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, primarily bacterial,
and the parameter that we used there was age groups.
And we begin with very young and very old, two extremes, and then you had everything in the middle.
Remember the age between, let's say, 2 and 50 years of age.
You're looking at organisms such as neisseria meningitis and maybe streptococcus pneumoniae.
Now, in this table, what we're paying attention to is,
well, what if there was an external type of damage taking place to the skull?
So, as supposed 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 group everything together here, please forgive me.
Now here, vancomycin and plus your third generation cephalosporin, is what you're thinking.
If there was a penetrating trauma, what kind of organisms are going to make it into the brain, or into the cavity?
Well, here, it could be staphylococcus aureus or coagulase-negative
such as your staphylococcus epidermidis.
We could have aerobic gram-negative bacilli including pseudomonas.
And here we have, once again, common denominator would be your vancomycin
and we have different types of our cefepime, our ceftazidime, and so on and so forth,
common denominator, the vancomycin.
There are overall, what we're looking at here is meningitis.
We did age groups and trauma and common organism that would then be expected to be seen.
Predisposing factor continuing on this table here, is if the patient was post-neurosurgery.
And here, you should be thinking about aerobic gram-negative bacilli.
And here once again, it would 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 was required?
Remember whenever there's a shunt that is required in your patient,
there's every possibility that you have organisms that you have -- has gained access.
So, here once again, we have your coagulase-negative, staphylococcus epidermidis,
and others including our pseudomonas.
The other one that you find to be quite interesting is, wow, with the CSF shunt
is think about -- look at these organisms, where are these organisms coming from?
Looks like your flora of the skin including your propionibacterium acnes.
Isn't that interesting? And vancomycin.
So overall, understand the concept 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, while we walk through a bunch of them, age groups obviously.
We have trauma, post-neurosurgery or maybe CSF shunts.
Preventive medicine for the most part, common denominator would be vancomycin.
Signs and symptoms, as you can expect from meningitis, nuchal rigidity, headache, photophobia.
Differential diagnosis, just to keep this in mind, sinusitis or abscess,
but the presentation would be quite different.
Diagnostic workup, head CT, blood cultures, and of course lumbar puncture.
We spend extensive time on the table with lumbar puncture.
Treatment, obviously antibiotics of very sorts.