Bacterial meningitis Flashcards by Omar Gazar

بسم الله الرحمن الرحيم وبه نستعين
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infections affectin muscle tone

C,tentai spastic
c,botulinum flaccid parlaysis

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Mention bacteria casuing meneingitis

NHS PAL
Nessiria menigitidis
Hemoplilus infulucnazer
Sterptococcus pnemoniae and aglagctae
Listera monocytogens

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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

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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

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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

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Fatal meningitsi killing within six hours of intial symtptoms with little time for treatment ?

as meningococcal meningitis

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small drak purplish hemohhrages of blood vessels of skin apeear in menigitis this called ?

Petichae

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Describe lumbar puncture cc in case of acute bacterial meinigits /

Milky turbid
leaving rapidly due to increased ICP

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After centrifugation of the CSF what resultis ?

Sediment for culture
Supernatant has WBCs
and glucose and protein
Detecton of Capuslar polysaccradie antigens

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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

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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

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Endotoxin of N,menigitdis is ?

LipooligoSaccharides

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describe nessirea

Polysaccardide Capusleted Oxidase + gram - diplococci with lipooligosaccardi endotoxin on the outer membrane.
menigniococcus
Non motile non spore forming
and appear in pairs

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The most common cause of purulent meningits is ?

Nessieria Menigitids called
Epidemic cerebrospinal Meningitis

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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

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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

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used in developend of vaccine against group b meniniogcoci

Factor H binding Protein

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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 + ____________________ 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 ________________________

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 _________________________________ -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 _________________ 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 ________________________ 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 __________________________ 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 ) _____________________ 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 ___________________________________ POLYSACCARDIE ANTINGEN OF Hib + Protein conjugation Preventing invasive Hib disease reducing nasopharyngeal carriage for infants bet 2 and 15 months

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