CNS infections Flashcards
Define meningitis
Inflammation of the subarachnoid space or spinal fluid
What are the two types of meningitis?
- Bacterial
- Aseptic
What is the cause of aseptic meningitis?
- TMP/SMX
- OKT3 antirejection monoclonal Ab
- Azathioprine
- NSAIDs
Define encephalitis
Inflammation of the brain
What are the predisposing risk factors for CNS infections?
- Immunosuppression
- Head trauma
- Neurosurgical patients
- Local infection
- Exposure to someone with meningitis
- Anatomical or functional asplenia
- Complement deficiency
- Recent travel to area with endemic meningococcal disease
What are the early classical signs/Sx of meningitis?
- Fever
- Nuchal rigidity
- Altered mental status
- Severe HA
- Positive Brudzinski’s and Kernig’s sign
- Photophobia
- Petechial rash
Which early sign/Sx is only found when patient is exposed to N. meningitidis organism?
Petechial rash
What are the late classical signs/Sx of meningitis?
- Irritability
- Drowsiness
- Seizures
- Coma
What are the diagnostic tests or procedures for meningitis?
- History and physical exam
- Lumbar puncture
- CSF gram stain and culture
- Rapid identification latex-agglutination
- Polymerase chain reaction (PCR)
- CT scan
Rapid identification latex agglutination is helpful to detect which organism antigens in the CSF?
- H. influenzae
- S. pneumoniae
- N. meningitidis
- E. coli
- Group B streptococci
(T/F) - Rapid identification latex agglutination is not useful if the gram stain comes out negative
FALSE - it is useful
When doing a lumbar puncture there are 5 things that need to be checked in order to diagnose a bacterial or viral meningitis. What are they?
- Opening pressure (mmHg)
- WBC count (cells/mm^3)
- Differential (%)
- Proteins (mg/dL)
- Glucose (mg/dL)
What is a normal opening pressure in a patient?
75-175
What is a normal WBC count in a patient?
< 5
What is a normal differential in a patient?
> 90 monos
What is a normal protein in a patient?
< 50
What is a normal glucose in a patient?
50-66% simultaneous serum value
What is the bacterial opening pressure value in a patient?
Elevated
What is the bacterial WBC value in a patient?
1000-5000
What is the bacterial differential value in a patient?
> 80 PMNs
What is the bacterial protein value in a patient?
100-500
What is the bacterial glucose value in a patient?
< 40-60
What is the viral opening pressure value in a patient?
Elevated