could have aerobic gram-negative
bacilli, including pseudomonas.
And here we have once again,
would be your vancomycin and we have
different types of our cefepime,
our ceftazidime and
so on and so forth.
Common denominator, vancomycin
There overall, what we’re
looking at here is meningitis,
within age groups and
trauma and common organism
that would then be
expected to be seen.
continuing on this table here,
is if the patient was
And here, you should be thinking
about aerobic gram-negative bacilli,
and here once again, it will be
something like your pseudomonas.
And we have coagulase-negative
such as our epidermidis.
Post-surgery, what happened?
Patient unfortunately starts
developing symptoms of meningitis.
Vancomycin, common denominator.
What if there was a shunt?
So what if a shunt is required?
Remember, whenever there is a shunt
that is required in your patient,
there’s every possibility that you
have organisms that has gained access.
So here, once again, we have your coagulase
negative Staphylococcus epidermidis
and others including
The other one that you’ll
find to be quite interesting
as well with the CSF
shunt is think about--
Look at these organisms.
A lot of these organisms are coming
from looks like your flora of the skin
Isn’t that interesting?
So overall, understand
And once you do, then you plug in the
details as to what are the organisms
that are gaining access
to the cranial cavity?
In summary, risk factors, well,
actually a bunch of them.
Age groups, obviously.
We have trauma, post neurosurgery,
or maybe CSF shunts.
Preventative medicine for the most part,
common denominator would be vancomycin.
Signs and symptoms as you
can expect from meningitis:
Differential diagnosis: Just to keep
this in mind, sinusitis or abscesses.
But the presentation
will be quite different.
Diagnostic workup: Head CT
and blood cultures and, of
course, lumbar puncture,
we’d spent extensive time on
a table with lumbar puncture.
antibiotics of various sorts.