Bacterial CNS I

Question 1

What are the predisposing factors for those potentially infected by pneumococcal meningitis?

Answer 1

Pneumonia and chronic otitis media.

Question 2

What are the predisposing factors for those potentially infected by meningococcal meningitis?

Answer 2

History of recent URTI (viral)
Complement deficiencies
Outbreaks in winter within schools and barracks.

Question 3

What are the three common symptoms of meningitis?

Answer 3

Fever
Headache
Stiff Neck

Question 4

What attributes are typically seen in bacterial meningitis?

Answer 4

Decreased PMNs
Decreased Glucose
Increased Protein
Increased Pressure

Question 5

What attributes are typically seen in viral meningitis?

Answer 5

Mono/lymphos
Rare PMNs
Normal Glucose
Normal or slightly elevated protein.

Question 6

This gram positive, alpha hemolytic, lance shaped bacterium most often causes what two symptoms upon infection?

Answer 6

Strep pneumo typically causes otitis media as well as Bacteremia
Less commonly it causes pneumonia and meningitis.

Question 7

What age demographic dause pneumoccoccal meningitis typically infect?

Answer 7

The very old and the very young

Question 8

What are the virulence factors of a pneumococcal infection?

Answer 8

Binds the oropharynx via choline binding proteins.
Pneumolysin and IgA protease
Capsule aids in dissemination
Pneumolysin interferes with macrophage uptake.

Question 9

How is an acute bacterial pneumococcal infection treated?

Answer 9

It is treated as a medical emergency with vancomycin and cephalosporin immediately for 10-14 days.

Up to 1/3 are immune to Penicillin and thus shouldn’t be used.

Question 10

Describe the PPV:PPV23 pneumococcal vaccine.

Answer 10

This is a purified capsular polysaccharide antigen from 23 types of pneumococcus.
Not effective in

Question 11

What age grouping should the pneumococcal PPV23 vaccine be used for?

Answer 11

Reccomended to be used for
> 65 yrs
or persons >2 years if immunocompromised or experiencing other medical risks.

Question 12

Describe the PCV13 pneumococcal vaccine.

Answer 12

This is a conjugated vaccine in which a polysaccharide is connected to a nontoxic diptheria toxin.

Question 13

What population should the pneumococcal vaccinations PCV7;PCV13 be used in treating?

Answer 13

This vaccine should be used when treating the younger population and is very useful in infants and young children,

Question 14

What are the recommended dosages for the PCV13 vaccination?

Answer 14

Routine vaccination for children with dosages given at 2, 4, 6 months and a booster dose at 12-15 months of age.

Question 15

What characteristics are unique to N. Meningititis?

Answer 15

Coffee bean shaped
Gram negative
Encapsulated with Lipooligosaccharide (similar to LPS)
Oxidase and Catalase positive
Ferments Glucose and maltose (This is the only species that ferments glucose)
Requires CO2 to culture.

Question 16

What are the symptoms most often seen following a N. Meningitis infection?

Answer 16

Meningitis and Bacterimia.
Less likely to cause pneumonia compared to strep pneumo.
Transmitted through aerosol commonly in areas of close locations.

Question 17

Which serotype of N. Meningitides is most commonly seen in children

Answer 17

This is serotype B.

Question 18

What virulence factors are commonly associated with N. Meningitides infections?

Answer 18

Pilli for nasopharynx.
Capsule protects from compliment and macrophage.
LOS immune system stimulation
Crosses blood brain barier by using neutrophils.

Question 19

How is N. Meningitides typically treated?

Answer 19

It is treated emperically with vancomycin and cephalosporin at first until diagnosed, at which point it can be treated with penicillin (unlike pneumococcal meningitis)

Question 20

Is there a vaccination available for N. Meningitides?

Answer 20

Yes there is a tetravalent polysaccharide vaccine available but is innefective for children

Question 21

What age grouping is N. Meningitides polysaccharide vaccines used in?

Answer 21

Typically most used in patients that are above 55 years of age.

Question 22

What age grouping is the MCV4 N meningitides conjugatged vaccine used in?

Answer 22

This is licinsed for used between ages of 11 and 55 and is approved for ages 1-55 with increased risk populations.
It contains the same 4 serotypes as the MPV4 vaccine but is more effective due to conjugation to a diptheria toxin.

Recommended that those age 11-12 recieve the vaccinations prior to entering highschool and college freshmen.

Question 23

What is Streptococcus agalactiae (GBS) identified by?

Answer 23

It is Beta hemolytic
Resistant to bacitracin
Gram positive.

Question 24

What are the virulence factors of GBS (Streptococcus agalactiae)

Answer 24

Just the polysaccharide capsule. Antibody responses are typically effective at removing these organisms but in newborns that lack maternal antibodies infection is possible.
(2% chance of early onset sepsis, pneumonia, and meningitis).

Question 25

What are the symptoms involved in early onset GBS infections in neonates?

Answer 25

Bacteremia*** Also seen in gram negative N. Meningitides
Meningitis
Pneumonia
Mortality rate of 10%

Question 26

What is the drug of choice for GBS infections?

Answer 26

Penicillin is the drug of choice for treating GBS infections. (Ampicillin is an effective alternative)
It can be administered intravenously for pregnant mothers to prevent early onset disease in newborns.

Question 27

What is unique about Haemophilus influenzae?

Answer 27

It is gram negative encapsulated bacterium requiring Hemin X and NAD V for growth on chocolate agar containing 6 serotypes a thru f.

Question 28

Prior to vaccination, which serotype of H influenzae caused most cases of invasive disease?

Answer 28

Serotype B.

Question 29

What are the symptoms of encapsulated vs non encapsulatged H. Influenzae infections?

Answer 29

Encapsulated: Meningitis and Epiglottits
Unencapsulated: Pinkeye, otitis media, synusitis.

Question 30

What vaccinations are available for H. Influenzae?

Answer 30

Both a conjugated and non conjugated are available though, the conjugated is far more efficient.
It is reccomended that the conjugated be given beginning at two months of age.

Question 31

If you see the words “Drumstick shaped Spore” you should immediately think what?

Answer 31

You should immediately think of Tetanus bacteria, gram positive anaerobe.

Question 32

What sort of toxin is Tetanus toxin and how does it work?

Answer 32

It is an AB toxin that is internalized and brought to the spinal cord where it inactivates the release of inhibitory neurotransmitters causing spastic paralysis.

Question 33

What is the treatment for Tetanus?

Answer 33

Immunoglobulin (Passive immunity)
or
Tetanus toxoid treatment (Active immunity)
The goal is to simply remove as much toxin as possible.

Question 34

What preventitive measures are available for tetanus?

Answer 34

Preventable measures can be taken by administration of the Tetanus toxoid vaccination via the DTaP at 2 months and boosters every 10 years.

Question 35

How does the Botulinim toxin work?

Answer 35

The botulinim toxin is an AB toxin that works by binding and entering motor neurons leading to the blocking of acetylcholine release.
This results in a flaccid paralysis.

Question 36

Meningitis with mycobacterium tuberculosis is typically seen following what event?

Answer 36

Typically seen following a pulmonary infection.

Question 37

S. Aureus meningitis is most often seen following what sort of event?

Answer 37

This is typically seen following a bacteremia infection resulting in brain abscesses.