Bacterial CNS Infection Flashcards

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2
Q

gram-negative diplococci found in the upper respiratory tract

A

neisseria meningitidis

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3
Q

gram-negative rods found in the GI tract

A

escherichia coli (usually in young, elderly, and immunosuppressed)

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4
Q

gram-negative coccobacilli found in the upper respiratory tract

A

haemophilus influenzae (not seen very much because of effective vaccine)

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5
Q

gram-positive cocci in short chains found in GI tract and lower female genital tract

A

streptococcus agalactiae (GBS)

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6
Q

what type of hemolysis is expected with Group B Strep?

A

subtle beta hemolysis

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7
Q

gram-positive cocci in short chains found in the upper respiratory tract

A

streptococcus pneumoniae (can see “halo” of capsule, can differentiate based on positive P disk–optichin and alpha-hemolysis)

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8
Q

gram positive cocci in clusters found in skin, nares

A

staphylococcus aureus (also beta hemolytic, catalase +, coagulase +)

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9
Q

gram-positive facultative intracellular rods found in GI tract

A

listeria monocytogenes (can cause meningitis in children)

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10
Q

acid-fast bacillus in lower respiratory tract

A

mycobacterium tuberculosis

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11
Q

spirochete that disseminates from the urogenital tract

A

treponema pallidum (Syphilis)

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12
Q

spirochete transmitted by black legged ticks

A

borrelia burgdorferi (Lyme disease)

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13
Q

what are the 3 most likely causes of bacterial meningitis in newborns?

A

1) GBS, 2) E. Coli, 3) L. monocytogenes

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14
Q

what are the 2 most likely causes of bacterial meningitis in people >3mo old?

A

1) Strep pneumoniae, 2) N. meningitidis

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15
Q

what is opisthotonos, and what is it a sign of?

A

rigidity with arched back and head thrown backwards, seen in infants, sign of meningitis

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16
Q

where is the greatest risk of getting meningitis?

A

the meningitis belt in central Africa (meningococcal form)

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17
Q

when and why is meningococcal meningitis so common in central Africa?

A

dry season (cold nights, wind-blown dust) irritates the nasal and respiratory passages, increasing the risk of invasive disease in those already colonized by N. meningitidis

18
Q

when were meningococcal polysaccharide vaccines first developed?

A

1969 by military doctors, basis of current bivalent and quadrivalent

19
Q

what is different about the meningococcal vaccine that was developed in the last 10 years?

A

it is a conjugate vaccine that protects against 4 of the 5 major disease-causing serogroups (A,C,Y, and W-135)

20
Q

what differs among the various meningococcal serotypes?

A

the polysaccharide capsule

21
Q

which meningococcal serotype is not covered by the vaccine, and why?

A

the type B capsule, because it is made of carbohydrates similar to those found in the fetal brain (molecular mimicry - poor immunogen, concern for cross-reaction)

22
Q

what distinguishes N. meningitidis from N. gonorrhea?

A

CAPSULE (otherwise looks very similar)

23
Q

describe the pathogenesis of N. meningitidis?

A

1) adheres to non-ciliated epithelium, 2) internalized, 3) replicated intracellularly, 4) trancytosed thru BL tissue, 5) disseminates into blood

24
Q

what type of skin lesions are seen with invasive meningococcal infections?

A

hemorrhagic skin lesions that are macular or non-blanching petechiae

25
Q

how do meningococci invade the CNS?

A

high blood concentrations, bacteria cross BBB of meningeal blood vessels and enter subarachnoid space, then can enter lateral ventricles through choroid plexus –> proliferation and super high concentration in CSF

26
Q

Brudzinski’s sign

A

severe neck stiffness causes a patient’s hips and knees to flex when neck is lifted off table (flexed) – sign of meningitis

27
Q

Kernig’s sign

A

severe hamstring stiffness causes inability to straighten leg when hip is flexed to 90 degrees

28
Q

describe the typical CNS profile for meningococcal meningitis

A

CSF is cloudy due to WBCs and bacteria, WBC highly elevated (1000-5000) with PMN predominance, decreased glucose (less than 1/2 serum level), elevated protein (>100)

29
Q

what is a common virulence factor found in bacteria (and fungi) that cause meningitis?

A

most of them have polysaccharide capsules (N. meningitidis, E. coli, H. influenzae, S. pneumoniae, GBS, S. aureus, c. neoformans

30
Q

name 4 non-encapsulated bacteria that infect the CNS

A

listeria monocytogenes, mycobacterium TB, treponema pallidum, borrelia burgdorferi

31
Q

what 3 virulence mechanisms enable listeria to invade the CNS?

A

transport inside monocytes (Trojan Horse), direct invasion of endothelial cells, invasion of cranial nerves (by bacteria in oral macrophages) and retrograde movement into CNS

32
Q

what virulence factor enables TB to get into the CNS?

A

it is maintained inside macrophages

33
Q

what is unique about T. pallidum and B. burgdorferi that allows them to enter the CNS?

A

they are spirochetes whose corkscrew motility allows them to squeeze through the epithelium of the BBB

34
Q

in what ways does listeria meningitis present atypically?

A

longer course, encephalitis-like symptoms, often no bacterial meningitis CSF findings, CSF gram stain shows no bacteria

35
Q

describe TB meningitis

A

TB forms small foci in the meninges and brain parenchyma that can rupture and lead to inflammatory meningitis; TB invades microglia cells and can become walled off in spinal cord (Pott’s disease)