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Neurology > Central Nervous System Infections Lecture > Flashcards

Central Nervous System Infections Lecture Flashcards

1
Q

Viral meningitis - time of year, viruses, diagnosis, treatment

A

COMMON
Late summer/autumn
Viruses - Enteroviruses eg ECHO or other microbes and non infectious causes
Diagnosis - viral stool culture, throat swab and CSF PCR
Treatment - supportive as self limiting

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2
Q

Viral encephalitis - viruses

A

Herpes simplex - diagnose QUICKLY

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3
Q

Is Viral Encephalitis travel or occupational related?

A

Yes.
Travel - West Nile, Japanese B encephalitis, Tick Borne Encephalitis
Occupation - Rabies

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4
Q

Clinical Features Encephalitis (6)

A 
Insidious onset - sometimes sudden
Meningismus
Stupor, coma
Seizures, partial paralysis
Confusion, psychosis
Speech, memory problems
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5
Q

Investigations for Encephalitis (3)

A

LP
EEG
MRI
if delay start pre-emptive aciclovir as prompt therapy improves outcomes

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6
Q

Describe MRI findings in Encephalitis

A

Inflamed portion of the brain brightest white. Usually temporal lobe

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7
Q 
Common causes of bacterial meningitis in..
Neonates
Children
10 to 21
21 onward
Elderly
A 
Neonates - listeria, group b strep, e.coli
Children - h.influenze
10 to 21 - meningococcal
21 onward - pneumococcal>meningococcal
Elderly - pneumococcal > listeria
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8
Q 
Common causes of bacterial meningitis with these risk factors...
Decreased CMI
S/P neurosurgery or opened head trauma
Fracture of the cribiform plate
Immunocompromised
A

Decreased CMI - listeria
S/P neurosurgery or opened head trauma - staphylococcus, gram negative rods
Fracture of the cribiform plate - pneumococcal
Immunocompromised - s.pneumonia, n.meningitidis, listeria

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9
Q

Bacterial Meningitis - Clinical Signs (3)

A

Fever
Stiff neck
Alteration in consciousness

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10
Q

Bacterial Meningitis - Signs and Symptoms (8)

A 
Headache
Vomiting
Pyrexia
Neck stiffness
Photophobia
Lethargy
Confusion
Rash
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11
Q

Signs of bacterial meningitis often absent or atypical in..? (3)

A

The very young
The very old
Immunocompromised people

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12
Q

In bacterial meningitis which kind of WBC would you expect to find in the subarachnoid fluid?

A

Neutrophils

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13
Q

Describe some potential pathogenesises of bacterial meningitis (3)

A
  1. Nasopharyngeal colonisation
  2. Direct extension of bacteria
    - parameningeal foci (sinusitis, brain abscess, mastoiditis)
    - across skull defects/fracture
  3. From remote foci of infection eg endocarditis, pneumonia, UTI
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14
Q

Antibiotic of choice for listeria monocytogenes

A

IV Ampicillin/amoxicillin

Gram positive bacilli

Intrinsically resistant to ceftriaxone

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15
Q

Which subgroup of patients do we mainly see crytococcal meningitis in?

A

HIV patients

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16
Q

When we send CSF for interpretation what do we want to know from…

  1. Haematology
  2. Microbiology
  3. Chemistry
A
  1. cell count, differential
  2. gram stain, cultures
  3. glucose, protein
17
Q

What is the typical cell type CSF findings in Viral meningitis

A

cells are lymphocytes

18
Q

What are the CSF findings for bacterial meningitis

  1. Cell type
  2. Protein levels
  3. Glucose levels
A
  1. predominantly polymorphs
  2. protein high
  3. glucose less than 70% of blood glucose
19
Q

What is the CSF findings for partially treated bacterial meningitis

  1. Cell type
  2. Protein levels
  3. Glucose levels
A
  1. predominantly lymphocytes
  2. protein high or very high
  3. glucose normal or decreased
20
Q

CSF predictive of bacterial meningitis with 99% accuracy if….

A

WBC count >2000
Neutrophils >1180
Protein >220mg/dl
Glucose

21
Q

What is aseptic meningitis?

A

Non pyogenic bacterial meningitis

22
Q

What spinal fluid formula does aseptic meningitis typically have?

A

Low WBC
Minimally elevated protein
Normal glucose

23
Q

Infectious and treatable causes of aseptic meningitis/encephalitis syndrome (9)

A 
HSV 1 and 2
Syphilis
Listeria (occasionally)
Tuberculosis
Cryptococcus
Leptospirosis
Cerebral malaria
African tick typhus
Lyme disease
24
Q

Non-infectious and treatable causes of aseptic meningitis/encephalitis syndrome (6)

A 
Carcinomatous
Sarcoidosis
Vasculitis
Dural venous sinus thrombosis
Migraine
Drug
Co-trimoxazole
IVIG
NSAIDS
25
Q

Indications for hospital admission in acute adult bacterial meningitis (5)

A
  • signs of meningeal irritation

  • an impaired conscious level

  • a petechial rash

  • who are febrile or unwell and have had a recent fit

  • Any illness, especially headache, and are close contacts of patients with meningococcal infection, even if they have received a prophylactic antibiotic
26
Q

Early inpatient action for acute adult bacterial meningitis (4)

A
  • take blood for culture and coagulation screen
    
- give the empirical treatment
  • LP
    
- take a throat swab which should be plated as soon as practicable by the microbiologist
    
- disrupt and swab or aspirate any petechial or purpuric skin lesions for microscopy and culture
27
Q

What should be done to investigate patients with papilloedema or focal neurological signs?

A

Urgent CT or nuclear magnetic resonance scan

BUT DONT delay appropriate antibiotics

28
Q

Who should undergo CT before Lumbar Punctures? (6)

A 
Immunocompromised patients
History of CNS disease
New onset seizure
Papilloedema
Abnormal level of consciousness
Focal neurologic deficit
29
Q

Indications for lumbar puncture in acute adult bacterial meningitis

A

All adult patients with suspected meningitis except when a clear contraindication exists (III) or of there is a confident clinical diagnosis of meningococcal infection with a typical meningococcal rash (III)

30
Q

Should antibiotics be given before or after lumbar puncture in acute bacterial meningitis?

A

BEFORE

31
Q

Should you give steroids if you are not confident you are using the correct antimicrobials?

A

NO

32
Q

What is the empiric antibiotic therapy for acute adult bacterial meningitis?

A

EMPIRIC ANTIBIOTIC THERAPY
IV CEFTRIAXONE 2g bd
ADD IV AMPICILLIN/AMOXICILLIN 2g qds IF LISTERIA SUSPECTED

33
Q

What is the empiric antibiotic therapy for acute adult bacterial meningitis IF penicillin allergy?

A

PENICILLIN ALLERGY (RASH OR ANAPHYLAXIS)
If there is a clear history of anaphylaxis to beta-lactams give chloramphenicol iv 25 mg/kg 6-hourly with vancomycin iv 500 mg 6-hourly or 1g 12-hourly.
If listeria suspected and penicillin allergy co-trimoxazole alone has been used successfully for this infection.

34
Q

When do we give steroids to patients suspected of bacterial meningitis?

A

Give to all patients suspected of bacterial meningitis (10mg iv 15-20 min before or with the first dose of antibiotic and then every 6 hours for 4d)
Unfavourable outcome reduced from 25% to 15% and mortality from 15 to 7%
Most striking benefit in pneumococcal meningitis
Less likely also to have impaired consciousness,seizures and cardio-respiratory failure
Do not give in post-surgical meningitis, severe immunocompromise, meningococcal or septic shock or those hypersensitive to sterroids

Neurology (13 decks)

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