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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
Q

Which serotypes of N. meningitidis are common in the WC?

A

B and W135

26
Q

Natural habitat of N. meningitidis

A

Human nasopharynx

27
Q

Transmission of N. meningitidis

A

Droplet spread

28
Q

Is Neisseria meningitis notifiable in SA?

A

YES

29
Q

Typical presentation in N. meningitidis

A
  1. Sore throat + fever + headache
    AND
  2. Neurosymptoms

WITH/OUT
3. Skin rash + haemorrhagic skin lesions
WITH/OUT
4. Acute adrenal insufficiency

30
Q

What is the first work-up in all cases of 1st episode meningococcal mengitis?

A

Complement analysis to look for complement deficiency

31
Q

What is the leading cause of bacterial meningitis?

A

Strep. pneumoniae

32
Q

Natural habitat of S. pneumoniae

A

Oropharynx

33
Q

What other 3 conditions are caused by S. pneumoniae?

A
  1. Pneumonia
  2. OM
  3. Sinusitis
34
Q

Risk factors for pneumococcal infection

A
  1. HIV/AIDS
  2. Base of skull #
  3. OM/ sinusitis
  4. Extremes of age
  5. Immune deficiencies (asplenia + hypogammaglobinaemia)
35
Q

What is considered a VF in H. influenzae?

A

Capsule

36
Q

Natural habitat of H. influenzae

A

URT

37
Q

Why is H. influenzae no longer the leading cause of bacterial meningitis in children?

A

Hib vaccine (introduced in 1999)

38
Q

Sequelae of H. influenzae

A

Permanent neurological problems

39
Q

Where does L. monocytogenes originate from?

A

The environment (soil + vegetation)

40
Q

Who is at risk of L. monocytogenes infection?

A
  1. Pregnant women
  2. The elderly
  3. Neonates
  4. Alcoholics
  5. Immunocompromised (HIV/ DM)
41
Q

Transmission of L. monocytogenes

A
  1. Contaminated food

2. Transplacental/ during delivery

42
Q

Clinical syndromes of L. mono in pregnant women

A

Acute diarrhea

43
Q

Clinical syndromes of L. mono in adults and late neonates (>14 days)

A

Meningitis / meningo-encephalitis

44
Q

Clinical syndromes of L. mono in early neonates (<14 days)

A

Septicaemia

45
Q

Where is S. agalactiae primarily found in humans?

A

Throat, colon and intermittent vaginal carriage in 10-40% of women

46
Q

Early onset S. agalactiae meningitis

A

Bacteraemia

Day 1-6 of life

47
Q

Late onset S. agalactiae meningitis

A

Meningitis

Day 7-90 of life

48
Q

E. coli: Early disease in neonates

A

Septicaemia

49
Q

E. coli: Late disease in neonates

A

Meningitis

50
Q

How is E.coli meningitis acquired?

A

Through the birth canal

51
Q

What tests must be done ASAP to confirm the diagnosis of acute bacterial meningitis?

A

Blood culture + LP

52
Q

Empiric Rx of acute bacterial meningitis

A

3rd gen cephalosporins

53
Q

T/F: Add steroids in HIV/TB settings

A

FALSE

54
Q

Listeria is resistant to cephalosporins. How are neonates treated?

A

Add Ampicillin +/- gentamycin

55
Q

Listeria is resistant to cephalosporins. How are high-risk adults treated?

A

Add Ampicillin +/- gentamycin

56
Q

Which infections requires PEP?

A

Neisseria + Haemophilus

57
Q

What PEP is for meningococcus?

A

Adults: Ciprofloxacin

Children: Ciprofloxacin or Ceftriaxone

58
Q

What PEP is for H. influenzae?

A

Rifampicin

Review of Infectious Diseases (7 decks)

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