2. Meningitis Flashcards

1
Q

what is meningitis?

A

inflammation of meningeal lining of brain and spine

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2
Q

where is CSF found?

A

within the subarachnoid space, beneath the arachnoid membrane, on top of the pia mater. It also surrounds the spinal cord and fills open spaces (ventricles) inside the brain

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3
Q

function of CSF?

A

CSF helps to maintain a constant pressure inside the skull, known as intracranial pressure (ICP).

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4
Q

common bacterial causes of meningitis in adults?

A

Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae

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5
Q

common viral causes of meningitis in adults?

A
Enteroviruses:
Echoviruses
Coxsackie viruses A and B poliovirus
Herpes viruses:
Herpes simplex virus 1 and 2
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6
Q

typical CSF in bacterial infection?

A
cloudy
white cell count increased
cell type = neutrophils
proteins = increased
glucose = low
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7
Q

typical CSF in viral infection?

A
clear
white cell count increased
cell type = lymphocytes
proteins = moderate increased
glucose = normal or slightly decreased
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8
Q

describe gram stain of neisseria meningitides

A

gram negative

diplococci

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9
Q

characteristics of neisseria meningitides?

A
  • Normal flora of nasopharynx

* Spread via Inhalation of respiratory droplets

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10
Q

clinical significance of neisseria meningitides?

A

• Gram-negative Sepsis, meningitis, meningococcal sepsis

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11
Q

virulence factors of neisseria meningitides?

A
  • LPS capsule = Antiphagocytic

* Pili – attaches to nasopharyngeal mucosa

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12
Q

investigations of neisseria meningitides?

A
  • Gram stain of CSF from lumbar puncture
  • Throat swab
  • Tumbler test
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13
Q

treatment/ prevention of neisseria meningitides?

A
  • Ceftriaxone (Passes through BBB)
  • Cefotaxime – In new-born children
  • ABCWY Vaccine
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14
Q

what type of antibiotic is ceftriaxone?

A

beta lactam - cephalosporin - inhibits cell wall synthesis

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15
Q

clinical features of meningitis?

A
• classic triad
- fever
- headache
- neck stiffness
• photophobia
• phonophobia
• vomiting
• non-blanching rash
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16
Q

investigations of meningitis

A
FBC, U&E, lactate, CRP
blood culture
lumbar puncture
PCR
Tumbler test
17
Q

what are two diagnostic tests for meningitis?

A

kernig’s sign - positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful
brudzinski’s sign - if flexing neck causes automatic flexion of knees

18
Q

how are pathogens of meningitis spread?

A

direct spread - through skull fracture, up through nose

haemotogenous spread - blood

19
Q

what is the tumbler test

A

placing tumbler glass over rash to see if it blanching or not

20
Q

what is the rash found in meningitis?

A

petechial rash - tiny bleed into the skin - low platelet count

21
Q

what is DIC?

A

The main mechanisms of DIC are inflammatory cytokine-initiated activation of tissue factor-dependent coagulation and insufficient control of anticoagulation pathways. At a simplistic level the coagulation process goes out of control. Lots of small clots form. These use up many of the anticoagulation factors. The consequence is that there is bleeding occurring at the same time as the small clots are being formed. As an example platelets (which are important in forming clots) are used up in making the clots and the platelet count becomes low. This allows for the small bleeds into the skin (petechiae).

22
Q

what is seen in patients with severe DIC?

A

Ecchymoses: The petechial lesions can coalesce and form larger lesions that appear ecchymotic. Ecchymoses (diameter >10 mm) are mainly noted in patients with severe DIC. These lesions are secondary to subcutaneous hemorrhage.