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Pmy2107 > CNS Infection > Flashcards

CNS Infection Flashcards

1
Q

What is septicaemia

A

Meningococcal bacteria multiply and produce poisions which attack blood vessel walls causing blood to Leak out

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2
Q

What is meningitis

A

Meningococcal bacteria cross from blood into lining of brain

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3
Q

Viral meningitis

A 
Often caused by 
Human enteroviruses 
Herpes 2 virus 
Mumps and measles 
Arboviruses
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4
Q

Fungal meningitis

A

Very rare but serious

Usally effects immunocomprimised

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5
Q

Bacterial meningitis

A

Serious , life threading condition
Most. Commonly effects extremes of age
Most common causes bacteria such as streptococcus pneumoniae and neisseria meningitidis

Major causes in neonates include E. coli
Gram negative enteric bacteria contribute to less than 10% casss

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6
Q

Neisseria meningitidis intro

A

Aerobic , gram negative diplococcus

Has a polysaccharide capsule which helps pathogenic strains revisit phagocytosis and lysis

Classified into serogroupsm
Most common = A,B,C W135 and Y

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7
Q

men A

A

Rare in uk. Causes large epidemic in sub sarharan Africa countries , Middle East and Indian sub content

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8
Q

MenB

A

~70% meningococcal causes In Europe and > 80% uk

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9
Q

MenC

A

Now rare. Usally occurs in ‘clusters’ in uk.

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10
Q

MenW135

A

Uncommon in uk. Usually associated with travellers returning from hajj pilgrimages to a Mecca in Saudi Arabia

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11
Q

MenY

A

Very rare in uk. Common in North America

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12
Q

Prevelance on neisseria men

A

Marked seasonal variation

Occurs at any age
Children <9 most at risk , peak incidence <1 year
Smaller secondary peak 15-19

Overall decline over last two years
gp sees average 1-2 over career

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13
Q

Transmission of n.men

A

~ 10% carry it in nasopharynx, usually without Ill effects

Penetrate mucosal cells and enter bloodstream in less than 1%. Crosses BBB and causes meningitis in 50%

Transmitted via droplets or secretions from URT
Transmission requires frequent or prolonged contact

Incubation period = 2-7 days

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14
Q

Risk factors of meningitis

A 
Young age 
Winter season 
Absent or non functioning spleen
Older age >65
Immunicomprimised state 
Incomplete immunisation 
Cancer 
Organ dysfunction 
Smoking 
Overcrowding 
Sickle cell disease
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15
Q

Pathophysiology of men

A

Colonisation of nasopharyngeal and invasion of sub mucosa by overcoming host defences - physical barriers ,m local immunity , phagocytes/ macrophages

Invasion of blood stream

Meningeal invasion via Bbb
bacterial replication In CSF
host inflammatory responses
Pus and abscess formation

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16
Q

Common , non specific symptoms

A 
Fever 
Vomiting /Naseua 
Lethargy 
Irritability / unsettles behaviour 
Ill appearance 
Refusing food/drink
Muscle ache /joint pain 
Difficulty breathing /respiratory symptoms
17
Q

Less common, non specific symptoms

A

Chills / shivering
Diarrhoea
Abdominal pain/distension
Sore throat or other ENT symptoms

18
Q

Neurological symptoms

A 
Bulging fontanelle 
Stiff neck or back p
Altered mental state 
Photophobia
Kernings sign
19
Q

Circulatory symptoms

A 
Non blanching  Rash
Limb pain 
Cold hands or feet 
Unusual skin colour 
Capillary refill time >2s
Shock and hypotension
20
Q

What is the rash called

A

Petechial/ purpuric rash

21
Q

Complications 30-50% survivors

A

Neurological - eg hearing loss, seizures, cognitive impairment , motor deficits, visual impairments

Physical- eg amputations ,skin scars

Reduced quality of life
Anxiety
Les ring difficulties
Emotional and behavioural issues

22
Q

Diagnosis

A 
Confirmed In secondary care 
Physical examination 
Monitoring of vital signs 
blood tests for CRP and WBC 
Lumbar puncture with examination of CSF
23
Q

Appearance of CSF

A

Turdy, cloudy

24
Q

Management overview

A

Urgent antibiotic treatment - based on clinical situation and most probable bacteria aetiology .further treatment depends on bacteria found in CSF

Antibiotic drug properties needed to achieve therapeutic conc of antibiotic in CSF- look at lipid solubility , ionic dissociation at blood pH, low mw

Adjunctive therapy eg corticosteroids

Supportive therapy - restore and maintain respiratory, cardiac and neurological function

25
Q

Empiric therapy of suspected meningitis

A

Single dose of benzylpenicillin sodium before urgent transfer to the hospital

26
Q

Adjunctive corticosteroid therapy

A

Regulates inflammatory response and decreases hydrostatic pressure

Dexamethasone initiated before/ with first dose of antibiotics and continued for 4 days

Should not be given to
Immmunocompromised patients
Those who have already received anti microbial therapy
Patients aged <1 month

27
Q

Fluid management

A

Careful balance of fluid and electrolyte balance is important

Over or under hydration associated with adverse outcomes
Eg Brain swelling , shock

Regular monitoring or clinical signs of hydration state needed
Repeated every 6-12 hours for first 48 hrs.

28
Q

What does chemoprophylaxis aim ti do

A

To reduce risk of invading disease by eradicating carriage in those at highest risk

29
Q

When is prophylaxis indicated, regardless of vaccination status

A

Prolonged close contact with the case in household setting during 7 days before onset of illness
Transient close contact with a case only if exposed to large particles / secretions from a resp tract of a case

30
Q

When is prophylaxis not indicated for meningitis

A 
Pupils in same school 
Work colleagues 
Friends 
Kissing in cheek or mouth 
Sharing food or drink 
Travelling beside 
Post mortem contact
31
Q

What drugs can be given as chemoprophylaxis

A

Ciprofloxacin
Can be guven as a single dose
More readily available in community pharmacies
Recommended in all age groups, pregnancy and breastfeeding
Should be given ASAP
May have unpredictable effects in those with epilepsy

Rifampicin
Preferred second line antibiotic
Must be guven twice daily for two days
Number of C/I , interactions , S/E

32
Q

Childhood vaccinations

A

MenC conjugate vaccine

Guven at 12 months
Routine booster dose guven at 13-15 years as MenACWY

MenB
Guven at 2,4 and 12 months

men ACWY
From 2915 those under 25 years and attending university guven a single dose

33
Q

Travel with meningitis

A

Individuals travelling to countries of risk should be immunised either MenACWY conjugate vaccine even if they have previously immunised with MenC conjugate

Pmy2107 (11 decks)

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