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Review of Infectious Diseases > Acute Meningitis > Flashcards

Acute Meningitis Flashcards

1
Q

Acute meningitis: Viral causes

A

Enteroviruses

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2
Q

Acute meningitis: Bacterial causes in ADULTS + CHILDREN

A

– Streptococcus pneumoniae
– Neisseria meningitidis
– Haemophilus influenzae
– Listeria monocytogenous

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3
Q

Acute meningitis: Bacterial causes in BABIES + NEONATES

A

E. coli
Strep. agalactiae
L. monocytogenes

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4
Q

Risk factors

A

URT colonisation
Breach of local barriers
Immunosuppression

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5
Q

Mucosal colonisation

A

Nasopharynx + GIT –> Bloodstream invasion

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6
Q

Breach of local barriers

A

Sinusitis, OM or surgery –> contiguous spread

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7
Q

Classic triad of meningitis

A

Fever, neck stiffness, altered level of consciousness

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8
Q

Symptoms

A

Headache, fever, neck stiffness and altered level of consciousness

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9
Q

DDx

A

Encephalitis (fever +change in mental status)

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10
Q

Most common cause of encephalitis

A

HSV (CSF + PCR)

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11
Q

Lab Diagnosis

A
  1. CSF

2. Blood

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12
Q

Contraindications to LP

A
  1. Coma/ decreased level of consciousness
  2. Papilloedema
  3. Unexplained new focal neurological deficit
  4. Unexplained seizures
  5. Ventriculo-peritoneal shunt
  6. Cardio-resp compromise
  7. Coagulopathy
  8. Sepsis at LP site
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13
Q

CSF NORMAL appearance

A

Clear + colourless

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14
Q

CSF NORMAL opening pressure

A

10-20 cm H2O

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15
Q

CSF NORMAL WCC

A

0-5 X 10 6/L lymphocytes

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16
Q

CSF NORMAL RCC

A

0-10 x 10 6/L

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17
Q

CSF NORMAL protein

A

0.2 – 0.4 g/L

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18
Q

CSF NORMAL glucose

A

3.3 – 4.4 mmol per litre OR

≥ 60% of a simultaneously derived plasma glucose

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19
Q

What does CRP <20 or PCT <0.5 mean?

A

Bacterial meningitis is excluded

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20
Q

Who should you do a GeneXpert + CrAg on CSF fo?r

A

All HIV patients with acute or chronic meningitis

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21
Q

Abnormal CSF results in absence of meningitis

A
  1. HIV
  2. Post-seizures
  3. SAH
  4. MS
  5. GBS
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22
Q

Gram positive bacteria

A

S. pneumoniae (diplococci)
L. monocyotgenes (bacilli)
Group B Strep (cocci in chains)

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23
Q

Gram negative bacteria

A

N. meningitidis (diplococci)
H. influenzae (coccobacilli)
E. coli (bacilli)

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24
Q

Reasons for culture negative bacterial meningitis

A
  1. Semi-treated
  2. AB given before specimen collection
  3. Organism that is difficult to culture
25
Which serotypes of N. meningitidis are common in the WC?
B and W135
26
Natural habitat of N. meningitidis
Human nasopharynx
27
Transmission of N. meningitidis
Droplet spread
28
Is Neisseria meningitis notifiable in SA?
YES
29
Typical presentation in N. meningitidis
1. Sore throat + fever + headache AND 2. Neurosymptoms WITH/OUT 3. Skin rash + haemorrhagic skin lesions WITH/OUT 4. Acute adrenal insufficiency
30
What is the first work-up in all cases of 1st episode meningococcal mengitis?
Complement analysis to look for complement deficiency
31
What is the leading cause of bacterial meningitis?
Strep. pneumoniae
32
Natural habitat of S. pneumoniae
Oropharynx
33
What other 3 conditions are caused by S. pneumoniae?
1. Pneumonia 2. OM 3. Sinusitis
34
Risk factors for pneumococcal infection
1. HIV/AIDS 2. Base of skull # 3. OM/ sinusitis 4. Extremes of age 5. Immune deficiencies (asplenia + hypogammaglobinaemia)
35
What is considered a VF in H. influenzae?
Capsule
36
Natural habitat of H. influenzae
URT
37
Why is H. influenzae no longer the leading cause of bacterial meningitis in children?
Hib vaccine (introduced in 1999)
38
Sequelae of H. influenzae
Permanent neurological problems
39
Where does L. monocytogenes originate from?
The environment (soil + vegetation)
40
Who is at risk of L. monocytogenes infection?
1. Pregnant women 2. The elderly 3. Neonates 4. Alcoholics 5. Immunocompromised (HIV/ DM)
41
Transmission of L. monocytogenes
1. Contaminated food | 2. Transplacental/ during delivery
42
Clinical syndromes of L. mono in pregnant women
Acute diarrhea
43
Clinical syndromes of L. mono in adults and late neonates (>14 days)
Meningitis / meningo-encephalitis
44
Clinical syndromes of L. mono in early neonates (<14 days)
Septicaemia
45
Where is S. agalactiae primarily found in humans?
Throat, colon and intermittent vaginal carriage in 10-40% of women
46
Early onset S. agalactiae meningitis
Bacteraemia | Day 1-6 of life
47
Late onset S. agalactiae meningitis
Meningitis | Day 7-90 of life
48
E. coli: Early disease in neonates
Septicaemia
49
E. coli: Late disease in neonates
Meningitis
50
How is E.coli meningitis acquired?
Through the birth canal
51
What tests must be done ASAP to confirm the diagnosis of acute bacterial meningitis?
Blood culture + LP
52
Empiric Rx of acute bacterial meningitis
3rd gen cephalosporins
53
T/F: Add steroids in HIV/TB settings
FALSE
54
Listeria is resistant to cephalosporins. How are neonates treated?
Add Ampicillin +/- gentamycin
55
Listeria is resistant to cephalosporins. How are high-risk adults treated?
Add Ampicillin +/- gentamycin
56
Which infections requires PEP?
Neisseria + Haemophilus
57
What PEP is for meningococcus?
Adults: Ciprofloxacin Children: Ciprofloxacin or Ceftriaxone
58
What PEP is for H. influenzae?
Rifampicin

Review of Infectious Diseases (7 decks)

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