Clinical Lab: Block 3 Flashcards
Define Pleocytosis
Inc of CSF cells from infections
What is the first onset Sx of meningitis Sx
Respiratory
What is the classic Sx Triad of meningitis in adults and kids?
What Sx do infants present with?
Fever, HA and Stiff Neck
Listlessness and bulging fontanelles
How is meningitis diagnosed?
Brain imaging
LP
What are the Big 3 bacterial causes of meningitis?
Strep Pneumo
Neisseri mening.
HIB
What will a lab report for bacterial meningitis show?
High PMNs 200-20K
Low glucose
High protein
What types of bacteria are more likely to cause meningitis in elders?
Strep Pneumo E Coli K pneumoniae S agalactiae L monocytogenes
What types of bacteria are more likely to cause meningitis in Adults
Strep Pneumo or N Meningitidis Staph H influenza G Bacilli Strep L monocytogenes
What types of bacteria are more likely to cause meningitis in children?
Strep pneumo
N Meningitidis
H influenzae
What types of bacteria are more likely to cause meningitis in neonates?
GBS S agalactiae
E coli
L monocytogenes
Strep
What are the S/Sx of Viral meningitis?
Mild/self limiting
Viral syndrome w/ URI and gastroenteritis
What viruses cause Viral meningitis?
Enterovirus Arbovirus HSV Adenovirus HIV Measles
Define Aseptic Meningitis
Under viral meningitis- seasonal usually affecting kids/infants from enterovirus (spring/summer), Arborvirus (wamr) or measles (winter)
What does a lab report of viral meningitis show?
100-1000 mostly lymphocytes
Normal glucose
High Protein
Other than URI/GI Sx, what nondescript Sx can appear with Aseptic Meningitis?
Non blanching maculo-papulo-vesicular rash
What are the S/Sx of Fungal Meningitis?
Gradual onset of HA, fever, stiff neck, drowsiness and seizure
What fungi microbes cause meningitis?
Dimorphics- Histoplasma, Blastomyces, Coccidioides
Cryptococcus
Candidia
Aspergillus
What type of PT usually contracts fungal meningitis?
What considerations are taken with this Dx?
Immune compromised
Geography and travel Hx
Pigeon raising
What will the lab report of fungal meningitis show?
100-1000 mostly lymphocutes
Low glucose
High protein
What parasites can cause meningitis?
Naegleria
Acanthamoeba
Taenia
Toxoplasma
What are the exposure risks of contracting parasitic meningitis?
Naegleria: swimming in warm fresh water
Taenia: consuming eggs
Toxo: improper cooking, litter boxes
What will the lab report of parasitic meningitis show?
100-1000 eosinophils
Normal/low glucose
High protein
S/Sx of chronic meningitis
Hydrocephalus HA Fever Meningismus Confusion
How is chronic meningitis Dx?
Non specific S/Sx but suspected in chronic encephalopathy or hydrocephalus
MRI/CT
LP
What type of organisms cause chronic meningitis
Slow growers- Crypto Neoformans common
What are the S/Sx of encephalitis?
Confusion/AMS
Personality changes
Aphasia/ataxia
Myoclonic jerk
How is encephalitis Dx?
PCR of CSF for herpes
Imaging, LP, Hx, PE
What animals carry rabies and which ones are low probability carriers?
Racoon, skunk, fox, bat, coyote
Dogs, cats, ferrets
How is rabies Dx in humans?
Saliva, Serum, CSF and Skin biopsies of neck hair follicles
Saliva- PCR
Skin- Atg
CSF- Abs
How is a rabies infection identified from brain tissue?
Negri bodies
Babes nodes
What are the S/Sx of a brain abscess?
HA/focal neuro deficit
Papilledema, N/V w/ Inc ICP
How is a brain abscess Dx?
Focal neurologic deficit or seizure suggests focal brain lesion
CT w/ contrast
NO LP
What microbes can cause brain abscesses?
Bacterial- polymicrobial= Staph A w/ infective endocarditis
Parasitic- Taenia Solium, Toxoplasma Gondii
Define Subdural Empyema
Collection of pus between dura and arachnoid membraines typically after sinus infection or surgery
What microbes can cause subdural empyema?
What are the S/Sx?
Strep, Staph, Enterobacteriaceae
Fever, worsening HA after sinus infection
How is subdural empyema diagnosed?
Imaging
Culture
NO LP
When are LPs mandatory?
If bacterial meningitis is suspected
When are LPs contraindicated?
What is the next step for the PT?
Inc ICP, Coagulopathy, Brain abscesses
Blood culture and empirical therapy
How many tubes of CSF are collected during an LP?
4 tubes of 1-2ml 1- glucose and protein 2- micro for stain/culture 3- hematology for count and differential 4- immunology and serology
What are the characteristics of CSF that are examined?
Turbidity
Color
Cell count
Gram stain
What type of meningitis causes CSF to be thick and cloudy with a high cell count?
Bacterial
What does it mean if during an LP each tube becomes progressively clearer?
Traumatic tap
Define Xanthochromia
Yellow/red discoloration of spinal fluid from breakdown of RBCs that when centrifued looks like cherry Kool-Aid
What is the most important information that can be received to help link Sx with causative agents?
Cell count- count of RBCs and WBCs and exam of RBC morphology
When is glucose altered in CSF?
Normal- viral, chornic
Low- bacterial
When is protein altered in CSF?
High- bacteria
Moderate elevation in viral
When is the WBC count altered in CSF?
Increased in septic meningitis w/ polymorphonuclear forms
Septic meningitis- mononuclear (lymphocytes) predominate
What CSF antigen screen is an AIDS defining illness?
Cryptococcal Ag kit
Since CSF Antigen screenings are so expensive, what other test is just as reliable and not as expensive?
Gram Stain
What lab test is the gold standard for diagnosing bacterial meningitis?
CSF cultures
PTs with meningitis are also ? so what other test may also be useful?
Blood cultures are usually positive
What organisms is responsible for meningitis in neonates born by vaginal birth?
GBS
What organisms is responsible for meningitis in neoneates with K1 Ag?
E coli
What organisms is responsible for meningitis in neonates, elderly and immune compromised PTs?
Listeria monocytognes
What organisms is responsible for meningitis in children from 6mon to 5yrs?
H. Influenzae
What organisms is responsible for meningitis in toddlers and young adults?
Neisseria meningitis
Polysaccharide vaccines are available for what serogroups of N Meningitidis?
A C Y W135
What organisms is responsible for meningitis in all age groups but have a higher prevalence in elderly PTs?
This form also occurs with what other issues?
Strep Pneumo
Pneumonia, mastoiditis, sinusitis, basilar skull fracture
What organisms is responsible for meningitis in AIDS PTs?
Cryptococcus neoformans
Recognize condition, manifestation and tests for organism
asdf
Characteristics of Strep Pneumo
Capsule transmitted by droplet/extension
Risks in splenectomy, CSF leaks, pneumococcal pneumonia or cochlear implant
Characteristics of Neisseria Meningitidis
Causes meningitis from a capsule of IgA protease transmitted through respiratory drops in close quarters or unvaccinated persons
Characteristics of Haemophilus influenza
Causes meningitis in unvaccinated kids as a capsules that colonize in URT from droplet spread in PTs w/ head trauma, otitis media or CSF leaks
Characteristics of Listeria Monocytogenes
Meningitis, still birth or rhomboencephalitis causing microbe that survives in phagocytic cells from unpasteurized milk/cheese in PTs that are immune suppressed or pregnant
Characteristics of Streptococcus Agalactiae
Causes meningitis from B hemolysin and hyaluronidase transmitted to neonate by GBS in pregnant/vaginal births
Characteristics of anaerobes
Cause of brain abscess from adhesions from oral flora in PTs w/ poor oral hygiene
What are the CNS slow bacteria?
Mycobacteria TB
Borrelia burgdoferi
Treponema pallidum
Characteristics of Mycobacterium Tuberculosis
TB Meningitis or CNS Tuberculoma that is transmitted by droplet and survives in lung tissue until immune suppression allows growth in kids/AIDS
Characteristics of Borrelia Burgdorferi
Neuroborreliosis, subacute meningitis or facial palsy caused by microbe that changes outer surface proteins from a Deer Tick
Characteristics of Treponema Pallidum
Neurosyphilis or Gummas in PTs with untreated syphilis
Characteristics of Arboviruses
Example- West Nile
Transmitted by arthropod vector mosquito that results in encephalitis
