24- Meningitis

Question 1

cytokines involved in meningitis

Answer 1

IL1 IL6 TNF

Question 2

non infectious causes of meningitis

Answer 2

medications, autoimmune dxs, vasculitis, malignant tumors

Question 3

meningitis is an infection and inflammation of

Answer 3

the CSF in the subarachnoid space and ventricular spaces that involved the adjacent meninges, transversing vessels and brain structures

Question 4

encephalitis is defined as

Answer 4

inflammation of brain parenchyma

CSF: has fewer WBC

Question 5

etiology of newborne meningitis

Answer 5

E coli, group B streptococcus (S agalactiae)

Question 6

Community acquired etiology of meningitis

Answer 6

S. aureus
Coagulase negative staphylococci
S. pneumonia
N. meningitidis
H. influenza
L. monocytogenes

Question 7

etiology of meningitis in old people >50

Answer 7

S pneumonia

Question 8

transmission steps for meningococcal meningitis

Answer 8

nasal colonization
extension to upper resp tract
local invasion into the blood stream
invasion of meningeal space
replication in the meningeal space

Question 9

symptoms of bacterial meningitis (tetrad)

Answer 9

fever, headache, nuchal rigidity, altered mental status

• pts with meningococcal infection often develop a petechial rash
• kernig sign: severe stiffness of the hamstrings, so an inability to straighten the leg when hip is flexed 90
• brudzinski sign: severe neck stiffness causes hips and knees to flex when the neck is flexed

Question 10

contraindications for lumbar puncture

Answer 10

• intracranial pressure is high with risk for cerebral herniation due to obstructive hydrocephalus, cerebral edema, space occupying lesion
• thrombocytopenia
• spinal epidural abscess

Question 11

when should a CT be done before lumbar puncture in meningitis

Answer 11

• immunocompromised
• history of CNS dx
• new onset seizure
• papilledema
• abnormal levels of consciousness
• focal neurologic deficit

Question 12

gram pos diplococci suggest

Answer 12

pneumococcal infection

Question 13

gram neg diplococci suggest

Answer 13

meningococcal infection

Question 14

small pleomorphic gram negative coccobacilli suggest

Answer 14

H influenza infection

Question 15

gram pos rods suggest

Answer 15

listeria

Question 16

empirical tx for meningitis

Answer 16

ceftriaxone, ampicillin

Question 17

HA meningitis tx

Answer 17

meropenem, vancomycin

Question 18

dexamethosone in meningitis

Answer 18

is adjunctive therapy, and not known to be entirely effective

Question 19

who should be targeted by chemoprophylaxis of meningitis

Answer 19

close contacts  (household, day care, direct exposure) in 7 days before diagnosis
in case of N meningitidis, and H influenza
- use ciprofloxacine, rifampicin, ceftriaxone

Question 20

nosocomial etiology of meningitis

Answer 20

proprionibacterium, and gram neg rods

Question 21

what does a latex agglutination test do

Answer 21

detects antigens of common meningococcal infections