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Bacterial infx CNS Flashcards

1
Q

What are the two categories of CNS infections?

A
  1. Those involving the meninges (meningitis)

2. Those which are confined to the brain (encephalitis)

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2
Q

What is the blood-brain barrier? What are the three functions it provides?

A

1 Separates blood and CSF

  1. Provides physical isolation for the CNS
  2. Protects the CNS, but not the PNS
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3
Q

What must microbes be able to do to cause CNS infections?

A

Disrupt the BBB

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4
Q

What is the BBB made of?

A

Tight junctions between endothelial cells and the cerebral microvasculature, cpithelial cells of the chorid plexus, and arachoind cells

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5
Q

What two features of the epithelial cells that comprise the BBB make them a good barrier?

A
  1. Tight junctions

2. Little pinocytosis/channels

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6
Q

How do CNS infections usually start? (3)

A
  1. Bacteremia or spread from a site adjacent/contiguous with the CNS
  2. Direct inoculation (rare)
  3. Neuronal spread
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7
Q

What are the three categories of meningitis? What are the usual causes of each?

A
  1. Acute pyogenic (bacterial)
  2. Aseptic (viral)
  3. Chronic (any class)
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8
Q

Bacterial meningitis is more or less fatal than viral?

A

More

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9
Q

What are the predisposing factors to pneumococcal meningitis? (2)

A

Pneumonia and chronic OM

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10
Q

What are the predisposing factors to meningococcal meningitis? (2)

A
  1. h/o recent URI (viral)

2. Complement deficiencies

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11
Q

Which type of meningitis occurs frequently in complement deficiencies?

A

Meningococcal

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12
Q

Where/when are meningococcal outbreaks (specifically) common?

A

Schools and military barracks

Winter months

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13
Q

What are the two common features of the bacteria that cause meningitis?

A
  1. Capsule

2. Fimbrae/pili

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14
Q

What is the function of the capsule of the meningitis-causing bacteria?

A

Resists immune mechanisms that allows them to travel to the CNS

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15
Q

What is the function of the fimbrae/pilli of the meningitis-causing bacteria?

A

help colonize the CNS cells

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16
Q

What are the two main things that cause the damage with meningitis?

A
  1. Toxins

2. Immune response

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17
Q

What is the significance of the bacterial toxins?

A

Incude the production of cytokines

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18
Q

What is the function of the cytokines released?

A

Cause inflammation and edema in the CNS

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19
Q

What are the four common symptoms of meningitis?

A
  1. Fever
  2. HA
  3. Stiff neck
  4. AMS
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20
Q

How do you diagnose meningitis? (3)

A
  1. Gram stain CSF
  2. Cultures
  3. Latex agglutination
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21
Q

What is the treatment for meningitis? What is this based on?

A

Empiric abx

Examination of CSF, age, preexisting conditions

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22
Q

The majority of cases of bacterial meningitis occur in what population group?

A

infants and children

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23
Q

What is the most (and second most) common pathogen of bacterial meningitis?

A
  1. Strep pneumonia

2. Neisseria meningitidis

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24
Q

What percent of meningitis are caused by Strep agalactiae?

A

5-10%

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25
What percent of meningitis are caused by listeria monocytogenes?
5-10%
26
What percent of meningitis are caused by H/influenzae?
5-10%
27
What percent of meningitis are caused by Strep pneumonia?
50%
28
What percent of meningitis are caused by N.meningitidis?
25%
29
Kids less than 2 month of age (or 2 yo) are have bacterial meningitis caused by what pathogen?
Strep agalactiae
30
What are the four major causes of bacterial meningitis in neonates?
1. Strep agalactiae 2. E.coli 3. Gram negative enterics
31
What is the gram stain and morph of strep pneumonia? Catalase?
Gram positive cocci, catalase negative
32
What is the hemolysis patterns seen in strep penumo? Is it optochin sensitive? bile?
alpha Sensitive to bile and optochin
33
Who are more frequently colonized by strep pneumonia kids or adults?
Kiddos
34
What are the three virulence factors that strep pneumo produces to help them spread in the body?
1. IgA protease 2. Pneumolysin 3. Capsule
35
How fast is the onset of pneumococcal meningitis?
hours
36
How do you diagnose pneumococcal meningitis?
Gram stain CSF | Latex agglutination
37
What does the latex agglutination test detect in pneumococcal meningitis?
Capsular antigens
38
What is the treatment for meningitis?
Initially vanco with a cephalosporin Later with more targeted
39
How do you prevent pneumococcal meningitis?
Vaccination
40
What does the vaccine against pneumococcal meningitis contain?
Purified capsular polysaccharide from 23 types of pneumococcus
41
Why is the vaccine for pneumococcal meningitis not effective in children?
They have a problem developing antibodies to polysaccharides
42
What are the recommendations for the PPV vaccine?
Adults >65 yo | Persons >2 with chronic illness or likely exposure
43
What is PCV13 used in the pneumococcal vaccine?
Pneumococcal polysaccharide conjugated to nontoxic diphtheria toxin
44
What is the gram stain and morph of Neisseria meningititidis? (**key shape**)
Gram negative diplococci with **coffee bean appearance**
45
What are the two virulence factors for N.Meningitidis?
1. LOS | 2. Capsule
46
Coffee/kidney bean appearing bacteria = ?
N. Meningitidis
47
How do you differentiate between N. Meningitidis vs gonorrhea?
Oxidizes both glucose and maltose
48
Is N. Meningitidis oxidase positive? Catalase?
Both positive
49
What type of agar is needed for N. Meningitidis?
Chocolate agar
50
Do we have vaccines against N. Meningitidis?
Four of the five common ones
51
How is N. Meningitidis transmitted?
Coughs, secretions etc
52
What are the serotypes of N. meningitidis most often causes disease? (5) Which one do we not have a vaccine against?
1. C 2. B** no vaccine 3. Y 4. W 5. A
53
What are the significant sequelae of N. Meningitidis infections?
Neuro deficits | Limb amputation
54
What are the symptoms of meningococcal disease besides HA, stiff neck? (3)
Abrupt fever, hypotension, rash
55
How do you diagnose Meningococcal meningitis?
1. gram stain CSF | 2. Antigen detection in CSF
56
What percent of patients with only bacteremia caused by meningococcal have detectable organisms in blood smears?
30%
57
What is the treatment for meningococcal meningitis? (initially vs confirmed Meningococcal)
Vanco initially, Penicillin if confirmed Meningococcal disease
58
What are the two types of vaccine against meningococcal disease? Which is actually used?
tetravalent polysaccharide only used for immune suppressed (MCV4) Tetravalent polysaccharide conjugate vaccine = actually used
59
How many doses of the vaccine against meningoccal disease ?
one dose in 2-5 years if indicated
60
What is the conjugated polysaccharide that the meningococcal vaccine is conjugated to?
Diptheria toxin subunit
61
Which type of meningitis displays decreased glucose levels in the CSF: bacterial or viral?
bacterial
62
Which type of meningitis displays increased protein levels in the CSF: bacterial or viral?
Bacterial
63
Which type of meningitis displays increased pressure in the CSF: bacterial or viral?
Bacterial
64
Which type of meningitis displays increased levels of mom/lymphocytes: bacterial or viral?
Viral
65
Which type of meningitis displays increased levels PMNs: bacterial or viral?
Bacterial
66
If a pt presents with meningitis, without knowing anything else, what is the most likely cause of it? What is it's a kid <2 yo (or months
Strep Pneumonia GBS for kiddos
67
What is the gram stain and morphology of listeria?
Gram positive rod
68
What is the gram stain and morphology of HiB?
Gram negative rod
69
What groups of people is Listeria a major factor for meningitis?
Very young and old
70
Bile test is used to differentiate between what pathogens?
Strep and enterococcus
71
What bacteria need chocolate agar?
1. Neiserria | 2. Heamophilus
72
Does the MCV4 vaccine against N. Meningiditis work well?
Yes, IgG and goodness

Microbio (50 decks)

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