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~ 90% of community-acquired viral meningitis is due to what?
Enteroviruses
what is the most significant cause of fungal meningitis?
Cryptococcus neoformans
children who get "aseptic" meningitis....normal cause??

when are they getting it?
Coxsackie A, B, echoviruses

Late summer or early fall --when kids go back to school

Both fecal-oral and respiratory transmission
Patients present with fever, chills, headache, stiff neck, nausea
and vomiting, photophobia. May be signs of mental dysfunction. You suspect meningitis, but are unsure... your first step is to:

send off labs to find out if it is viral or bacterial

start anitbacterial tx immediately

obtain an MRI

dont worry about tx, most meningitis is viral and self limited
start antibacterial therapy immediately
describe what your WBC count will be like in bacterial and viral meningits
bacterial: +1000, PMNs

viral: less, lymphocytes
in the winter time, what 2 viruses could have caused meningitis?
enterovirus or herpes
what fungal infection can cause CNS infections without pts being immunocompromised??
C. gatti

more pathogenic than - Cryptococcus neoformans
what are some of the pathogenic factors of - Cryptococcus neoformans? 3
Negatively charged capsule (inhibits phagocytosis);

excess production of capsular material inhibits chemotaxis

melanin production: from conversion of brain catecholamines (e.g., DOPA, acts as a chemoattractant); Also utilizes nitrogen from creatine, creatinine.

melanin protects organism from oxidative compounds
(free radicals) produced by macrophages
how is Cryptococcus neoformans obtained?
Inhaled as a yeast:
From dried pigeon or blackbird droppings (nitrogen rich).
No person-person spread.
Does not cause disease in pigeon
Primarily in immunocompromised, spread via blood to CNS
if you suspect at all that a pt has cryptoccocal meningitis, what is the standard test?

***
Traditional:
India Ink Stain
(of CSF)
tx for cryptococcal meninigits?
typically itraconazole

amp B or fluconazole would work