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CNS > 4. Bacterial Meningitis > Flashcards

4. Bacterial Meningitis Flashcards

1
Q

How do pathogens get into the CSF?

A

Haematogenously, esp from nasopharynx
Adjacent focus of infection
From nasopharynx via bony defect or head injury

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2
Q

Where do pathogens replicate in meningitis?

A

Subarachnoid space

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3
Q

What are the bacterial causes of meningitis?

A

Strep pneumo
N. meningitidis
Haemophilus

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4
Q

What are the bacterial causes of meningitis in the neonate?

A

Group B strep
E.coli and other gram negative bacilli
Listeria

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5
Q

What are the risk factors for meningitis?

A

No spleen (Hib, pneumo, meningitidis)
Diabetes and alcoholism (pneumo)
Immunosuppression (listeria and crypto)
Fracture or defect of skull (recurrent pneumo)
Complement deficiency (recurrent neisseria)
Pregnancy (listeria)

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6
Q

What is the gram stain of neisseria meningitidis?

A

Gram negative diplcocci

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7
Q

What is the transmission of neisseria meningitidis?

A

Droplet

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8
Q

What is the gram stain of strep pneumo?

A

Gram positive diplococci

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9
Q

What is severe haemophilus influenza meningitis associated with?

A

Deafness
Seizures
intellectual impairment

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10
Q

What is the gram stain of listeria?

A

Gram positive bacillus

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11
Q

What is the gram stain of haemophilus?

A

Gram negative coccobacillus

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12
Q

What kind of pathogen is cryptococcus?

A

Encapsulated yeast

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13
Q

What is the predominant feature of cryptococcus meningitis?

A

Headaches in an immunocompromised person

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14
Q

How is cryptococcus meningitis detected?

A

Antigen detection in blood and CSF

CSF microscopy with india ink

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15
Q

What extra-cranial symptoms are associated with leptospirosis infection?

A

Renal and hepatic failure

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16
Q

What are the complications of meningitis?

A 
Hearing loss
Subdural abscess
Cranial nerve palsies
Intellectual disability
Hydrocephalus and raised ICP
Dissemination
17
Q

How is a diagnosis of meningitis made?

A

Clinical assessment most important

LP, blood for culture and PCR

18
Q

What are the contraindications for LP?

A

Raised ICP

Coagulopathy

19
Q

What is seen in CSF in bacterial meningitis?

A

Very high protein
Low glucose
High polymorphs, lymphocytes in leptospirosis and TB

20
Q

What is the management of meningitis?

A

IV antibiotics and steroids
Treat complications, supportive etc
Notify public health

21
Q

What are the empiric antibiotics for an infant under 3 months old?

A

Amoxicillin
Ceftriaxone
Gentamicin

22
Q

What are the empiric antibiotics for children and adults?

A

Ceftriaxone and vancomycin

Add amoxicillin if elderly, immunocompromised or pregnant

23
Q

What is the minimum duration of antibiotics in meningococcal meningitis?

A

7 days

24
Q

What is the minimum duration of antibiotics in haemophilus meningitis?

A

10 days

25
Q

What is the minimum duration of antibiotics in pneumococcal meningitis?

A

14 days

26
Q

What is the minimum duration of antibiotics in group B strep meningitis?

A

14-21 days

27
Q

What is the minimum duration of antibiotics in listeria or aerobic gram negative meningitis?

A

21 days

28
Q

Which pathogens can be vaccinated against?

A

N. meningitidis
Hib
Strep pneumo

29
Q

Which groups are prophylactic antibiotics used in?

A

Asplenism (penicillin for strep pneumo)

Close contacts with rifampicin for meningococcal and Hib

30
Q

What precautions are used for a patient with meningitis?

A

Droplet

31
Q

What pathogens cause cerebral abscesses?

A

Strep and staph
Aerobic gram negatives and anaerobes
Toxoplasma gondi
Aspergillosis

32
Q

What are the clinical effects of cerebral abscess?

A

Headache, seizures
Nausea and vomiting, altered mental state
Signs of infection

33
Q

How is a cerebral abscess diagnosed?

A 
Avoid LP due to high ICP
CT/MRI
Gram stain and culture of abscess fluid
PCR 
Blood culture
34
Q

What is the management of a cerebral abscess?

A

Surgical aspiration and drainage
Cefotaxime, metronidazole and flucloxacillin empirically
Treat underlying cause

35
Q

Which pathogens are steroids recommended to be given for?

A

Hib
Pneumo
TB

36
Q

When should steroids be given?

A

Before or with first round of antibiotics

37
Q

What is the most common cause of cerebral abscesses?

A

Strep mitis

CNS (21 decks)

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