🧠 CNS Infections (Members Edition: Slides via QR) | Empiric and Targeted Treatment, & Prevention 💊💉

🎁 Plus & Pro Members Perk: Scan the QR code shown in this video to download the full slide deck (PDF) for personal study, rotations, and board prep. Not a member yet? Join Plus/Pro to unlock slides for this and future masterclasses.

🚀 Welcome to the members-only CNS infections masterclass! Built for NAPLEX, CPJE, and USMLE prep and real-world practice, this all-in-one session turns guidelines into clear, defensible bedside decisions—from rapid recognition to empiric therapy, pathogen-directed treatment, and prevention.

Here’s what you’ll master:

1️⃣ Pathophysiology & clinical presentation 🧬⚠️
Understand the blood–brain/CSF barriers, routes of spread, and the inflammatory cascade that drives edema and ↑ICP. Recognize red flags fast: fever, neck stiffness, altered mental status, photophobia, seizures; when to image before LP, and what to send in CSF (OP, cell count, glucose, protein, Gram stain, culture, PCR).
Learning Objective 1: Explain the pathophysiology and clinical presentation of central nervous system infections.

2️⃣ Suspected meningitis: empiric therapy that saves lives ⏱️💉
Start dexamethasone (suspected pneumococcal) before/with first antibiotics. Choose age/risk-based regimens:
• 18–50 (community-acquired): vancomycin + ceftriaxone (or cefotaxime)
• 5+ or immunocompromised: add ampicillin for Listeria
• Health-care–associated/post-neurosurgery/shunt: vancomycin + cefepime (or meropenem)
• Severe β-lactam allergy: vancomycin + moxifloxacin ± TMP-SMX (for Listeria)
Learning Objective 2: Given a patient with suspected meningitis, recommend guideline-concordant empiric treatment.

3️⃣ Confirmed bacterial meningitis: pathogen-directed wins 🎯🧠
Narrow using CSF Gram stain/culture/PCR and MICs:
• Streptococcus pneumoniae: high-dose ceftriaxone (or penicillin G if susceptible) ± continue dexamethasone
• Neisseria meningitidis: ceftriaxone (or penicillin G/ampicillin if susceptible)
• Haemophilus influenzae: ceftriaxone
• Listeria monocytogenes: ampicillin (± early gentamicin)
• MSSA/MRSA: nafcillin/oxacillin or vancomycin; consider rifampin for hardware/shunt
• Gram-negative bacilli/Pseudomonas: cefepime or meropenem
• Enterococcus: ampicillin (if susceptible) or vancomycin
Dose at meningitis levels, adjust for renal function, and set duration by pathogen/response.
Learning Objective 3: Given a patient with confirmed bacterial meningitis, recommend pathogen-directed treatment.

4️⃣ Prevention & post-exposure strategies 🛡️💉
• Vaccines: MenACWY, MenB, Hib (select adults), and pneumococcal per age/comorbidities
• Chemoprophylaxis for close contacts (meningococcal): rifampin, ciprofloxacin, or ceftriaxone by age/pregnancy/resistance patterns
• Risk reduction: manage otitis/sinusitis, CSF leak care, shunt hygiene, catch-up immunizations, rapid contact tracing in congregate settings
Learning Objective 4: Develop a patient-specific plan for the prevention of meningitis.

✨ Members get slides via QR + the full lecture to build a repeatable, exam-ready CNS toolkit—recognition → empiric therapy → targeted treatment → prevention.

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