CNS infection

Question 1

Symptoms of meningitis

Answer 1

Fever, stiff neck, photophobia, some brain function disturbance

Question 2

Causative organisms of acute meningitis

Answer 2

Bacterial:Neisseriameningitidis(Gram-ve),Streptococcuspneumoniae (Gram +ve)
§ Neonates: Group B Strep, Listeria monocytogenes, E. coli
§ Elderly: Group B Strep, Listeria monocytogenes

Viral:Enterovirus(coxsackie,echovirus),mumps,HSV2
§ Viral presents the same as bacterial (but often less severe)

Question 3

Cause and presentation of chronic meningitis

Answer 3

Presentswithheadachesformonths,

caused by TB or cryptococcus

Question 4

How does meningococcal meningitis present ?

Answer 4

Non blanching rash

Can present with septicaemia as well- which presents with hypovolaemia, coagulopathy, acidosis and multi organ failure

Question 5

What is aseptic meningitis and what is the main causative organism

Answer 5

Meningitis with negative CSF

Enteroviruses (e.g. Coxsackievirus group B and echoviruses) are responsible for 80-90% cases

Question 6

Symptoms of Encephalitis

Answer 6

Confusion, fluctuating consciousness

Question 7

Main causative organisms of encephalitis

Answer 7

HSV1 but West Nile virus is increasing

Toxoplasmosis, immunocomprimsied

Question 8

Symptoms of brain abcess

Answer 8

Headache, vomiting, seizure, swinging fever

Question 9

How brain abscesses occur

Answer 9

Through local extension- otitis media

Haematogenous spread- endocarditis

Question 10

Who are at risk of getting bacterial meningitis

Answer 10

o Overcrowding,youngadults/veryyoungorold
o N.meningitidis:Complementdeficiency,hyposplenism(susceptibleto
encapsulated organisms), hypogammaglobulinaemia
o S.pneumoniae:Complementdeficiency,hyposplenism,immunosuppressed
(alcoholic), infection (pneumonia), entry #, previous head trauma w/ CSF leak

Question 11

CSF of bacterial infection

Answer 11

Turbid, low glucose, high WBC, polymorphs (neut, bass, eso)

Question 12

CSF of viral infection

Answer 12

Clear, normal glucose, high WBC, mononuclear (lymph and mono)

Question 13

CSF of TB infection

Answer 13

Clear/turbid, low glucose, high WBC, mononuclear, high protein

Question 14

Treatment of Bac Meningitis

Answer 14

Resuscitate! IV ceftriaxone and corticosteroids (cover Listeria with ampicillin)
o Ifconsciousnessaffected,considerIVacyclovirtocoverencephalitis