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DTMH Block 3 > Bacterial Meningitis > Flashcards

Bacterial Meningitis Flashcards

1
Q

In SA which populations have the highest rate of bacterial meningitis?

A

<1yo
Follow by 1-4yo

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2
Q

Which causes of bacterial meningitis are vaccine-preventable?

A

S. pneumo
Haeif B
Neime
Strag

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3
Q

Which organisms have the highest risk for morbidity?

A

STRPN -> HAEIF -> NEIME

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4
Q

What are the risk factors for bacterial meningitis?

A
  1. Immunodeficiencies
    - hereditary
    - asplenia
    - malignancies
    - HIV
    - medications
    - CKD, DM, alcoholism, liver disease
  2. Anatomical defects
    - cranium
    - sinuses
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5
Q

What is the definition of meningitis?

A

Meningeal inflammation with abnormal WBCs in CSF (>5 WBC OR any lymphocytes)

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6
Q

How is bacterial meningitis transmitted?

A

Droplet spread

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7
Q

Discuss the routes of meningitis

A
  1. Haematogenous (BBB, BCB)
  2. Direct invasion
  3. Neural centripetally
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8
Q

Discuss the pathogenesis of bacterial meningitis

A
  1. Nasopharyngeal colonisation -> invasion -> bacteremia
  2. Meningeal invasion -> replication in subarachnoid space -> release of bacterial components (LPS, cell wall)
  3. Damage to microvascular endothelium -> increased BBB permeability -> vasogenic edema
  4. Cerebral vasculitis
  5. Subarachnoid space inflammation -> CSF outflow resistance -> incensed ICP
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9
Q

What are the bacterial and host factors regarding mucosal colonisation that attribute to bacterial meningitis pathogenesis?

A

Bacterial
- fimbriae
- IgA protease
Host
- mucosal colonisation
- secretory IgA
- cilia

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10
Q

What are the bacterial and host factors regarding intravascular survival that attribute to bacterial meningitis pathogenesis?

A

Bacteria
- polysaccharide capsule (antiphagocytic)
Host
- complement activation
- specific antibodies

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11
Q

What are the bacterial and host factors regarding meningeal invasion that attribute to bacterial meningitis pathogenesis?

A

Bacteria
- fimbriae
- lipoteichoic acid
Host
- BBB
- BCB

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12
Q

What are the bacterial and host factors regarding survival in subarachnoid space that attribute to bacterial meningitis pathogenesis?

A

Bacteria
- polysaccharide capsule
Host
- poor opsonic activity

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13
Q

What are the clinical features of acute bacterial meningitis in adults?

A

Fever
Headache
Neck stiffness
Altered GCS
Vomiting
Photophobia

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14
Q

What are the clinical features of acute bacterial meningitis in infants?

A

Irritability
Poor feeding
Bulging fontanelles
Hypothermia

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15
Q

What is aseptic meningitis?

A

Lymphocytic pleocytosis without an apparent cause on CSF

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16
Q

What are some causes of aseptic meningitis

A

Drugs
Autoimmune
Vaccines
Malignancies

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17
Q

What is the hallmark of acute encephalitis?

A

Diffuse involvement of cerebral cortex

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18
Q

What are the common bacterial meningitis pathogens in neonates?

A

S. agalctiae
E. coli
L. monocytogenes

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19
Q

What are the common bacterial meningitis pathogens in 1-23m?

A

S. agalactiae
E. coli
H. influenzae
S. pneumo
N. meningitidis

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20
Q

What are the common bacterial meningitis pathogens in 2-50y?

A

S. pneumo
N. meningitidis

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21
Q

What are the common bacterial meningitis pathogens in >50y?

A

S. pneumo
N. meningitidis
H. influenza (some)
L. monocytogenes
Aerobic GNBs

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22
Q

What are the common bacterial meningitis pathogens in immunocompromised patients?

A

S. pneumo
N. meningitidis
L. monocytogenes
Aerobic GNBs (including pseudo)

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23
Q

What are the common bacterial meningitis pathogens in basilar skull fractures?

A

S. pneumo
H. influenza
S. pyogenes

Exposure to the nasopharynx

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24
Q

What are the common bacterial meningitis pathogens in head trauma?

A

S. aureus
CNS
Aerobic GNBs (pseudo)

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25
Q

Which vaccines are given at birth according to the SA EPI schedule?

A

BCG
OPV - 0

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26
Q

Which vaccines are given at birth according to the SA EPI schedule?

A
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27
Q

Which vaccines are given at 6w according to the SA EPI schedule?

A

Rotavirus - 1
PCV - 1
Hexavalent - 1

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28
Q

Which vaccines are given at 10w according to the SA EPI schedule?

A

Hexavalent - 2

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29
Q

Which vaccines are given at 14w according to the SA EPI schedule?

A

Rotavirus - 2
PCV - 2
Hexavalent - 3

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30
Q

Which vaccines are given at 6m according to the SA EPI schedule?

A

MMR - 1

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31
Q

Which vaccines are given at 9m according to the SA EPI schedule?

A

PCV - 3

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32
Q

Which vaccines are given at 12m according to the SA EPI schedule?

A

MMR - 2

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33
Q

Which vaccines are given at 18m according to the SA EPI schedule?

A

Hexavalent - 4

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34
Q

Which vaccines are given at 6y according to the SA EPI schedule?

A

TdaP - 1

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35
Q

Which vaccines are given at grade 5 according to the SA EPI schedule?

A

TdaP (campaign only)

36
Q

Which vaccines are given at 9y according to the SA EPI schedule?

A

HPV (campaign only)

37
Q

Which vaccines are given at 12y according to the SA EPI schedule?

A

TdaP - 2

38
Q

At which ages is rotavirus vaccine given?

A

6w
14w

39
Q

At which ages is hexavalent vaccine given?

A

6w
10w
14w
18m

40
Q

At which ages is PCV vaccine given?

A

6w
14w
9m

41
Q

At which ages if MMR given?

A

6m
12m

42
Q

What is the most common cause of bacterial meningitis?

A

S. pneumo

43
Q

What are the SA PCV vaccines available?

A

PCV 7 (2009)
PCV 13 (2011)

44
Q

What is the rate of CTX non-susceptibility for s.pneumo in SA?

A

8-10%

45
Q

What are risk factors for mortality with s. pneumo meningitis?

A

HIV
Smoking
Chronic lung disease

46
Q

In which age group is haemophilus influenzae most common?

A

Infants

Low incidence overall

47
Q

What is the rate of ampicillin non-susceptibility to haemophilus influenza?

A

8%

48
Q

In which population does n. meningitides occur?

A

Healthy, young patients
Highest incidence is in infants

49
Q

What are risk factors for n. meningitidis meningitis?

A

Terminal complement deficiency
Lack of MAC formation

50
Q

What was the usual outbreak season of n. meningitidis?

A

Dry season in the sub Saharan “meningitis belt”

51
Q

Which serotype is not included in the n. meningitidis vaccine?

A

B

52
Q

What is the rate of penicillin non-susceptibility in n.meningitidis in SA?

A

55%

2 cipro resistant isolates which has consequences for PEP

53
Q

What is the difference between early and late neonatal meningitis

A

Early - <7d
Late - >7d

54
Q

When is the s. agalactiae conjugate vaccine given in pregnancy?

A

3rd trimester

55
Q

What are risk factors for l. monocytogenes meningitis?

A

Extremes of age
Cell-mediated immunity defects

56
Q

What is the clinical presentation of l. monocytogenes?

A

Gastroenteritis

57
Q

What is the clinical presentation of l. monocytogenes specific to pregnancy?

A

Malaise
Transient bacteremia
Placentitis
Amnionitis

58
Q

What is the clinical presentation of l. monocytogenes specific to neonates?

A

Acute bacterial meningitis
Septicemia
Encephalitis

59
Q

Which antibiotics is l. monocytogenes intrinsically resistant to?

A

Cephalosporins (the first line for acute bacterial meningitis)

Ampicillin is the drug of choice

60
Q

Name other causative organisms of meningitis

A

Enterovirus
VZV
Mumps
HSV
HIV
Rickettsia
Treponema pallidum

61
Q

What is the normal CSF WCC?

A

0-5

62
Q

What is the normal CSF protein?

A

0.15-0.45

63
Q

What is the normal CSF glucose?

A

2.5 - 3.5 (>60% serum glucose)

64
Q

What is the normal CSF pressure?

A

50-150

65
Q

What are the CSF parameters in bacterial meningitis?

A

++ WCC
>50% PMN
Protein >1
Glucose <2.2
Pressure increased

66
Q

What are the CSF parameters in viral meningitis?

A

++WCC
>50% lymphocytes
Protein normal
Glucose normal
Pressure normal

67
Q

What are the CSF parameters in fungal meningitis?

A

+WCC
>50% lymphocytes
Protein normal
Glucose normal/low
Pressure increased

68
Q

What are the CSF parameters in TB meningitis?

A

++WCC
>50% lymphocytes
Protein 1-5
Glucose normal/low
Pressure normal/increased

69
Q

How much CSF must be included for culture?

A

> 1ml

70
Q

Which biomarkers have good NPV for bacterial meningitis?

A

CRP<20 with NBO and normal CSF

71
Q

When is PCR multiplex assay performed?

A

If
- viral suspected
- previous antibiotics
- pleocytosis but gram NBO

72
Q

Which bacteria are included on the BioFire?

A

E.coli
Haemophilus
L. mono
N. meningitidis
S. agalactiae
S. pneumo

73
Q

Which viruses are included on the BioFire?

A

CMV
EV
HSV1+2
HHV-6
HPeV (human parechovirus)
VZV

74
Q

Which fungi are included on the BioFire>

A

Crypto neoformans
Crypto gattiii

75
Q

In which patients should you add ampicillin for?

A

<1m
>50y
Immunocompromised

76
Q

In studies in high income countries, meningitis with which organism had decreased hearing loss?

A

H. influenzae

77
Q

In studies in high income countries, meningitis with which organism had decreased mortality?

A

S.pneumo

78
Q

Which risk factors must you exclude in recurrent meningitis?

A

Anatomical defects
Asplenia
Immunodeficiency

79
Q

Which bacterial meningitis organisms are notifiable?

A

Neisseria
Haemophilus
L. monocytogenes

80
Q

Which bacterial meningitis organisms require PEP?

A

Neisseria - single dose cipro
H. influenza - rif daily for 4d

81
Q

Which HCWs are considered close contacts requiring PEP?

A

Any exposure to nasopharyngeal secretions

82
Q

When does an index cause need PEP?

A

If not treated with 3rd gen cephalosporin (for nasopharyngeal colonisation)

83
Q

When does an index meningococcal need droplet infection precautions?

A

Until 24h post treatment initiation with 3rd gen cephalosporin

84
Q

What antibiotic should you add if the s.pneumo is CTX resistant or non-responsive?

A

Vancomycin

85
Q
A

DTMH Block 3 (18 decks)

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