Bacterial meningitis Flashcards
بسم الله الرحمن الرحيم وبه نستعين
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infections affectin muscle tone
C,tentai spastic
c,botulinum flaccid parlaysis
Mention bacteria casuing meneingitis
NHS PAL
Nessiria menigitidis
Hemoplilus infulucnazer
Sterptococcus pnemoniae and aglagctae
Listera monocytogens
Mention Modes of infectos of meniegitis
PDLH
=Peripheral nerves as rabis + herpes zoster
=Direct implanatation iatrogenic as lumbar puncture
=Local extension from skull and spine
=Hematogenous spread :-
By arterial blood supply and Connections between facial veins and Venous sinuses
Classify meiengitis
According to speed of intial presentation and speed of progerssion :
Acute from hours to days and by pyogenics as S,penumoniae + Neissiera mengitifdis
Subacute from days to few weeks and by CM? fungal cryptococcus and Mycobacterium tuberclosis
Chronic reaching 4 weeks by
Complications of mentioned above or
Viral infections
Menigintis symptoms and signs causes
Fever due to inflammation
Edema causeing increased ICP interfering with brain functions
causing Confuson dorwiness nause pain
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Spinal meningits casuign motor and sensory defecits
Stiffness of Neck
Fatal meningitsi killing within six hours of intial symtptoms with little time for treatment ?
as meningococcal meningitis
small drak purplish hemohhrages of blood vessels of skin apeear in menigitis this called ?
Petichae
Describe lumbar puncture cc in case of acute bacterial meinigits /
Milky turbid
leaving rapidly due to increased ICP
After centrifugation of the CSF what resultis ?
Sediment for culture
Supernatant has WBCs
and glucose and protein
Detecton of Capuslar polysaccradie antigens
Compare between bavteral viral fungal menigits supranatant
Bacterial and fungal increased protein and pressure with decreased glucose bacterial with PMNL , but fungal with Lymphocytes
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Viral normal or increased protein and pressure with normal glucose and Lymphocyte infilatraion
When you cannot perform Lumbar puncture in MENIGITIS ?
In case of patient with papilledema or Focal Neurological defecits
due to increased pressure may casue brain herniation
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in case of MASS lesion in CT scan whether abscess or tumor
Endotoxin of N,menigitdis is ?
LipooligoSaccharides
describe nessirea
Polysaccardide Capusleted Oxidase + gram - diplococci with lipooligosaccardi endotoxin on the outer membrane.
menigniococcus
Non motile non spore forming
and appear in pairs
The most common cause of purulent meningits is ?
Nessieria Menigitids called
Epidemic cerebrospinal Meningitis
how to classify N,menigitids
According to capsular polysachharide antigen to 13 serological types
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The most common are
ABCY W135
A C MOST epidmeic menigitis world wide
B sporadic
Carriage rate increased in close quarters as military camps
Mention virulence factors of the Nessieria meningitids
P2LIF
Polysaccardia capusle : antiphagocytic + antigenic for capsule
Pili for attachment to mucosa
Lipooligosaccardia capsule endotoxin for fulminant meningococcemia + septic shock
IgA proteases helping to attach to upper respiratory tract mucous degrading IgA
Factor H binding protein :
inhibiting c3b precenting Membrane attack complex and lysis = Immune evasion + used in developend of vaccine against group b meniniogcoci
used in developend of vaccine against group b meniniogcoci
Factor H binding Protein
Host of menigococciN,menengitids
Humans only
mode of transmission of N menigitisds
By droplets to colonize in nasppharynx as normal flora transient
in 5-10 % of noraml population
carries are asymptompatic
Explain pathogensis of Nessiera meningitidis
From the nasopharynx to CNS how ?
Hematogenosu to subarachanoid space
Through olfactory nerve sheath direct spread
CC by fever sore thoracth headache coma death
nucal rigidity vomiting
it is
Epidiminc+ higly contagious + rapidly progressive
-fulminant Menignicoocemia
-chronic carriesrs
Explain Fulminiant meniogicocemia in the pathogenisis of the n menigitis mentnigitsi
Due to severe inflammatory responese to the Lipooligosaccaride endotoxin of the N,menigitis casuing ?
=Severe fever HEADACHE SDSA
=DIC and throbocytopenia and purpra
=Shock and hypotension and cirulatory collapse
=Adrenal insufficiency
water house friedrechsen syndrome
death
mENTION IMP OF supranantan after centifugation
-For Leckocytic count esp neurtophils
-Increased glucose and protein
-Detection of capsular polysaccaride antigen by latex agglutinations or ring periceptiation test
Laboraty diagnosis of the N,menigtidis by speciments of ?
CSF
Blood
Naspaygneal swab
Hoow to benfit from sediments
1-Gram stain : gram - diplococci
2- Culture on chocolate blood agar or Selevtive chocolate : thayr martin 5-10% CO2
Ferminting glucose and maltose with acid only
Oxidase = +
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Preesumpative diagnosis of meninigococaal menigits if ?
Rapid diagnosis by?
if Gram-diplccis + oxidase +
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Rapid diagnosis by Latex agglutination test
sensitive and specific diagnosis by ? of menigocooal menignits
PCR
How to diagnose Carrier asympoomatic
By nasopharyngeal swab
it will be mixed with commensal so cultured on selectiv media thayr - martin medium 5-10 %co2
then by gram and oxidase and sugar utilization tests
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Compaer between Commensal nessiera and N,menigitis ?
Commensal :-
-Grow in ordinary media without co2 enrichment at room temp.
-Sugar utilizton differ
-no reacton with Specific antisera as Antibodes for Capsular polysaccardie anitgen
HOW To prevent MENIGNIOCOCCAL MENINIGTS ?
-CHEMOPROPHYLAXIS :
Rifampicin in close contacrs
Ciprofloxacin single dose in adolescents
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-Vaccination :
Unconjugate menigococcal vaccine inclduing ACY W135 Serotypes
- quadrivalnet Conjugate menigococcal vaccine conjugated with protein for high titres of antibodies in children
Vaccin agains Group b N ,meneigitids contains ?
Factor H binding protein
Describe s.penomnia
Gram + streptococci catalse -
-non motile
-non spore forming
-lanceolate in pairs
-polysaccharide capsule
-Alpha hemolyic in blood agar
Mentions ways of spread of S.penumoniae to meiniges?
From lobar pnemnina hematogenous to the Meninges
From Otitis media to mastoid bone to meninges as direct spread
Qulleng reaction or capsulear swelling reaction marns ?
Each one of 90 serotypes ofs,pnemoniae has specifica antisera to the polysaccharide capsule antigne when added to the culture will cause sewlling of the capsule
Mention virulence factors of Streptococcus pnemoniae
CIPA
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Capsule : antiphagocytic
IgA protease : enabling attachment to the upper respiratory tract mucosa
Pneumolysin : destructing membrane of the host cell
Autolysin : Destruction of peptidoglycan of the bacteria itself being fragments casuing sever inflammatory reaction causing tissue damage and necrosis
How to dGriangose S,penmoiae ?
CSF OR BLOOD SPEMCIEN
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Blood agar cc by ? agdoc
1-Alpha hemolysis
2-gram + diplococci
3-draugths man appearcnce due to autolysin
4-Optochin inhibiting growth
5-Catalase Negative
Rapid and accurate detection of peunomcoccal meningiits bY?
Detection of polysaccradie capsule antigne in CSF
Vaccination of s.pemnoniae
-Polysaccaride 13 valent pnemocaocal vaccine :
conjugated + to immounpcmprided as spleenetomized and children under 5
-polysaccharid 23 valent pneumococcal vaccine healyhy individulas age 65 without conjugation
chrmoinc heart and lung and other conditions
Hemophilus influnzae
S small gram……. ……..
most virulent H .iflunzar have…….
The capsulated strain has ,,,,,types from ….. to …… the most virulent is …… casuing meninigts in children from ….to……..
transmitted from person to person by……..
Negative coccobacilli
Capsule
6 a-f most b
6months to 6 yeears
Respiratory droplets
gorwht media of H,influenzae requirements speical ?
Heme Factor x
NAD Factor V
mENTION VIRULERNCE FACOTRR OF H,influncae
CI2P
antiphagocytic acpusel most imp
IgA protease
Inflammatory PROCESS: lIPOPOLYSACCRIDE ENDOTOXIN
Pilli
Lab diagnosis of H.influnzae
specme,nm : CSF blood
Direct gram smear: Gram - coccobaclli
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in 5-10 con2 enriched media aerobic for 1-2 days
cannot grow on ordinary media requiring ?
Hemin facot x
NAD factor V
ON CHOCLATE AGAR (hEated blod agar )
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rapid capuslear antigen by latex agglutination IF ELISA
PCR
Stellatism
In mixed culture with staph the H.influnzea has a good growth around staps
vACCINATION OF H.infulenzae
Polyribosylribito phospahte
PRP
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POLYSACCARDIE ANTINGEN OF Hib + Protein conjugation
Preventing invasive Hib disease
reducing nasopharyngeal carriage
for infants bet 2 and 15 months
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