Bacterial Infection Flashcards
CSF sensitive indicator or presence of active neurosyphilis infection
- pleocytosis > 1000 cells (lower in AIDS)
- elevation of CHON
- Elevated Oligoclonal bands
- (+) serologic test
- Normal glucose
In Brucellosis, Blood:CSF titer is elevated at
1:640 and 1:128 respectively
Treatment of Anthrax
Penicillin
if bioengineered: Ciprofloxacin , RIfampicin and Meropenem
What infections may manifest with petechial rash?
S. Aureus
Echovirus type 9
Enterovirus
Most frequent cranial nerve affected in Lyme disease
Facial nerve
Most common pathogenic organism in infants and unvaccinated child
E. Coli and Group B Strep
Pathologic changes in syphilitic optic atrophy
perioptic meningitis with subpial and fibrosis replacing degenerated optic nerve fiber
Immediate effect of bacteria in the subarachnoid space
inflammatory reaction in pia, arachnoid and CSF
When will you give AED
a. cortical vein thrombosis
b. seizure occured
Prognosis of Legionella
resolves rapidly and completely
What finding is present in post traumatic meningitis?
CSF rhinorrhea
Disease associated with M. Pneumonia?
a. GBS
b. Aseptic meningitis
c. Hemorrhagic leukoencephalitis (hurst)
d. Myositis
e. Cranial Neuritis
MRI findings in sarcoidosis
T2 signal abnormality (similar to demyelinating)
Frequency of meningovascular syphilis
35%
What is duration of reassessment of patient with syphilis
every 3-6 months and CSF should be retest 6 months interval
Organism that causes Lyme Disease
Borrelia Burgdorferi
Why is thrombosis occurs more in veins than arteries
Thinner walls and slower current of blood flow
How many percent of patient with abscess will have permanent neurological deficit
30%
Striking pathological findings in tabes dorsalis
thinning and grayness of posterior roots (lumbar)
Most common organism implicated to abscess (3)
Streptococci, anaerobic and microaerophils
What is prognosis if the treatment is late and coma supervene
50% mortality rate
this condition originates with osteomyelitis in a cranial bone from an infection in the ear
cranial epidural abscess
In transverse lateral sinus thrombophlebitis the following tends to spread in
Jugular bulb
What are the CNS involvement of Legionella?
diffuse brainstem and cerebellar syndrome
Mortality rate of TBM
10% (highest in children)
21% AIDS
What is the organism involve in Whipple Disease
Gram (+) B. Tropheryma Whipplei
How many percent sarcoidosis affects the CNS
25%
What is the duration of antibiotic therapy?
10-14 days
Criteria of neuroborreliosis
- no past history of neuroborreliosis
- active CSF ELISA serology
- anti-borrelia antibody index greater than 2
- favorable outcome after specific antibiotic treatment
- No alternative diagnosis
Drug of choice in epidural abscess
Vancomycin +/- cephalosporin
Condition described as autosplenectomized?
Sickle cell anemia
All dural sinuses drain to
Internal jugular vein
Suspected in the presence of evolution and extremely rapid delirium and stupor and when the onset is attended by stupor
Meningococcemia
layers of invasion (superficial to deep)
dura-subdura space-pia arachnoid - BRAIN
Meningitis associated with alcoholics, splenectomized and very elderly patients
S. Pneumoniae
Dose of steroids in children
0.15mg/kg for 4 days
This condition starts with unilateral axillary cervical adenopathy?
Cat scratch disease
Treatment of choice in Borreliosis
Doxycycline 100mg BID 14 days (early stage)
If involvement of CNS may give ceftriaxone 2g daily
Treatment of Aspergillosis
Amphotericin with voriconazole and echinocandins
Itraconazole for less immunocompromised patients
In trauma, what are the portal of entry of S. Pneumoniae?
Frontal and ethmoid
treatment duration of blastomycosis
6 weeks
How many reduction of risk if given prophylaxis op h. influenzae
2-4%
What parameters in the CSF will last to disappear even after the infection subsides
Glucose
What is Bannwarth Syndrome
Painful meningoradiculitis of the cauda equina
Cranial nerve abnormality is frequent in what type of meningitis?
S. Pneumoniae
invasion of nerve by exudate or ischemic damage as nerve traverses SAS
Diagnostic tool for cat scratch disease
PCR; elevated complement fixing titer
What anti-koch medication causes optic neuritis
Ethionamide and Ethambutol
Meningovascular syphilis accounds for how many percent of neurosyphilitic syndromes
10%
Oculomastica movement is seen in what condition
Whipple Disase
This condition associated wth chronic sijnusitis with osteomyleitis at the base of skull as a complication of otitis and mastoiditis
Aspergillosis
What bacteria will have sharp decline of incidence after 50 years?
N. Meningitidis
Describe the capsule of abscess
Thinner medial (paraventricular)
What part of cavernous where there is involvement of superior and inferior petrosal veins
posterior
Jugular foramen syndrome may involves the torcula in this condition
Transverse sinus thrombophlebitis
What is the mainstay therapy to sarcoidosis
Corticosteroids
What is adjunct to amphotericine that shows to decrease the relapse and more rapid sterilization of CSF
Flucytocine 100mg/kg/d
Treatment of TB CNS infection
HRZE - 2months or HRZ + moxifloxacin
layers of exudates
Inner - next to pia made up of lymphocytes
Outer - beneath the arachnoid made up of fibrin and neutrophils
What is the sinus affected when it manifest as monoplegia and homonymous hemianopia
Septic Thrombosis of Superior Sagittal Sinus
Symptomatology of subdural empyema
chronic history of sinusitis and mastoiditis
MRI findings in bacterial meningitis
meningeal exudates
cortical reaction
venous occlusion
Most common site of subdural empyema
Frontal and ethmoid
Most significant factor in the pathogenesis of meningitis
Maternal infection
The most indispensable part of examination of patients with signs of meningitis
Lumbar puncture
Late effects or sequelae of Meningitis (3)
- Meningeal fibrosis around optic nerves and SC
- chromic meningoencephalitis
- Persistent hydrocephalus
Prognosis of paretic syphilis
Fairly good with antibiotics
40-50% disease arrested but dependent
Death occurs 3-4 years without treatment
Earliest stage in meningitis?
neutrophilis in Virchow-Robin space
This organism is common in immunocompromised and debilitated individuals
L. Monocytogenes
Neurological syndromes of Lyme Disease (3)
Acute radicular pain
chronic lymphocytic meningitis
peripheral and cranial neuropathies
3 common etilology of Encephalitis associated bacterial meningitis
a. M. Pneumonia
b. L. Monocytogenes
c. Legionairres Disease
Late syndrome of syphilis
vascular syphilis
Mycoplasma is how many percent of all pneumonia
10-20%
Cefepime and cefepime are given in the presence of this kind of organism?
Pseudomonas
Osler Triad
Pneumococcal meningitis
Pneumonia
Endocarditis
TB PCR has ____ sensitivity
80%
Organism that causes abscess secondary trauma, surgery, drug addicts
S. Aureus
how much dose of amphotericin reduction permits by amphotericine
0.3-0.5mg/kg/d
Drug of choice for N. Meningitidis
Penicillin and Ampicillin
Cranial nerve involved in CST
III, IV and VI
Criteria in prediction of very low risk of bacterial meningitis (if they lack the following)
- (+) GS
- Absolute neurtophil is 1000cells
- CSF CHON is 80mg/dl
- absolute neutrophil 10,000 atleast
- History of Sz at the presentation
Culture method used in TB culture
Ziehl Nielsen
Drug of choice in syphilis
Pen G IV 18-24 million uniys for 10-14 days
How many percent of subacute neuroapthies and facial palsies resolve in 1 year after treatment in Lyme Disease
90%
Infection causes substantial hemorrhage in CSF (5)
- Hanta virus
- Dengue Fever
- Ebola virus
- Amebic meningoencephalitis
- Anthrax meningitis
Ratio of sex in neonatal meningitis
3:1
What is the neurological picture of Aspergillosis
Infectious vasculitis
Most common site of sarcodiosis
Peripheral lymph node
lung-liver-skin
How many percent culture proves positive in bacterial meningitis
70-90%
What is the location of subdural epyema
Outer arachnoid and inner dura
Drug of choice in abscess
Vancomycin
2nd/3rd gen cephalosporin or meropenem or metronidazole +/- oxacilin
What infection causes focal cerebral vasculitis in AIDS
Cat scratch disease
MRI findings of abscess
T1 - enhance capsule and restriction diffusion
T2 - capsule is HYPOINTENSE
Where do abscess resides when the focus is middle ear infection
anterolateral wall of cerebellum
middle and inferior temporal lobe
Most common cranial nerve involved in primary neurosarcoidosis
Facial (part of uveoparotid syndrome)
What organism causes cat scratch disease
Bartonella hensalae
What cellular components first to disintegrate during process of resolution?
Neutrophils (4th day)
TB myeloradiculitis is affected in 2 ways:
- Compressing the spinal roots and cord
- Exudates invades the parenchyma
- In the form of tuberculous osteomyelitis of spine (epidural abscess)
Describe the lesion of sarcoidosis
collection of epitheloid cells surrounded by rim of lymphocytes
IV drug users the most common cause organism causing bacterial meningitis
S. Aureus
When does seizure occur in transverse thrombophlebitis
When there is spread in SSS and cortical veins
In the presence of rapidly evolving cerebral signs secondary to abscess, one should suspect this
Septic emboli
Age predilection of Whipples Disease
middle age
What is the drug of choice for Listeria
Ampicillin 2gm/IV q4 with Gentamicin in 3 divided dose
What is the drug of choice for S. Aureus
Cefepime
Ceftazidime
Vancomycin
This is transmitted through ingestion of domesticated livestoke
Brucellosis
Otitic infection resulting to abscess is due to what organism
Enteric
What is the single most effective drug in TBmeningitis
INH 5mg/kg
Mode of spread in otogenic and rhinogenic in abscess
Direct extension
Hematogenous
Mechanism of disease of M. Pneumoniae
a. Present in CNS during acute illness
b. Autoimmune opperative
First step in the presence of focal lesions and increased ICP
CT/MRI
What is the drug of choice in Intensive eradication (melioidosis)
IV Ceftazidime 10 days
What drugs will you prescribe if the patient is allergic to penicillin or cephalosporin
Chlorampenicol
Skin reactions are observed in the following conditions:
PPP
Hypotonia and insensitivity of bladder is secondary to:
deafferentation of s2 and s3
what parameters should be monitored if given amphotericin
BUN at critical level 40mg/dL
treatment of tabes dorsalis
treated symptomatically
This condition demonstrate high level of neurotropism if left untreated
Borreliosis
Majority of route of brain abscess is
Metastatic “hematogenous”
Gold standard in diagnosis of Lyme Disease
ELISA (acute and convalescent)
90% (+) IgM
What is the treatment of SSS septic thrombosis
Antibiotic
Heparin
AED
What artery is implicated in syphilitic meningitis
Heubner arteritis
When does focal cerebral lesions or intractable seizure develops in meningitis
2nd week
Fraction of LDH associated with bacterial meningitis
Fraction 4 and 5 (derived from granulocytes)
Fraction 1 and 2 (derived from brain)
What is the size of abscess that appears in the scans
1 cm and above
Only manifestation of Asymptomatic Neurosyphilis
Argyll Robertson
How does subdural empyema gain entry? (2)
a. direct extension
b. Spread of septic emboli
Where is the lesion if there is 5th or 6th nerve involvement in cranial epidural abscess
petrous part of temporal bone
What organism causes Melioidosis
Burkholderia Pseudomallaei
Chief signs of tabes dorsalis (3)
absent DTRs
impaired vibratory and positional sense
Romberg sign
2 stage of pathogenesis of TB meningitis
a. bacterial seeding of meninges and pial
b. Rupture of one or more tubercles and spread to SAS
What is prognosis of syphilitic optic atrophy
poor if vision of both eyes is greatly reduced
CSF findings of subdural empyema
Erosion of sinus or nose erosion
meningeal enhancement
How do abscess travel in cerebellum
thru transverse sinus
Congenital Heart Disease is how many percent of all abscess
5%
Biopsy finding of jejunum of whipples
Macrophage filled with PAS
What is found in spinal fluid that helps to diagnose sarcoidosis
angiotensin converting enzymes
When is VDRL diagnostic to syphilis
if CSF is (+); negative in late-onset
How many percent of cases where organism can be detected in spinal fluid in Lyme’s Disease
30%
Cell components of the central zone of caseation in TB meningitis
Epitheloid cells
Giant cells
Lymphocytes
Plasma Cells
Subacute form of meningitis may take a form of the following (3)
- Hydrocephalus
- Subdural effusion
- Venous and arterial infarction
Aseptic reaction in neurosyphilis is secondary to
AIDS
What is the over all mortality rate of bacterial meningitis
5%
Antibiotic for subdural empyema
3rd Gen Cephalosporin
Metronidazole
Sensitive test for partially treated meningitis?
Counterimmunoelectrophoresis
What condition may take a form of rhombencephalitis
L. Monocytogenes
How many percent of AIDS patient are subject to Blastomycosis
6-12%
What is the benefits of corticosteroids in Meningitis
a. fever subside rapidly
b. decrease the incidence of SNHL
If the abscess is located in frontal and sinus where is usually the focus?
Sinuses
Give 4 foci of brain abscess
Purulent pulmonary infection
Bacterial endorcarditis
Paranasal sinus
Middle ear infection
What are the indication in giving patients with steroids in TB meningitis
SAH block
Raised ICP
Striking feature of nearly all type of subacute and chronic features
Subintimal fibrosis
What dose of steroids shown to reduce the mortality and improve overall outcome if given?
1st dose of antibiotic
Seizure is almost encountered in what type of bacterial meningitis
H. Influenzae
Why is spinal and cranial nerves will not early manifest during infection despite being surrounded by exudates?
perineural sheath become infiltrated by inflammatory after several days
What is the benefits of corticosteroids in Meningitis
a. fever subside rapidly
b. decrease the incidence of SNHL
c. reduced coma and sezuyre
d. decreased incidence of deafness
Treatment of Legionella
Fluroquinolones
Levofloxacin, Moxifloxacin, Azithromycin and RIfampin
What medication can be given as prophylaxis to H. influenzae
Single dose of Ciprofloxacin
or
Rifampicin 60mg q12 in adult or 10mg q12 in children
Neurologic manifestation of Lyme Disease
Aseptic Meningitis
Meningoencephalitis
cranial and peripheral neuritis
What is given in brain swelling
Mannitol
Treatment of choice in Cryptococcosis
Amphothericin 0.7-1mg/kg/d
Most common pathogenic organism in adults
(4)
S. Pneumonia
meningococcus
H. Influenza (unvaccinated children)
L. Monocytogenes
If odontogenic in origin of abscess what is the drug of choice
Penicillin + Metronidazole
treatment for M. Pneumoniae infections
Macrolides
Fungal infections occur in setting of the following conditions:
Leukopenia
Inadequate T-Lymphocytes function
Major site of infection (in order) in thrombophlebitis
- Transverse
- Cavernous
- Petrous
- Sagittal Sinus
Contraindication for surgery in abscess
- deep
- multiple
- aspiration should be done stereotactically
How many reduction of mortality if patient is given with steroids in TB meningitis
41-32%
What is the early reaction to bacterial invasion secondary to abscess
Localized inflammation
septic thrombosis
Aggregates of degenerating leukocytes
Most common cause of meningitis associated with lumbar puncture
Klebsiella and Proteus
Do you need to continue to treat weakly positive VDRL in the presence of normal cells and protein levels?
No
How many percent neurological sequalae observed in
a. children c HiB
b. child and adult with pneumoccocal
a. 25%
b. 30%
What is the location of headache in abscess
post-auricular and occipital
Candidate for Surgery in Abscess (4)
- solitary
- superficial
- well encapsulated
- associated with foreign body
Most important neurological deficit in subdural empyema
seizure
How is steroids given in TB meningitis
0.4mg/kg daily
Tapering dose at 3-6 weeks
Duration of treatment of TB meningitis and tuberculoma
9-12 months
Organism that is implicated in persistent pleocytosis
Nocardia, Aspergillus, and Actinomyces
neurologic manifestation of whipples
dementia, ataxia, supranuclear ophthalmoplegia adn myoclonus
What gram negative organism causing fatal respiratory disease
L. Pneumophilia
2 pathways of bacterial infections to intracranial structures?
- hematogenous
2. direct extension
The infection is zoonotic in brucellosis by:
Ingestion of raw milk
fungal infection that may occur in both normal and immunocompromised host
Crytococcosis
Characteristic CSF findings of Anthrax
hemorrhagic and inflammatory
What medication will you add if the culture yields positive for L. Monocytogenes?
Ampicillin
What is the rim of abscess represents
Fibroblast
Portal of entry of Blastomycosis
Respiratory tract
2 etiology associated with acute toxic encephalopathy
Reye syndrome and post infectious encephalitis
What is the percent of patients left with neurological deficits (survivors)
20-30%
What organism that has not been isolated in brain and spinal fluid
Legionella
2 pathway of meningitis
- infected thrombi form in diploic vein –> dural sinuses
2. osteomylelitic focus erode the inner table of bone
Treatment of Whipple Disease
Penicillin or ceftriaxone 2 weeks then TMP SMX 1 year
Pathologic changes in cryptococcosis
granulomatous meningitis with cystic nodules in deep brain (cryptococcomas)
What cells predominates in CSF in patient with Listeria
PMN
What is the mechanism of Deafness in meningitis
Suppuration of cochlear of ototoxic effect of aminoglycosides
Scala tympani is connected to SAS
What thrombophlebitis where there is no antecedent infection can be recognized?
Cavernous sinus thrombophlebitis
Drug of Choice for Nosocomial Meningitis
Vancomycin
Cephalosporin (3rd Gen)
Other causes of neonatal meningitis
Obstetric abnormalities (3rd quarter) prolong labor premature infants
deformity of charcot joints occurs in ____ percent of tabetics
less than 10%
Differential Diagnosis of CST (4)
- Mucormycosis
- Carcinomatosis of sphenoid bone
- Wegeners Granulomatosis
- Sphenoid wing mengioma
Subependymal astrocytes that protrude to ventricles
Granular ependymal lining
What should be suspected in infants with meningitis
unilateral or bilateral subdural effusion
What condition where iron is deposited in mononuclear cells
Paretic Syphilis
Metastatic focus from lungs and paranasal sinuses that cause abscess is secondary from what organism
Anaerobic strep
treatment of brucellosis
Doxycycline and streptomycin/gentamicin
or
Doxycyclin and rifampin
This condition is due to modified bacillus with exaggerated celullar immune response to limited class of antigen
Sarcoidosis
What is lacking in patients with blastomycosis1
headache fever and stiffneck usually present with increased ICP
2 Phases of Melioidosis
A. Intensive eradication
B. Eradication
Lightning pains may respond to what medication in syphilis
Gabapentin or Carbamazepine
What is the CSF picture of tuberculoma
Same but glucose is not reduced
Pathologic changes in meningovascular syphilis
Inflammation and fibrosis of small arteries (Heubner arteritis)
Clinical picture of syphilitic meningitis
No fever
CSF is lymphocytic predominates
How many percent of TB meningitis develop Papilledema
20%
Laboratory findings and CSF of Legionella
Normal
Most common organism in subdural empyema
a. streptoccocus
b. bacteroides
2 serologic diagnosis of syphilis
VDRL and FTA-ABS
What are the things to suspect in patient with recurrent bacterial meningitis
Congenital neuroectodermal sinus
Fistulous connection between nasal sinus and SAS
Brain abscess is usually situated _______________ artery
Distal MCA
When is treatment should stop in syphilis
No symptoms for 6 months and normal CSF
What is the drug of choice in eradication (Melioidosis)
Cotrimoxazole +/- Doxycycline
Pathophysiology of hydrocephalus in TB meningitis
Blockage of the basal cisterns
Analgesia and joint sensitivity in tabes dorsalis are caused by
Partial loss of A and C fibers in the roots
What geographical regions Meliodosis is common
South East Asia
Skin manifestation of Lyme Disease
Erythema chronicum migrans
Reactions of bacteria to meningeal venules and capillaries (4)
Hyperemia
Increase Permeability
Exudation
Migration
6 Causes of thrombophlebitis?
- Ear infection
- Mastoiditis
- Paranasal sinus
- Skin ad upper lips, nose
- Complication of meningitis, epidural abscrss and brain abscess
- Trauma to large veins
Most common bacteria producing meningitis (4)
- H. influenza
- N. Meningitidis
- S. Pneumonia
- L. Monocytogenes
Differential Diagnosis of Sarcoidosis
MS Sjohrens SLE LGV Cryptococcus
Early clinical syndrome of syphilis
aseptic meningitis
Differential diagnosis of Abscess
Tuberculoma Metastatsis Toxoplasmosis Subdural hematoma Resolving cerebral hemorrhage
Antibiotic Regimen of Bacterial Meningitis in Adults and Children
3rd Gen Cephalosporin
Vancomycin
If ELISA is positive for Lyme Disease what is the next step
Westernblot or immnoblot analysis
Associated with Osler Reundu Weber Telangiectasia aided by effect of venous stasis
Pulmonary AVM
Mortality rate of surgery in abscess
5-10%
What anti-koch medication cross BBB
INH and PZA
