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Microbiology-HH3 > Central Nervous System > Flashcards

Central Nervous System Flashcards

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1
Q

3 components of the meninges?

A

dura mater, arachnoid mater, pia mater

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2
Q

CNS?

A

brain and spinal cord

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3
Q

What does inflammation fo the Brian cause?

A
  • pressure increase in the brain

- brain is enclosed in a hard bone skull, brain can only swell so big

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4
Q

Blood-Brain Barrier?

A
  • capillaries that limit access to CSF and brain tissue
  • limits toxin and chemical access tot the brain
  • pharmacologically it can be difficult if treating a brain infection/ injury
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5
Q

CNS Host Factors?

A
  • sterile site
  • no normal flora
  • few immune cells present (b/c it is sterile)
  • pathogen has advantage when infection occurs due to lack of normal flora and immune cells
  • inflammation increases permeability of BBB (pathogen entry increases, more permeable to toxins as well as immune cells and medications
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6
Q

CNS Infections: Portals of Infection?

A
  • trauma to skull and meninges
  • peripheral neurons (migrates to the CNS such as rabes)
  • respiratory system
  • GI
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7
Q

Inflammation of the meninges?

A

-can occur due to infection or not because of infection

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8
Q

Acute Meningitis?

A
  • fast onset
  • less than 2 weeks
  • medical emergency
  • seriously ill
  • bacterial cause mainly
  • always caused by an infection
  • increases ICP
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9
Q

Chronic and Aseptic Meningitis?

A
  • more than 2 weeks
  • viral cause
  • usually caused from a weak pathogen that can cause damage in immunosuppressed patients
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10
Q

Systemic infection: clinical findings?

A
  • fever
  • myalgia
  • rash
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11
Q

Meningeal Inflammation: clinical findings?

A
  • neck stiffness
  • brudzinki’s sign
  • kernig’s sign
  • jolt accentuation of headache
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12
Q

Cerebral Vasculitis: clinical findings?

A
  • inflammation of cerebral vasculature

- seizures

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13
Q

Elevated ICP: clinical findings?

A
  • headache
  • nausea and vomiting
  • seizures
  • neurologic symptoms
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14
Q

Signs and Symptoms of Meningitis?

A
  • no single S and S is sufficient for diagnosis

- fever, headache, neck stiffness, altered metal state

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15
Q

Meningitis clinical triad?

A

fever, nuchal rigidity (neck stiffness), headache

-present in 44% of patients

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16
Q

Absence of all 3 meningitis triad symptoms?

A
  • rule out meningitis
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17
Q

When is nuchal rigidity (neck stiffness) considered absent?

A
  • flexion of neck is painful but full ROM is present

- chin to neck movement

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18
Q

Brudzinki’s sign?

A
  • unconscious movement

- patient lyes on their back, neck is flexed forward. and knees will pop up to release pressure in spinal cord

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19
Q

Kernig’s sign?

A
  • patient on their back
  • hip flexed at 90 degrees
  • try to extend and straighten the knee, pain in lower back or posterior thigh and/ orresistance is a positive test result
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20
Q

Jolt accentuation of headache?

A

-worsening of headache with active horizontal head Turing at 2-3 turns per second

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21
Q

Can you rule out meningitis with absent jolt accentuation, Brudzinski’s and Kerning sign, but positive fever, headache and altered mental state?

A

-No

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22
Q

What procedure should you preform with any client suspected with meningitis?

A

-lumbar puncture

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23
Q

CSF glucose, WBC and protein levels in bacterial meningitis?

A
  • low CSF glucose
  • high CSF proteins
  • elevated WBC, mainly neutrophils
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24
Q

why are CSF glucose levels low in bacterial meningitis?

A

-inflammation causes impairment of glucose transport form the blood

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25
Q

why are CSF protein levels high in bacterial meningitis?

A
  • increased permeability of the BBB
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26
Q

WBC, glucose and protein levels in CSF of viral meningitis?

A
  • normal glucose
  • normal-moderately high protein level
  • elevated WBC (from monocytes and lymphocytes
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27
Q

2 pathogens associated with 80% of bacterial meningitis?

A
  • streptococcus pneumoniae

- neisseria meningitides

28
Q

Pathogen associated with GI caused meningitis?

What bacterial meningitis causing pathogen do we have good vaccines for?

A
  • listeria monocytogenes

- haemophilus influenza

29
Q

Rare causing bacterial pathogen? (meningitis)

A

-group B streptococcus

30
Q

gram - or +: S. pneumoniae and neisseria menigitidis?

A

S. pneumoniae= gram positive

N. M= gram negative

31
Q

2 viruses that can cause meningitis?

A
  • enteroviruses (Coxsackie B)

- herpes simplex virus

32
Q

Pneumococcal Meningitis?

A

-caused by S. pneumoniae
-505 of bacteria meningitis
75% of use are colonized with it in nasopharynx
transmitted by respiratory. droplets
-infectious 1-3 days prior to onset of symptoms and remains infectious until bacterium is absent in nasal and oral discharge

33
Q

Pneumococcal meningitis public health implications and immunizations?

A
  • reported to public health
  • no droplet precaution unless patients cough and sputum has increased
  • no cemoprophylaxis
  • infant pneumococcal conjugated vaccine
  • adult/elderly (65+) pneumococcal polysaccharide vaccine
34
Q

Neisseria Meningitides: movement, fimbriae and capsule?

A
  • move in and out of cells
  • attach with fimbriae
  • capsule protects against human immune system
  • steals iron from us
35
Q

Meningococcal meningitis?

A
  • caused from neisseria meningitides
  • affects children, adolescents and young adults
  • 25% of all bacterial meningitis
  • rates decline as you age
  • produces an endotoxin; fever, weakness, generalized aches, petechial rash
  • transmitted via droplets
  • infectious period 7 days prior to symptom onset and until pathogen is not present in nasal or oral discharge
36
Q

Why is meningococcal meningitis associated with younger populations?

A

-associate with a lot of people when young

37
Q

What causes the petechial rash?

A
  • endotoxic shock and disseminated intravascular coagulation

- scattered all over the body

38
Q

% of fatalities and % of permanent neurological or physical deficit with neisseria meningitides?

A

10% fatality

20% of survivors show permanent neurological or physical deficits

39
Q

Public health implicated of NEISSERIA MENINGITIDIS?

A
  • vaccinations to control the outbreaks
  • MEN-C-C (ages 2months -11yrs
  • Men-C-ACYW (grade 7)
  • Bexsero (2 months-17 years old
  • ciprofloxacin and rifampin
40
Q

Why is ciprofloxacin only given to patients aged 18 years+?

A

-change the development of cartilage in younger patients

41
Q

leading cause of meningitis prior to 1986?

A
  • H. influenza

- was once highly pathogenic

42
Q

H. influenza caused meningitis implications?

A

resp. droplet trasmission

- isolation post targeted antibiotic therapy

43
Q

Listeriosis?

A

-caused by listeria monocytgenes
-transmission by ingestion of unpasteurized foods, deli meats, poor hand hygiene
-young patients and elderly (extreme ages) and pregnant women
10% of meningitis cases

44
Q

% of people colonized with S. pneumoniae?

A

75% of people colonized

45
Q

Group B streptococcus

A

30% of women colonized
40-70% will transmit during delivery
1-3% will develop infection
-swab rectum and vagina at 35-37 weeks gestation to test
-comes through the mouth, moves into the blood stream and then into the brain

46
Q

Risk factors for Group B streptococcus?

A
  • GBS positive
  • premature labour (didn’t swab swab yet)
  • UTI caused by GBS
  • treat with antibiotics
47
Q

What age group is susceptible to GBS?

A

newborns-1 month olds

48
Q

Basic bacterial meningitis treatment?

A
  • bacterial antibiotic therapy
  • administered after blood cultures
  • directed at pathogens
  • antibiotic drugs that can cross BBB
49
Q

General Treatment Regimen for bacterial meningitis?

A

corticosteroid co-administered with antibiotic

-antipyretics, fluid and electrolyte supplements, nutritional support

50
Q

Viral meningitis?

A
  • less acute in severity than bacterial

- supportive treatments

51
Q

Enteroviruses: meningitis?

A

-85% of viral meningitis
-direct contact, fecal-oral route
most common in summer and fall
-usually in immunocompromised patients
-lasts 7-10days

52
Q

% of meningitis survivor that have neurological or physical deficits?

A

40%

53
Q

Encephalitis?

A
  • inflammation of the brain
  • viral is the most common
  • seasonal, geography, travel history, occupational exposure, immune status of patient influence the risk of you acquiring it
54
Q

Most common cause of encephalitis?

A

-viral

55
Q

Clinical triad of signs and symptoms of encephalitis?

A
  • fever
  • headache
  • altered LOC
56
Q

Clinical findings of encephalitis? (CSF lab values, neurologic symptoms)

A
  • disorientation
  • seizures
  • increased protein and lymphocyte and normal glucose in CSF
  • serology= look for antibodies for various viruses
57
Q

Serology?

A

-looks for antibodies for various viruses

58
Q

Viral encephalitis: initial sites of infection?

A
  • Resp. tract
  • GI
  • GU
  • SC tissues
  • viruses most commonly access the brain via the blood stream
59
Q

Viral encephalitis: HSV

A
  • herpes simplex virus
  • most common cause of non-epidemic encephalitis in Canada
  • no cure
  • constantly reoccurs
  • some antivirals slow down the replication of the pathogen
  • start HSV therapy when we see viral encephalitis
  • control immune system with corticosteroids
  • older or younger you are, the worse the potential outcomes
60
Q

Symptoms with Viral Encephalitis (HSV)?

A

-focal temporal lobe symptoms (hemiparesis, aphasia, visual field cut)

61
Q

West nile virus?

A

-triggers swollen lymph noses and can cause both meningitis as well as encephalitis

62
Q

Brain abscess?

A

-puss containing cavity surrounded by inflamed tissue
-up to 25% mortality rates
(infection within the brain)

63
Q

Major symptoms of brain abscess?

A
  • headache
  • mental status change
  • fever
  • focal neurologic deficits
  • symptoms depends on the location of the abscess
64
Q

3 major predisposing conditions for brain abscesses?

A
  1. Neutropenia
  2. Transplantation
  3. HIV
65
Q

Diagnosing a Brian abscess?

A

CT SCAN with injection of contrast material

- can be treated without surgery

66
Q

Empiric therapy for brain abscesses?

A

antimicrobial therapy

  • aspiration or surgery to remove abscess
  • corticosteroids when there is high ICP
67
Q

How do you diagnose bacterial meningitis?

A

-hx, physical examination, lab tests

Microbiology-HH3 (6 decks)

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