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SBCP Microbiology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Define meningitis

A

Infection in sub arachnoid space of the LEPTOmeninges

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2
Q

Clinical features in infant with meningitis

A

Bulging fontanelle, crying, poor feeding

Non blanching rash

Headache, neck stiffness, fever vomiting etc…

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3
Q

CSF findings in viral meningitis (lymphocytes, neutrophils, glucose, protein)

A

Lymphocytes: High

Neutrophils: Low

Glucose: normal

Protein: Slightly elevated

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4
Q

CSF findings in bacterial meningitis (lymphocytes, neutrophils, glucose, protein)

A

Lymphocytes: Slightly raised

Neutrophils: Very raised

Glucose: Very low

Protein :elevated

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5
Q

CSF findings in TB meningitis (lymphocytes, neutrophils, glucose, protein)

A

Similar to virus except glucose is low and ziel neelson is +ve

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6
Q

Cause of intracellular meningitis?

A

Neisseria meningitidis

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7
Q

Cause of intercellular meningitis?

A

Haem. influenzae

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8
Q

How do neisseria men. and H. influenze overcome the immune system to cause meningitis?

A

Polysaccharide capsules are able to evade complement system in blood

Once in CNS, there is no complement system so they grow unimpeded

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9
Q

How is the BBB broken down in meningitis? (recognise)

A

Bacteria replicate and lyse

This causes release of interleukins IL1, IL6 and TNF

Polymorphs are attracted to infection site

THis causes endothelial disruption, albumin leak, and CEREBRAL OEDEMA!!

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10
Q

Most common causes of meningitis in infants?

A

Group B strep

E coli

Listeria

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11
Q

Most common causes of meningitis in toddlers

A

N. meningitis

Strep pneumoniae

H influenzae

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12
Q

Most common cause of meningitis in adults

A

N. meningitidis

S. pneumoniae

(H. influenzae less common)

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13
Q

What are the ‘NHS’ bacteria?

A

Neisseria meningitis

H. influenzae

Strep pneumonia

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14
Q

Who gets neisseria meningitis? What is it sensitive to?

A

Children and YAs

Penacillin

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15
Q

Who gets H. influenzae? What is it resistant to?

A

Young kids

B lactamase +ve, so penicillin resistant

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16
Q

Who gets strep pneumoniae? What is is resistant to?

A

Extremes of age

Starting to see penicillin resistance

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17
Q

What type of organism is strep pneumoniae? What do you see on blood agar?

A

Gram +ve diplococci

Draughtsman colony, green zone of haemolysis

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18
Q

What type of organism is Haemophilis influenzae?

A

Gram negative rod

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19
Q

Culturing requirements for H influenzae?

A

Needs X and V factors

Grows best on enrichment media eg chocolate agar

Smells like semen lol

Invasive strains are often capsulated.

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20
Q

Diseases caused by H influenzae?

A

Pneumonia

Meningitis

Epiglottitis

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21
Q

What type of organism is neisseria meningitidis?

A

Gram -ve diplococcus

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22
Q

Culturing features of neisseria meningitis?

A

Oxidase positive

IDENTIFIED SUGAR FERMENTATION

MeninGos do Maltose and Glucose!

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23
Q

Treatment of meningitis for adults and children

A

Ceftriaxone (/benzylpenicillin)

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24
Q

Treatment of meningitis in infant?

A

Ampicillin + cefotaxime

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25
What immunotherapy can be used for meningitis?
Dexamethasone before antibiotic may decrease cerebral oedema in children
26
What does Hib/menC vaccine protect against?
H influenzae and meningococcal meningitis group C
27
Describe Hib vaccine components (recognise_
PRP polyribosylribitol phosphate T cell independent (no IgG boost)
28
New meningitis vaccines? (3)
New conjugate meningococcal group C Meningococcal polysaccharide A, C (not B neisseria) Pneumococcal 7 valent vaccines
29
Which meningitis is not protected against with vaccines?
Group B Neisseria meningitis
30
Prophylaxis for meningitis if there is an unimmunised child under 4 in the household?
Rifampicin
31
Prophylaxis for menigitis?
Ciprofloxacin for all close contacts in past 10 days
32
Viral causes of meningitis?
Enteroviruses -80% ``` Also: HSV 2 (and 1) VSV, CMV Mups Adenovirus HIV ```
33
Examples of enteroviral causing meningitis?
Coxsachie or echovirus most common
34
Treatment of viral meningitis?
SUPPORTIVE Anti-HSV not proven May be preventable by vaccination
35
Prognosis of viral meningitis?
Better than bacterial
36
Non-viral causes of aseptic meningitis? (i.e couldn't culture anything or use PCR identification)
``` Fungi TB!!! Syphillis Brucella Mycoplasma Protozoa Helminths ```
37
Age group affected by TB meningitis?
<6 yrs
38
How does TB meningitis present?
3-6 months after initial infection/exposure Millary TB in 50% GRADUAL ONSET: - personality change, irritability - FEVER, drowsiness, neck stiffness - decreased LOC
39
**Tests for TB meningitis?
+ve TUBERCULIN test +ve Mantoux CSF clear and similar to viral CSF except with low glucose Hard to diagnose under microscope as bacilli are scarce Can also look at gastric washings
40
Prognosis of TB meningitis?
Poor
41
Treatment of TB meningitis?
4 drugs, RIPE for 10 months, then cute down to RI
42
Organisms causing meningitis | in immunocompromised host?
Listeria in raw mik or soft cheese Cryptococcus yeast
43
Causes of encephalitis? (8)
MAINLY VIRAL HSV 1 (most common) Also: - Influenza - VSV - Enteroviruses - Rabies - Arboviruses - Hendra and Nipah viruses - Japenese B
44
Non viral causes of encephalitis? (9) (recognise)
``` N. meningitidis Listeria monocytogenes Scup typhus Leptospirosos Melliodosis ``` Malaria TB Borrelia and Brucella
45
Investigations and management of encephalitis
High dose aciclovir and abx if high suspicion CSF THroat and stool samples INeural imaging, EEG
46
Most common cause of encephalitis?
HSV 1 Causes 1-4 cases per million per year 80% of those untreated will die
47
Clinical features of HSV1 encephalitis
``` Headache Fever Decreased LOC Confusion Dysphasia ```
48
Treatment of HSV 1 encephalitis?
Aciclovir 14-21 days
49
CNS complications of measles
Post infectious encephalitis (autoimmune) Measles Inclusion body encephalitis (immunocompromised) *** SSPE, Subacute sclerosing panencephalitis several years after exposure in children (progressive neurodegenerative condition)
50
3 main types of demyelinating encephalopathies?
All are viral - Measles, SSPE, MIBE - Progressive multifocal encephalopthy by JC virus in AIDS - Rubella encephalitis
51
What does the JC virus cause in the CNS of AIDS patients?
Progressive multifocal encephalopathy, a demyelinating disease
52
Clinical features of a brain abcsess
Varied! Headache, drowsiness, confusion Seizures N + V Motor/sensory impairments Papillodema and ataxia
53
Causes of brain abscesses?
Contiguous suppurative focus 40-50% (otitis media or another infection crossing into CNS) Haematogenous spread from distant infection 25% Trauma 10%
54
Common causes of brain abscess
Often polymicrobial ``` Staph aureus Streptococci Bacteriodes Fusobacterum Pseudomonas etc ``` Need to look at infection sourse
55
Tx for abscess with unknown cause?
Cover for streptococci with penicillin or cefotaxime or ceftriaxone
56
Tx for brain abscess causesd by staph aureus
Vancomycin
57
Tx for brain abcess caused by pseudomonas aeruginoas
Cefepime or ceftazidime
58
Tx for brain absess in HIV patient?
May need to consider cover for organisms like Toxoplasma
59
3 examples of prion diseases
Sporadic CJD (dementia, ataxia, can detect 14-3-3 protein in CSF) Familial Transmissable Spongiform Encephalopathies TSE (autosomal dominant) Kuru
60
Another name for bovine spongiform encephalopathy?
New variant CJD | mad cow disease, not spordaic
61
Which prion disease has 14-3-3 protein in CSF?
New variant CJD Also see a high T2 signal in post thalamus at MRI Plaques on the brain
62
Who gets new varieant CJD?
Younger patietns 60% have psychiatric symptoms initially

SBCP Microbiology (9 decks)

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