CNS infection Flashcards
What pathogens tend to cause viral meningitis?
Enteroviruses e.g. ECHO virus
What viruses can cause encephalitis?
Herpes simplex
Varicella zoster
HIV
CMV
Measles
Travel e.g. west Nile virus
What is the treatment for viral encephalitis?
IV aciclovir
How does viral encephalitis present?
Insidous onset; sometimes sudden
Meningismus
Stupor, coma
Seizures, partial paralysis
Confusion, psychosis
Speech, memory symptoms
What condition is cryptococcal meningitis associated with?
HIV
What condition does testing a lumbar puncture sample with India Ink show positive?
Cryptococcal meningitis
What might be seen on lumbar puncture results for cryptococcal meningitis? (Opening pressure, cell type, glucose, proteins)
Opening pressure increased
Lymphocyte predominant
Glucose decreased
Proteins increased
What meningitis might the following lumbar puncture report indicate?
Opening pressure - normal
Lymphocyte predominant
Protein - normal
Glucose - normal
Viral meningitis
What meningitis might the following lumbar puncture report indicate?
Opening pressure - increased
Neutrophil-predominant
Protein - increased
Glucose - decreased
Bacterial meningitis
In which condition is elevated levels of 14-3-3 proteins elevated?
Creudtzfelt-Jakob disease
What do the prions in Creudzfelt-Jakob disease do to cause neurological dysfunction?
Convert normal alpha-helical prion proteins into abnormal beta-sheet proteins
What are the common causes of bacterial meningitis in neonates?
Listeria
Group B strep
E. Coli
What are the common causes of bacterial meningitis in children?
H. influenza
What is the most common cause of bacterial meningitis in ages 10-21?
Meningococcal
What tends to be the most common cause of bacterial meningitis in those >21?
Pneumococcal>meningococcal
What tends to be the most common cause of bacterial meningitis in the elderly?
Pneumococcal > listeria
What infection is associated with fracture of the cribiform plate?
Pneumococcal meningitis
Which bacteria are associated with infection of a CSF shunt causing meningitis?
S. epidermidis
S. aureus
aerobic GNR
Propionibacterium acnes
What are some of the disabilities caused by meningitis?
Limb loss
Deafness
Blindness
Cerebral palsy
Quadriplegia
Severe mental impairment
What are some of the causal bacteria in meningitis in the immunocompromised?
Listeria monocytogenes
Mycobacterium tuberculosis
Nocardia asteroides
Cryptococcus neoformans (AIDS)
What is the causal bacteria of meningococcal meningitis?
Neisseria Meningitis
Where is Neisseria Meningitis found?
In the throats of healthy carriers
What causes the symptoms in Neisseria Meningitis infection?
Endotoxin
What is the most common causal bacteria of meningitis in children under four?
H. influenzae type b
What prevention of meningitis due to haemophilus influenzae can be taken?
A conjugated vaccine directed against the capsular polysaccharide antigen is available
What is the causal bacteria of pneumococcal meningitis?
Streptococcus pneumoniae
Which patients are most susceptible to pneumococcal meningitis?
Hospitalised patients
Diabetics
Alcoholics
Young children
Patients with CSF skull fractures
What is the antibiotic of choice for listeria monocytogenes?
- IV Ampicillin/amoxicillin:
- Ceftriaxone no value as intrinsically resistant
Who is most likely to get infection from listeria monocytogenes?
Neonates
Elderly
Immunosuppressed especially malignancy
How does tuberculous meningitis present?
Reactivation in the elderly
Non specific ill health
How should cryptococcal meningitis be treated?
IV amphotericin b/flucytosine
Fluconazole
What are the signs and symptoms of meningitis??
Headache
Vomiting
Pyrexia
Neck stiffness
Photophobia
Lethargy
Confusion
Rash
What is the emprical antibiotic therapy in meningitis?
IV ceftriaxone
Add IV ampicillin/amoxicillin if listeria suspected
What should also be given alongside antibiotics to treat suspected bacterial meningitis?
IV steroids
What drug should be given alongside empirical treatment in age >55 and why?
Ampicillin
Listeria coverage
What antibiotics should be given if pneumococcal penecillin resistance suspected?
Vancomycin + rifampicin
What antibiotics should be given for meningitis with history of penecillin allergy?
Chloramphenicol and vancomycin
What antibiotic should be given for listeria infection if penecillin allergy known?
Co-trimoxazole
Which type of bacterial meningitis has administration of steroids with antibiotics been most successful in?
Pneumococcal
When should steroids not be given to treat meningitis?
Post-surgical meningitis
Severe immunocompromise
Meningococcal or septic shock
Hypersensitivity to steroids
What antibiotics are used for contact prophylaxis for meningitis?
Rifampicin 4x
or
Ciprofloxacin (adults and children >12)
