Bacterial Infections of the CNS I (meningitis/encephalitis)

Question 1

Nearly 100% of patients with meningitis will present with two of these four symptoms

Answer 1

fever, headache, stiff neck (nuchal rigidity), and altered mental status

Question 2

Approximately half of all patients with meningitis present with

Answer 2

Fever, Headache, and Stiff Neck

Question 3

Labs for Dx of Meningitis

Answer 3

gram stain of CSF, cultures, latex agglutination

Question 4

Bacterial meningitis or Viral Meningitis/encephalitis? presence of PMNs

Answer 4

bacterial

Question 5

Bacterial meningitis or Viral Meningitis/encephalitis? presence of mono/lymphos

Answer 5

viral

Question 6

Bacterial meningitis or Viral Meningitis/encephalitis? rare PMNs

Answer 6

Viral

Question 7

Bacterial meningitis or Viral Meningitis/encephalitis? increased protein

Answer 7

bacterial

Question 8

Bacterial meningitis or Viral Meningitis/encephalitis? decreased glucose

Answer 8

bacterial

Question 9

Bacterial meningitis or Viral Meningitis/encephalitis? normal glucose

Answer 9

viral

Question 10

Bacterial meningitis or Viral Meningitis/encephalitis? increased pressure

Answer 10

bacterial

Question 11

Bacterial meningitis or Viral Meningitis/encephalitis? normal or slightly increased protein and pressure

Answer 11

viral

Question 12

Tx: bacterial meningitis

Answer 12

empirical antibiotic therapy (specific after organism identified)

Question 13

majority of bacterial meningitis cases occur in

Answer 13

infants and children

Question 14

common agents of bacterial meningitis

Answer 14

S. pneumoniae (50%), N. meningitides (25%) Group B Strep, Listeria monocytogenes, Haemophilus influenzae

Question 15

Group B strep meningitis is common in

Answer 15

the very young and the very old

Question 16

incubation of 3-4 days with abrupt onset of fever, hypotension and rash, headache, neck stiffness

Answer 16

meningococcal disease

Question 17

gram + coccus catalase -, frequently grows in chains (liquid culture), oval cells, polysaccharide capsule

Answer 17

Streptococcus pneumoniae

Question 18

round mucoid colonies on blood agar, alpha-hemolytic

Answer 18

Streptococcus pneumoniae

Question 19

susceptible to optochin, susceptible to bile

Answer 19

Streptococcus pneumoniae

Question 20

most common cause of vaccine-preventable death in the US

Answer 20

pneumococcal disease-causes bacterial meningitis among infants and and young children

Question 21

Streptococcus pneumonia clinical syndromes

Answer 21

pneumonia, bacteremia, meningitis, otitis media

Question 22

Neurological sequelae is common among survivors of bacterial meningitis caused by this bacteria

Answer 22

Streptococcus pneumonia

Question 23

Streptococcus pneumoniae causes bacterial meningitis in the

Answer 23

very old and very young

Question 24

pneumococcal bacteria bind these in the oropharynx

Answer 24

choline binding proteins of the bacterial cell wall bind carbohydrates on the surface of epithelial cells

Question 25

pneumococcal bacteria destroy ciliated epithelial cells and degrade secretory IgA using

Answer 25

pneumolysin and IgA protease (pneumolysin also interferes w/ macrophages)

Question 26

characterized by an acute onset (within hours), high mortality (30%), and neurological sequela (10-20%)

Answer 26

pneumococcal meningitis

Question 27

pneumococcal meningitis Dx

Answer 27

gram-stain CSF, latex-agglutination (presence of capsular antigens), culture, biochemical analysis, susceptibility testing

Question 28

Tx: of pneumococcal meningitis

Answer 28

vancomycin w/ a cephalosporin (modify after identification, treat for 10-14 days)

Question 29

Prevention of pneumococcal meningitis

Answer 29

PPV23 purified capsular polysaccharide antigen from 23 types of pneumococcus, PCV13

Question 30

What is one problem with the PPV23 vaccine?

Answer 30

It is not very effective in children under the age of 2

Question 31

Who is the PPV23 vaccine recommended for?

Answer 31

adults over 65, persons over 2 with chronic illness, asplenia, immunocompromised, HIV infection, environments or settings with increased risk

Question 32

What vaccine is recommended for kids under two for pneumococcal meningitis?

Answer 32

PCV7, PCV13-pneumococcal conjugate vaccine-polysaccharide conjugated to nontoxic diphtheria toxin-very effective against invasive disease (less effective against pneumonia and acute otitis media)

Question 33

What are the recommendations for the PCV13 vaccine?

Answer 33

routine vaccination of children-doses at 2, 4, 6, months, booster dose at 12-15 months

Question 34

gram-negative diplococcus, kidney bean appearance, polysaccharide capsule (12 serotypes), LOS

Answer 34

Neisseria meningitides

Question 35

Neisseria meningitides-oxidase? catalase? glucose? maltose?

Answer 35

oxidase and catalase positive, ferments both glucose and maltose

Question 36

cause of bacterial meningitis that is epidemic in sub-Saharan Africa

Answer 36

Neisseria meningitides

Question 37

Neisseria meningitides most commonly manifests as

Answer 37

bacteremia, meningitis (also as pneumonia, arthritis, otitis media, epiglottitis)

Question 38

How is neisseria meningitides transmitted?

Answer 38

aerosolized droplets

Question 39

This type of meningitis is commonly associated with people living in close quarters such as in househoulds, military barracks, schools, and dormitories

Answer 39

bacterial meningitis caused by Neisseria meningitides

Question 40

In meningitis caused by neisseria meningitides fatality rates are highest in

Answer 40

adolescents

Question 41

undergo facilitated uptake by epithelial cells

Answer 41

Neisseria meningitides

Question 42

Complications include endotoxemia-organ failure, DIC

Answer 42

meningococcal disease (neisseria meningitides)

Question 43

May occur with or without meningitis, bacteria in the blood accompanied by fever, purpuric rash hyptoension and multiorgan failure

Answer 43

Meningococcemia

Question 44

results from hematogenous dissemination-presentation includes fever, headache, stiff neck

Answer 44

Meningococcal Meningitis

Question 45

Dx: of meningococcal meningitis

Answer 45

recognize clinical signs and lab identification (gram stain of CSF/blood) culture, biochemical analysis, susceptibility testing, may also test lesion material

Question 46

Tx: meningococcal meningitis (N. meningitides)

Answer 46

penicillin (may begin with vancomycin and/or a cephalosporin before identification)

Question 47

What is recommended for family members, classmates, and co-workers of those infected with meningococcal meningitis (N. meningitides)?

Answer 47

prophylactic treatment

Question 48

What are the downfalls to the MPV4 vaccine for meningococcal meningitis?

Answer 48

only protects against A, C, Y, W-135 not B serotype, and is not effective in children under the age of 2, produces little affinity IgM, little IgG, not recommended for routine vaccination

Question 49

The meningococcal polysaccharide vaccine is not recommended for routine vaccination but is recommended for certain high-risk populations such as these

Answer 49

terminal complement deficiency, functional or anatomic asplenia, certain laboratory workers, traverls to and US citizens residing in countries in which N. meningitidis is hyperendemic or epidemic

Question 50

meningococcal conjugate vaccine (MCV4) is approved for ages 1-55 and protects against

Answer 50

A, C, Y, W-135 but not B serotype (conjugated to non-toxic diptheria toxin subunit)

Question 51

Unlike the other meningococcal vaccine this vaccine has booster response observed and a higher affinity antibody response/higher IgG response

Answer 51

MCV4

Question 52

Vaccination is recommended for students entering high school and is mandated by law in a dozen states for those entering college

Answer 52

MCV4